New Recommendations for Giving CPR

Life-saving technology supports focus on the compression part of CPR

ILLUSTRATION BY Emma Moreman

When your heart stops beating, minutes count. Deprived of the oxygen that a functioning heart brings, the brain and other organs don’t last long. In fact, the brain can begin to die after only four minutes without oxygen, leading to irreversible brain damage.

Cardiopulmonary resuscitation (CPR) or chest compressions restore blood circulation and buy a cardiac arrest victim time until paramedics arrive — doubling or even tripling the person’s odds of survival, the American Heart Association (AHA) says.

CPR must continue uninterrupted, however, and if you’ve ever taken a CPR class, you might know from firsthand experience that it can be difficult to give effective CPR consistently over an extended (or even not-so-extended) period of time. Particularly in rural parts of New Hampshire, where the nearest hospital might be a considerable distance away, the endurance of any CPR-performing Samaritan can be tested, for sure.

Fatigue and maintaining chest compression continuity present a problem even for the pros. Although paramedics might seem like superheroes when they arrive at an emergency scene, they, too, can keep up effective compressions for only so long. Add adverse environmental conditions into the mix — icy or unshoveled walkways, say, 90-degree humidity or a patient located in a spot that complicates transport — and it becomes clear that providing consistent compressions is not easy. Imagine, for example, trying to make your way down a staircase while turned sideways and accompanying a patient on a stretcher, attempting to maintain deep, nonstop chest compressions. Giving quality chest compressions while going down stairs is “virtually impossible,” says Richard A. Boss, MD, a cardiologist at Concord Hospital Cardiac Associates.

But the latest cardiac emergency guidelines from the AHA emphasize the importance of chest compressions, designating them as the top priority after calling 911 and relegating the pulmonary or breathing component of CPR — while still important, of course — to the back seat. The goal now is clearly to “start the chest compressions, then worry about the breathing,” Boss says. If you are alone and unsure of how to interrupt the compressions to deliver breath, “you’re better off just pumping,” Boss says.

In addition, today’s recommendations call for delivering 100 chest compressions per minute, keeping pace with the beat of the famed Bee Gees song, “Stayin’ Alive.” Not only must compressions must be fast, they should be two inches deep — and they mustn’t stop, Boss says. “Even here in the hospital we need at least two people providing chest compressions so that every two minutes, we can swap people out. And if you look at people’s effectiveness, even within those two minutes of time, it clearly goes down as they develop fatigue.”

Some Granite State hospitals, recognizing the difficulties that rescuers face, now equip their ambulances and hospital buildings with a battery-powered, mechanical chest compression device called LUCAS. Paramedics or hospital personnel strap the device onto the patient, centering a compressor over the victim’s chest, and the machine does the rest, delivering two-inch compressions at a rate of 100 times per minute. Because it’s a machine, “it never gets tired,” Boss says.

In addition, LUCAS frees up medical personnel to focus on other tasks, such as monitoring patient breathing and administering medication. “When you can hook up the machine and just let it run and do its thing, then you can concentrate on carrying the person out and transporting them safely. It does make a big difference,” says Laura Thibeault, RP, EMS manager at Exeter Hospital.

The device delivers more effective chest compressions than a person can because of the consistency it provides, Thibeault says, and using it is better than planning to have two paramedics alternate the task of performing CPR because “multiple rescuers are not always available, and every time you switch out, you’re basically interrupting chest compressions,” which can adversely affect the patient’s outcome. The continuity of compressions is so important that “even taking a few seconds to see if there’s an underlying heart rhythm or to check to see if there’s been a spontaneous return of pulse” is considered too long an interruption, she says.

In some instances, LUCAS can stay with the patient, pumping away, throughout the ambulance ride, into the hospital, and even into the catheterization lab, Thibeault says, where it can be left running while a doctor works to clear blocked arteries.   

Call in the reinforcements

“Bystander CPR,” in which ordinary, non-medical folk provide CPR or chest compressions during an emergency, is considered a key to survival for cardiac arrest victims. “Every great outcome that I’ve been aware of has had bystander CPR involved,” says Laura Thibeault, RP, EMS manager at Exeter Hospital.

If you don’t know how to give CPR, now is a great time to learn. If you think you’re too busy to learn, or worry that you might do something wrong and hurt the person you’re trying to help in an emergency, or just can’t imagine yourself locking lips with an unconscious stranger, consider that the life you could save will likely be that of a family member, since 88 percent of cardiac arrests occur at home, according to the American Heart Association (AHA). Plus, today’s “Hands-Only CPR,” which is chest compression-only CPR — no breaths required — has been proven to be just as effective as CPR with breaths when provided as treatment for cardiac arrest victims, according to the AHA.

Without a heartbeat, full brain death can occur within 10 minutes, Thibeault says. “If somebody’s not there right away to start CPR, often when [paramedics] get there, it’s already been too long.”

Hospitals, fire departments and other organizations throughout New Hampshire offer CPR training for beginners — often for a fee of around $30 to $45, but sometimes free of charge. To find a class visit the AHA website, heart.org, and to watch a brief how-to video, visit www.heart.org/handsonlycpr. You can also check The American Red Cross at redcross.org/take-a-class, or contact your local hospital or fire department.