Evolution of CPR Techniques: From Mouth-to-Mouth to Modern-Day Hands-Only CPR
Evolution of CPR Techniques: From Mouth-to-Mouth to Modern-Day Hands-Only CPR
Ironically, the first time you learned about cardiopulmonary resuscitation (CPR) or artificial respiration, the process involved breathing directly into a patient. However, times have changed. In this article, we will explore the journey of medical practices related to CPR, from mouth-to-mouth resuscitation (MTR) to modern-day iterations that prioritize survival and quick response.
The Early Days of Resuscitation: Mouth-to-Mouth Resuscitation (MTR)
In the 1970s, the process of resuscitation was relatively straightforward. When faced with an unconscious patient with a pulse but not breathing, the protocol involved performing expired air resuscitation, which was essentially mouth-to-mouth respiration. This method relied on the rescuer’s own breath to deliver oxygen to the patient's lungs. For instances where the patient was unconscious, without a pulse, and not breathing, the protocol called for CPR – chest compressions combined with MTR every 15 compressions. However, this approach was far from perfect, mainly due to the time-consuming and often faulty method of checking for a pulse.
The Simplification of CPR Protocols
The process of resuscitation was problematic due to the significant time required to verify a pulse. This created a delay in initiating effective life-saving measures such as chest compressions. To optimize these procedures, the CPR protocols were simplified:
Unconscious but with a pulse, not breathing: Perform expired air resuscitation (MTR). Unconscious, no pulse, and not breathing: Perform CPR (chest compressions and MTR).The early protocols were quite straightforward, but the thinking behind them was flawed. The time taken to check for a pulse was both lengthy and error-prone. This inefficiency led to a new set of protocols that prioritized immediate chest compressions:
CPR: Unconscious, non-breathing, start CPR immediately.The Transition to Modern Protocols: ABC to DRABC to DRSABCD
The CPR protocols were further refined with an acronym that stands for Defuse, Respond, Assess, Breathing, Circulation, Defibrillation. Over time, the protocol evolved to:
Defuse: Is there any danger to you or the patient? Respond: Is the patient responsive? Assess: Check for airway patency and breathing. Breathing: If not breathing, start CPR. Circulation: Apply a defibrillator if available.This process became more logical and streamlined, reducing the time it took to start lifesaving measures. The CPR technique also evolved, with the recommended rate increasing from 60 compressions per minute to 100 to 120 per minute, emphasizing the importance of circulation.
The Future of CPR: Hands-Only CPR in the Age of COVID-19
One of the most significant shifts in CPR protocols came during the COVID-19 pandemic. Due to the risk of virus transmission, hands-only CPR became the recommended approach for those unable to perform mouth-to-mouth resuscitation. Research has shown that hands-only CPR can provide adequate air exchange and improve the delivery of oxygenated blood to the brain and cardiac arteries. This method can help reduce the risk of brain damage if spontaneous circulation is restored.
Immediate CPR and Defibrillation: Increasing Survival Rates
In home settings, approximately 80% of cardiac arrests occur. Delaying CPR can significantly decrease the chances of survival. Immediate CPR can increase the likelihood of survival from about 1% to 6%. When defibrillation is added, the survival rate can rise to 50%. These statistics highlight the critical importance of quick response and effective CPR.
Understanding the Other 50%
It is crucial to note that not all cardiac arrests or sudden deaths are due to resuscitation failures. For instance, sudden death due to heart attacks is often the result of blocked arteries, particularly the Left Anterior Descending artery. Heart attacks can manifest as sudden death, especially if the left ventricle, responsible for pumping freshly oxygenated blood around the body, is affected.
Additionally, there are unshockable rhythms that cannot be corrected by defibrillation. In such cases, CPR remains vital as it can provide necessary oxygen to the brain and vital organs. As resuscitation techniques continue to evolve, the goal remains to save more lives and reduce the risk of long-term damage due to cardiac arrest.
By understanding the evolution of CPR and the current best practices, individuals can better prepare themselves to respond effectively in emergency situations. Whether it's performing hands-only CPR, recognizing the signs of cardiac arrest, or ensuring immediate access to defibrillation, the key to increasing survival rates lies in quick action and adherence to updated protocols.