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Chest Compression Only
CPR Save your Breath…
Save a Life
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Sudden Cardiac Arrest —
Any Age, Anybody
Sudden Cardiac Arrest —
Any Age, AnybodyChris Miller, at age 15 – Saved by Erika Yee, a band mate who learned compression-only CPR in Girl Scout Camp.
Russell Vossbrink, at age 36 - A crime lab investigator saved by a co-worker.
Rafael “Ralphie” Rendon, at age 14 - Collapsed during high school football practice. A volunteer coach responded.
Brian Duffield, at age 41 - Collapsed after a swimming workout. A paramedic was nearby.
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Causes of Death (U.S.)
Causes of Death (U.S.)
Lloyd-Jones D, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
Circulation. 2009 Jan 27;119(3):e21-181.
Sudden Cardiac Arrest
• Heart disease kills more people each year than cancer
− 1 in every 4 deaths
• Every year 230,000 - 325,000 people have a cardiac arrest outside of a hospital.
− Only 7.6% will survive
Heart Disease
26%
Cancer23%
All other causes
19%
Stroke6%
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Cardiac Arrest: Fact vs. Fiction
Cardiac Arrest: Fact vs. Fiction
Stereotype Reality
Male
Old
OverweightSmoker
High cholesterol
Chest PainDizziness
Heart Attack
Male and Female
Any Age
No KnownRisk Factors
Often No Cardiac History
Often No Symptoms
Gender
Age
RiskFactors
MedicalHistory
PresentingSymptoms
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• Blockage in coronary artery
• Person usually conscious
• Upper body discomfortor pain
• Heart stops
• Person is unconscious
• Often no previous symptoms
• Person may be gasping or not be breathing at all
Heart Attack vs Cardiac Arrest
Heart Attack vs Cardiac Arrest
Heart Attack: Cardiac Arrest:
OFTEN A CARDIAC ARREST OCCURS DUE TO A HEART ATTACK.
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Primary vs Secondary Cardiac Arrest
Primary vs Secondary Cardiac Arrest
• Heart stops pumping
• Blood in arteries full of oxygen
• Often unexpected witnessed collapse
Secondary CA
• Heart stops pumping due to lack of oxygen
• Drowning, Drug Overdose or Choking
Primary CA
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Out-of-Hospital Cardiac Arrest
Out-of-Hospital Cardiac Arrest
• Approximately 70-80% of all adult cardiac arrest are a primary cardiac arrest.
Chest Compression Only CPR
Ann Emerg Med. 1997 Jul;30(1):69-75.
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What is Chest Compression Only
CPR?
What is Chest Compression Only
CPR?• A new method of resuscitation developed
through extensive research at The University of Arizona Sarver Heart Center for primary cardiac arrest
• Continuous forceful chest compressions to circulate the person’s blood to their brain and heart
• Rescue breathing isn’t necessary.
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Why isn’tRescue Breathing
Necessary?
Why isn’tRescue Breathing
Necessary?
–Lungs are full of air
–Blood is full of oxygen
–Circulating the oxygenated blood is the key
During Primary Cardiac Arrest:
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Why Might “Rescue Breathing” be Harmful?
Why Might “Rescue Breathing” be Harmful?
• Any interruption of chest compressions stops blood flow to the brain
• Increased pressure in the chest decreases blood return to the heart
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Ewy GA, et al. Circulation. 2007;116(22):2525-30.
Blood FlowingTo The Brain
Blood FlowingTo The Brain
Chest Compressions Only
Compressions + Breaths (30:2)
Pausing forbreaths meansNo Blood Flow
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What Stops People from Doing CPR?
What Stops People from Doing CPR?
Coons SJ, et al. Resuscitation 80;334-340:2009 This study was designed and funded by the Sarver Heart CenterThe University of Arizona College of Medicine and SHARE
Mouth-to-Mouth
Harming the Person
Legal Consequences
Won’t Perform Properly
Physically Unable
Chest Compressions Only
Better than dead
Good Samaritan Law
Easier to Do
Do Your Best / Call For Help
Fear / Concern
Solution
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When to useChest Compression Only
CPR?
When to useChest Compression Only
CPR?
• Obvious Breathing Problems:–Drowning –Choking–Drug overdoses
•Children less than 8
• Someone who unexpectedly collapses, and is unresponsive.
WHEN IN DOUBT, DO COMPRESSIONS!!
TraditionalCPR (30:2)
Chest CompressionOnly CPR
• Vast Majority
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40%
30%
25%
20%
15%
10%
5%
0%
18% 18%
34%
Surv
ival to
Hosp
ital D
isch
arg
e
NoCPR
TraditionalCPR
CCOCPR
Bystander CPR in Arizona (2005
to 2010)
Witnessed Primary Cardiac Arrest
Bystander CPR in Arizona (2005 to 2010)
Witnessed Primary Cardiac Arrest
Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010
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What to do:3 Cs–
What to do:3 Cs–
Compress Chest at 100 Per Minute
Call 911 Send Someone for an A.E.D.
(if available)
Are You Alright?
CheckShake & Shout
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How to Do Chest Compression Only CPR
How to Do Chest Compression Only CPRWith the victim on the floor:
1. Kneel beside them2. Place the heel of one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum at the armpit line)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.
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Chest Compressions:Rate and Depth
Chest Compressions:Rate and Depth
•Allows the heart to refill•Staying Alive (Beegees) orI Gotta Feeling (Black Eyed Peas)
•After each compression, take all weight off the chest
At least
100Compressions per Minute
At least
2 inchesin depth
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Are They Breathing?
Are They Breathing?
• Gasping is a sign of cardiac arrest
• Majority of people with cardiac arrest gasp
• Can be a sign of minimal, but adequate blood flow to the brain.
• DO NOT stop chest compressions if they gasp
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AutomaticExternal
Defibrillators(AEDs)
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AEDs
AEDsThey may look different, but they all function the Same!
Open and Follow Instructions
• Turn AED ON• Apply Pads to Bare Chest• Plug in Pads (if necessary)• Analyze Patient (CLEAR!)• Push Shock to defibrillate,
if directed (CLEAR!)• Immediately resume CPR
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The Universal Symbol
The Universal Symbol
•Safe•Easy•Voice Prompted
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For more info on purchasing or
maintaining AEDs, talk to your event
leader!
For more info on purchasing or
maintaining AEDs, talk to your event
leader!
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http://tinyletter.com/UAmedREACT
Never forget!REACT CCO newsletter
1 email every 3 months, unsubscribe any time.
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What to do:3 Cs–
What to do:3 Cs–
Compress Chest at 100 Per Minute
Call 911 &Send Someone for an A.E.D.
Are You Alright?
Check
Shake & Shout
Use an A.E.D. When it Arrives
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Thank YouSave your Breath…
Save a Life
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How to Do Chest Compression Only CPR
How to Do Chest Compression Only CPRWith the victim on the floor:
1. Kneel beside them2. Place one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum between the nipples)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.
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Appendix
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Bystander CCO CPR Improves Chance of
Survival from Cardiac Arrest
Bystander CCO CPR Improves Chance of
Survival from Cardiac Arrest100%
80%
60%
40%
20%
0%
Time between collapse and defibrillation (min)0 1 2 3 4 5 6 7 8 9
Surv
ival (%
)
Nagao, K Current Opinions in Critical Care 2009EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008.
EMS ArrivalNo CPR
TraditionalCPR
CCO CPR
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Three-Phase Model of Resuscitation
Three-Phase Model of Resuscitation
Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8
0 2 4 6 8 10 12 14 16 18 20
Arrest Time (min)
CirculatoryPhase
ElectricalPhase
MetabolicPhase
0
100
Myocardial ATP
Per
cen
t
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SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.
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25%
20%
15%
10%
5%
0%5.2%
7.8% 13.3%
Surv
ival to
Hosp
ital D
isch
arg
e
NoCPR
TraditionalCPR
CCOCPR
150/2,900
52/666
113/849
Bystander CPR in Arizona (2005 to 2010)
All out-of-hospital cardiac arrests
Bystander CPR in Arizona (2005 to 2010)
All out-of-hospital cardiac arrests
Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010
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• FAST for Stroke if people ask about stroke• Face –Does one side droop? Smile?• Arms – Raise arms? Is one weak or
numb?• Speech – Slurred? Repeat a simple
sentence?• Time – Have symptoms? Call 911! Get to
hospital immediately!