I have been attending courses lately to update some of my first responder skills. I have been told by some that when they recertified in CPR they were no longer taught to apply breaths, just compressions. I have been told by others that applying breaths is still being taught. The information is coming from police, nurses, firemen, one person who works for American Red Cross, and COVID-19 has nothing to do with the way they were trained. Opinions are 50/50 on the topic.
What have you learned lately? When you took a CPR course or recertified, did the instructor(s) teach you to apply breaths or not? If no rescue breathing is recommended, what was the rationale behind not applying breaths between sets of compressions? What state do you live in? Is this regional or something that will be phased in nationwide?
AHA has 2 classes: BLS for healthcare professionals, and BLS for lay people. The former gets airway training (BVM, pocket mask w/1-way valve, but no OPA/NPA), the latter is compressions-only. I don’t know what ARC or the other groups teach. This is not location/state-dependent, but ‘teaching organization’ dependent.
Data shows more community compliance if we say “do compressions only” instead of “do compressions and ventilate with mouth-to-mouth”. Then they just won’t do anything. This predates COVID.
I have been a BLS instructor for AHA for…well, a very long time.
I did American Red Cross for heathcare workers/first responders earlier this year, I recall it being compression only. My old department was teaching compression only all the way back in like 2015. The argument was that if you were getting good enough compressions, you would be collapsing the chest enough to induce some movement of air, anyway, while moving up to do the breaths wasted valuable time that should have been spent on compressions. We did BVM the patient if we had two people, though.
Coronary perfusion pressure rises slowly during compressions and falls to nada as soon as you stop for breaths. If there is any doubt as to what the right answer is, just push. The only thing as important early on as compressions is defibrillation.
I have some practical experience with CPR and was curious what medical reason there was for compressions only. I no longer carry issued airways or a bag-valve-mask. I was contemplating purchasing a bag-valve-mask for my kit.
One of the hurdles to getting more bystander CPR was aversion to ventilations. The criticality of consistent, continuous compressions was already known. AHA, ARC, and the medical community made peace with the blockers and rewrote some lay curriculum for compressions-only. They also created some options for familiarization/completion courses instead of certified courses that didn’t require portions of the usual testing, increasing the amount of people willing to take the class at least have the knowledge in a credible way.
Certification courses that include ventilations and barrier devices are still the standard of care for medical personnel and professional rescuers.
Properly performed ventilation+compression courses in general are still better than compressions-only.
Rescue breathing is a critical skill in infant/child products.
Ventilations haven’t gone away, they are just made optional/deemphasized by training product. Anyone that says otherwise is wrong.
Another factor in this is access time. Compressions-only is most viable where there is fast access to rescuers. In areas of delayed response, ventilations become important again for everyone. However, even then the longer you’re doing even good CPR the lower chances of survival are.
Contents of various training products are available the ARC, AHA, and NSC websites.
The main reason I place an “advanced” airway device (adults) early on is to explain in my documentation why we started continuous compressions. AHA guidelines. Well, that, and because whoever got there before me inflated the belly.
This topic can be both very simple, and complicated, hence my earlier answers of “if you’re asking…push”.
The last two times recert it’s been just compressions only. Main reason is the American Heart certified not Red Cross and their fee for a card. My organization is probably going to skip recertification this year due to budget cut to only if required for mission. I was informed 6 days before I had training on new Alcohol breath testing machine to cancel it that I wouldn’t be paid for going.
I thought it was quite odd I just got a new CPR Rescue mask in I ordered and have it in front of me when I seen this thread. My old one is probably in my SCUBA diving bag still.
Organizations can do whatever they want, I worked for EMS agency where we stopped doing ACLS because we had better outcomes with our own protocols.
The hospital in which I work now, the cardiac service uses their own protocols. They still have to take ACLS for accreditation purposes, but their internal policies and protocols are different than some of the AHA algorithms.
For the others: this is not a new change and has been the standard for lay people life support for a while now. It is merely to ensure better community compliance with compressions.
Quoting the above for absolute truth. Great post and the bullet points above are why you see such a widespread adoption of “hands-only” CPR being taught to laypeople.
The 2 biggest factors to surviving (adult) pre-hospital cardiac arrest are downtime to CPR and early defibrillation if appropriate. Time is muscle, and your brain tissue will begin to die after roughly 5 minutes without blood circulating to exchange oxygen for the waste products of metabolism. Performance-wise, the most significant things are to ensure that compressions are at an adequate depth (you can feel a carotid pulse when someone is performing chest compressions if you’re unsure if they are deep enough. This is usually a problem with bystander CPR or with infants) and that the chest is allowed to fully recoil. We naturally ventilate through negative pressure; by allowing the chest to fully recoil, we not only provide time for the chambers of the heart to fill with blood, but we also allow our lungs to fill to their functional residual volume with room air. While this is obviously not the same volume as ventilating, it is sufficient for gas exchange in the lungs and is part of why you’ll see some environments push for passive oxygenation without interrupting chest compressions.
I left an EMS agency that was pretty much ACLS/PALS to the T and my current employer has a vastly different standard of care. Heads-up CPR, passive oxygenation via high-flow NC, single-dose Epi, Levophed for certain PEAs, etc.
Quite a…shock…for crews on a scene flight when we take over care for an arrest.