introduction
At the end of 2005, the American Heart Association (AHA) published the International Guidelines for Cardiopulmonary Resuscitation and Cardiovascular Rescue (hereinafter referred to as the 2005 edition guidelines), which is one of the most commonly used guidelines in the world. To emphasize the importance of effective chest compressions, the 2005 edition of the guidelines changed the cardiopulmonary resuscitation (CPR) compression ventilation ratio from 15: 2 to 30: 2, and the ventilation time from 2 seconds to 1 second.
Nonetheless, clinical studies have shown that early CPR provided by professional emergency personnel and non-medical personnel has deficiencies, excessive emphasis on ventilation, and insufficient attention to continuous chest compressions. The main manifestations are slow compression frequency, insufficient depth, frequent interruption and long time, and the phenomenon of artificial hyperventilation is common.
The importance of effective compression has been confirmed
After the publication of the 2005 edition of the guideline, animal studies such as Gordon at the University of Arizona, Gedds at Puredue University, and the SOS-KANTO study published in 2007 in Japan are remarkable.
Research conducted by Gordon et al. Using an out-of-hospital cardioplegia model showed that compared with the 30: 2 CPR group, the recovery rate of spontaneous circulation and the 24-hour survival rate of the pigs in the continuous cardiac compression group were not significantly different, while the 24-hour neurological function survived normally The rate, the success rate of a defibrillation is higher, and the coronary perfusion and mean arterial diastolic pressure are also higher.
Geddes et al found a resuscitation method that requires only abdominal rhythm compressions without the need for mouth-to-mouth artificial respiration (OAC-CPR). Compared with traditional CPR, OAC-CPR can increase the coronary perfusion rate by about 60% without compromising organ function. Animal experiments suggest that when ventricular fibrillation occurs, the coronary perfusion index (CPI) of the pigs in the OAC-CPR group can reach 24% of the normal state, while the CPI of pigs in the traditional CPR group is 17% of the normal value. OAC-CPR can provide a certain amount of pulmonary ventilation while achieving more effective coronary perfusion.
The theoretical basis for the birth of OAC-CPR includes: â‘ The abdominal organs contain 25% of the human blood supply. The rapid increase in abdominal pressure can cause these blood to flow into the heart; â‘¡ Abdominal compression can raise the diaphragm, so it can be done at the end of each compression Cause the rescued person to inhale; â‘¢ OAC-CPR can effectively improve coronary perfusion, which can deliver more oxygen-rich fresh blood into the heart, which is the key to improving the success rate of resuscitation; â‘£ In the process of implementing OAC-CPR , The aortic pressure continues to be higher than the pressure of the right atrium, thus ensuring that blood with low oxygen content will not flow back into the heart.
In early CPR, artificial respiration does not improve the success rate of resuscitation, and continuous uninterrupted chest compressions can increase the success rate of resuscitation. Abella (Abella) and other hospital resuscitation data suggest that those who received 87 times / min chest compressions had a spontaneous circulation recovery rate higher than 72 times / min, and those who received uninterrupted chest compressions had a higher survival rate.
The SOS-KANTO study confirmed that continuous compression without ventilation can improve patient survival. The study included 58 medical units and included 4068 cases of out-of-hospital cardiac arrest studies from September 2002 to December 2003. The results showed that compared with traditional CPR, patients who received compressionless ventilation had a higher survival rate (6.2% vs. 3.1%). This result almost subverts the basic life support method of modern CPR. The researchers believe that the reason for the high survival rate of those who only receive chest compressions may be that the chest wall rebounds to produce ventilation and achieve gas exchange. After 4-10 minutes of resuscitation without ventilation, the minute ventilation and arterial oxygenation decreased. Within 6 minutes of non-rescue of cardioplegia, ventilation is not important for the first 12 minutes after the start of resuscitation.
Simplified CPR operation can allow more people to participate in rescue
The main cause of patients requiring CPR is cardiogenic, and 80% of cardiac arrests are caused by ventricular fibrillation. For cardiac arrest caused by ventricular fibrillation, effective chest compression is performed within the first minute after the arrest to maintain coronary perfusion and restore myocardial blood supply than artificial ventilation. For cardiac arrest due to a sudden drop in blood oxygen partial pressure due to ventilation disorders (such as asphyxia, drowning, etc.), the key to resuscitation is to improve ventilation, improve blood oxygen partial pressure and oxygen saturation, ventilation and compression are equally important.
The factors that determine the survival rate of cardiac arrest patients also include whether there are witnesses during cardiac arrest and whether non-medical personnel can implement CPR in time. One of the reasons for the low survival rate of out-of-hospital cardiac arrest patients is that too few non-medical staff implement CPR, and only 20% to 30% of the United States where the first aid knowledge is more popular. (1% vs. 3%).
Although there is no evidence to prove that mouth-to-mouth artificial respiration can spread disease, the mouth-to-mouth artificial respiration in traditional CPR makes eyewitnesses unwilling to actively implement CPR because of concerns about infectious diseases. In a study involving 433 physicians and 152 nurses, 45% of physicians and 80% of nurses said they would refuse resuscitation of mouth-to-mouth artificial respiration to strangers.
Therefore, simplifying CPR operations and enabling the general public to grasp and implement them in a timely and effective manner at the sighting site is the key to improving the success rate of CPR. The main direction of simplification should include abandoning artificial respiration in the early stages of resuscitation. After witnessing patients with sudden cardiac arrest and calling the emergency system, non-medical personnel actively implement CPR, and at the same time avoid interruption of compression due to ventilation, the resuscitation success rate will be greatly improved.
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