Nice summary of the current understanding of CPR in the community… Having done some research work in the area, I have a couple of comments and clarifications:
Only a few cities have reported CPR success as high as 25%, Seattle being one, where a lot of things have been done right to reduce your chances of dying from cardiac arrest; and getting the community trained in CPR is an important link… The rest of the cities, not so good… Even 4% would be an overstatement of your survival chances…
Studies have shown that bad CPR is as good as no CPR. Also, since it’s a complex procedure, the skill to do CPR correctly diminishes drastically with time… Hence, to save a life, you have to keep training those 12 thousand or so community people…
All my good samaritans out there, don’t feel bad about not knowing correct CPR… Even health professionals (doctors, nurses, EMS personnel) do not fare so well when it comes to CPR skills… And that may be one reason why, even with all the drugs and fancy defibrillators, the in-hospital survival rate from cardiac arrest is not more than 40%
Given the above, the most recent guidelines from the ILCOR (accepted by various countries’ experts, including Europe and US) have recommended:
a. That lay rescuers should not be forced to do mouth-to-mouth breathing during CPR (for several scientific and personal hygiene reasons), it’s still good enough if they can do the more important task - deliver chest compressions - “push hard, push fast” and minimize interruptions…
b. That lay rescuers should get instructions from the dispatcher (the friendly voice over the telephone when you call ‘911’, that tells you ‘Don’t Panic!’) how to do correct CPR
Another clarification… Although defibrillation can ‘convert’ VF rhythm to normal rhythm (as stated in original SDS report), chest compressions are still very important, even in cases with VF rhythm… They ensure adequate blood supply to the heart and brain while you are looking for the nearest defibrillator, opening it, reading instructions, hooking it up, etc…
Bystander CPR, therefore is not something standalone… It is a crucial link in the ‘Chain of Survival’ that includes four equally important components:
a. Early activation of EMS system
b. Early bystander CPR
c. Early defibrillation
d. Early initiation of advanced life support
So, if I may, I would rephrase paperbackwriter’s advice as:
“So if you’re planning on having a heart attack, I recommend you go to Seattle, arrange to have a recently trained stranger on hand who can start CPR immediately upon your collapse, another stranger to call 911, and a defibrillator in the vicinity which the trained stranger would hopefully know how to operate.”
I was first trained in CPR about 25 years ago in a first responder class. (I never actually used this training; it was just an elective class I took because I thought it would be nice to know.)
I took my first recertification class about a decade later — and was surprised to see that the ratio of breaths to compressions had changed a good deal since my initial training.
Over the following decade, I took recertification classes fairly regularly, since I was working part time at the Y. The breaths-to-compression ratio changed at least another time or two, finally ending up with the “Just do the finger sweeps and position to head to open the airway and concentrate on the chest compressions” version.
The last class I took included AED training, and I agree that they appear to be ridiculously easy to use. The device does a pretty good job of stepping you through what it needs.
The building I work in has 3 AEDs stationed at various places in it. I’ve noticed that lately the one closest to my office has started chirping from time to time, which I presume means that its battery needs to be changed out. I mentioned this to the safety officer a number of times, but he pretty much blew me off. I have the feeling that the AED (and probably all the others that were installed throughout our organization) are going to end up being useless pieces of junk hanging on the wall if this isn’t looked into.
I have been trained in CPR and First Aid every two years for the last thirty years, and probably half a dozen times before that.
I have absolutely saved lives 3 times, and possibly saved lives another 3. One person accounts for half of those times. (Tough little broad.) If your AED is not within one minute of use, it is almost certainly useless. That means a person who knows how to use it, and the device are ready to start using it within sixty seconds of the onset of frank symptoms.
Las Vegas casinos and civil buildings in Seattle are about the only places outside of hospitals where that is likely.
Yeah, the batteries are probably dead or nearly so. I’m an EMT, and when I was working for a private ambulance company, we had to check the batteries every single day. The pads expire as well, so they need to be checked frequently, too.