Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Hands Only CPR

Hi Last year I spent several weeks with my brother driving around the South , he was an EMT/First responder and trainer for CPR in the rural areas. He knew of the rescues and events on Whitney and would come out about every year. I ask him how many people he had used CPR on made it , his reply outside the hospital over 300 and one lived a year.

This started me to think why and his thoughts on AED's His answer was it tells the people in remote locations a graphic resource of the condition , when the device says do not shock and a flat line on the screen the untrained them have a hint it maybe over. I have heard that no one has recovered with CPR over 10,000' but cannot verify. I have found reports of 1in 20 if acted on very fast and near medical help.He said many of his calls were to remote locations , rural farm houses miles from town on dirt roads and seniors with many existing conditions,also some would respond and pass later in the Hospital .
He talked about the change of CPR that uses only hands Please check the AHA website. They have a video and some background.Also Glendale AZ has started a mass training program and shows some results. Thanks Doug

Doug,
This has been a big discussion between me and a teammate. I've checked out the results in Arizona and personally feel it's the way to go. However, until the Red Cross, etc. says otherwise, we've got to do CPR how they instruct. I don't think it will be long before they go to compressions only. Since I've had a card I've watched it go from 10 compressions and 1 breath to 30 and 2.

Doug, they figure that no one feels comfortable or knows how to effectively do mouth to mouth. Plus, there is presumably enough O2 in the bloodstream to last awhile (30 seconds?) and so it is imperative to concentrate on just that factor by keeping it circulating with chest compressions. Any response to resuscitative efforts is likely to be in that short window of time anyway.
Yes, the success rate is low, but not zero.

And it corresponds mightily to circumstances - for example resuscitating a climber hit by lightning is different than a massive heart attack presenting as sudden death.

Have a nice holiday. Harvey

I first got certified in 1980 or so and remember 5/1 for a team and 15/2 for a solo effort. It seems every year or two another change.
Me, I'm 0 for 3 if that's any indication.

CPR done outside of the hospital and one lived a year.

That statistic is why I think society goes overboard with training people to do CPR. Yes, a small percentage of people are saved to get to the hospital, but from my limited knowledge, very few are successfully saved. By successfully saved, I mean to go on and live a normal life.

I am a big proponent of AED's they save people all the time.

I qualify my position by stating this pertains to CPR outside of a hospital setting.

I learned CPR many years ago, but only used it once, about two years ago, and that was successful (the fellow is still alive). It was initiated less than a minute after he collapsed (he was riding a bike).

Interesting subject. Here's what Wikipedia had to say:

Used alone, CPR will result in few complete recoveries, and those that do survive often develop serious complications. Estimates vary, but many organizations stress that CPR does not "bring anyone back," it simply preserves the body for defibrillation and advanced life support.[35] However, in the case of "non-shockable" rhythms such as Pulseless Electrical Activity (PEA), defibrillation is not indicated, and the importance of CPR rises. On average, only 5%-10% of people who receive CPR survive.[36] The purpose of CPR is not to "start" the heart, but rather to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is impalpable by the layperson rescuer, the current consensus is to perform CPR on a patient that is not breathing. Studies have shown the importance of immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improve survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York City, without those advantages, the survival rate is only 1-2 percent.[37] In most cases, there is a higher proportion of patients who achieve a Return of Spontaneous Circulation (ROSC), where their heart starts to beat on its own again, than ultimately survive to be discharged from hospital (see table below). This is due to medical staff either being ultimately unable to address the cause of the arrhythmia or cardiac arrest, or in some instances due to other co-morbidities, due to the patient being gravely ill in more than one way.

Type of Arrest	ROSC	Survival
Witnessed In-Hospital Cardiac Arrest	48%	22%
Unwitnessed In-Hospital Cardiac Arrest	21%	1%
Bystander Cardiocerebral Resuscitation	40%	6%
Bystander Cardiopulmonary Resuscitation	40%	4%
No Bystander CPR (Ambulance CPR)	15%	2%
Defibrillation within 3–5 minutes	74%	30%

ROSC = Return of spontaneous circulation

(me): So, I guess it would depend on the root cause of the cardiac arrest. In the case of cardio-vascular disease, stroke, or head injury, I suppose it's not surprising that CPR doesn't necessarily prolong life. That's not to say it's not worthwhile to know. How about in the case of drowning or electrical shock? In those cases, absent other medical issues, you likely stand a chance of a better outcome (IMHO).

Very interesting subject. As they say timing is everything especially when it applies to how fast you can start defibing a person in cardiac arrest. Trouble with AEDs is that they are very expensive and where do you keep one?. I own a secondary bussiness that sells physical education sysyems to school across the country. We used to inlude a Phillips portable battery operated AED on the cart.It cost us $1500.00 for each portable AED and we purchased thousands of them.Trouble is that Phillips would not follow up or give the schools instructions on battery life and how to check their battery charge.So much to our surprize the batteries went dead on many of these portable AEDs and no one knew it.So AEDS if administered immediately might save some lives but in reallity they are very impractacle to own and have available when needed.The portable battery operated AEDs need constant battery upkeep and replacements and are very expensive.
As Clamber abouts chart show the chance of survival if you administer defib in 3-5 minutes still only gives a 30% survival rate.How many can get to an AED and administer it in 3-5 minutes?

Clamber, there were some serious problem with your quotes. This is not on you, but on Wikipedia, which slightly, but very significantly altered the info from the primary sources, which they referenced.

In the primary source, it actually said:

Studies have repeatedly shown the importance of immediate bystander CPR plus defibrillation within 3–5 minutes of collapse to improve survival from sudden VF cardiac arrest.
In cities such as Seattle, Washington, where CPR training is widespread and EMS response and time to defibrillation is short, the survival rate for witnessed VF cardiac arrest is about 30 percent.
In cities such as New York City, where few victiims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VF cardiac arrest averages 1–2 percent.
=================================
NOTE that they are now referring ONLY to VF or Ventricular Fibrillation.

Something like 75% of acute cardiac deaths are caused by VF, so that lowers the numbers considerably.

Also, a lot are unwitnessed, further lowering the numbers.

you also mentioned:
"However, in the case of "non-shockable" rhythms such as Pulseless Electrical Activity (PEA), defibrillation is not indicated, and the importance of CPR rises."

Actually.....not. The only real point of CPR is to support someone to rapid defibrillation, which reverses the underlying cause, the VF. However, if they don't have a shockable rhythym, there is virtually no way to diagose and treat the underlying cause in a timeframe that will result in recovery. Or in other words, they are untreatable by lay people (and virtually all professionals all of the time). Nowadays, we pretty much stop, except in special situations, if we have PEA (in the ER).

" Approximately 20-30% of patients from all documented sudden death events have bradyarrhythmia or asystole at the time of initial contact, indicating a terminal event from massive myocyte necrosis, pump failure, or VF progression to asystole"
http://emedicine.medscape.com/article/158712-overview

It is also not something that people like to talk about, but many (most?) survivors are the victims of severe permanent brain damage.

I don't mean to be a downer, but the results are dismal.
For the several years that I was an ER physician, I only recall one patient that arrived in the ER in cardiac arrest, who walked out of the hospital, and he was not having a heart problem. (tension pneumothorax)

However, I agree with the elimination of the breathing. It caused far too many problems with efficient compressions....and if the compressions are not done right, and they are not done continuously, they might as well not be done at all.

On an up note, see:

www.youtube.com/watch?v=vTHvUs_eA7g

en.wikipedia.org/wiki/Therapeutic_hypothermia

and

www.dicardiology.net/node/34726/3/

CaT

Doc,

At my work we have three AED's strategically placed, and on at least one occasion that I know of, one of them was put into use well within the 3-5 minute timeframe (likely w/in about a minute and a half). Far as I know, the individual in question made a full recovery and is still working for the company to this day. The company promotes and pays for CPR/AED training for any and all that are interested. New classes for first timers and re-cert classes several times per year.

I would imagine there must be some sort of maintenance schedule for AED's, yes? At least it would be unreasonable not to at least turn them on every few months just to make sure they've got battery power.

Ken,

So, since you went to the trouble to document the failings of the Wikipedia "translation" of the cited documents, you could do the world a favor and update the Wikipedia page on the subject! Seriously, why not? I'm sure I'm not alone in appreciating receiving accurate and valid information from an expert on the subject when I research something.

Unfortunately, from everything quoted above, (except for links provided by CAT, which I haven't perused yet), I walk away with the notion that CPR is nothing but a money-making entreprise for the American Red Cross that really doesn't accomplish much. Except in a rare case or two, like the one I mentioned at the beginning above. I imagine that person would view it as worthwhile, but they would have likely been okay had they only been treated with the AED anyway (in this particular circumstance), right?

ClamberAbout there is a schedule for battery maintenance according to our supplier but it is left up to the sales person to be responsible.In our case our sales rep never mentioned a battery maintenance schedule and since we ship over over the country it slipped through the cracks.Once we found out batteries needed to be checked and replaced we made our sales rep contact every school to check the batteries.The cost of the AED and lack of training to everyone who may have to use the AED led us to drop adding them in our systems.I personally felt that it was giving a false sense of security to PE teachers that they might be able to save someone with a portable AED due to the lack of proper training and the problems with no one checking out battery life on their AEDs.It seems that survival rates are not very good even when administered correctly in 3-5 minutes.

Clamber, that is a great idea, and although I've never done the Wiki thing, I think it is worth the effort. I'll see if I can make some time for that soon.

The whole CPR thing has been very disappointing, although I must say that things have improved over the years. However, the one thing that has not changed, is that the time is everything. With the possible exceptions of hypothermia and some drowning, these events are pretty much over in about 10 minutes. I remember doing for long periods, in years past.

I was a bay area medic, CPR, ACLS, instructor. Outside of the hospital I never saw it work. You need people to react fast with the defib and drugs. Not likely on the side of any trail.

I've seen it work once, and I wonder if there is any research out there to suggest that the type of heart failure that occurs might have something to do with possible recovery.

The gentleman I saw go down was a Scottish highland athlete, highly fit, actually the opposite of what you would expect of a guy throwing logs and weights and rocks. His diagnosis ended up being a misfiring of the heart, which required a pacemaker placement. They were able to revive him on the field when he collapsed, and then had to repeat it in the ambulance on the way to the hospital. He took a year off from competing, then came back on a limited basis.

There was no AED available at the fairgrounds in Sacto when this went down.

Laura,
No doubt recovery depends directly on the type of heart attack. They used to say the first warning sign of a heart attack for someone 40 or younger is death.
http://www.aed.com/faqs/

I was just looking for our Sequoia Kings park protocols for CPR. Can't find them. They define what either EMTs or Park Medics do and how long before stopping CPR in a field situation. If I remember right, it's about 10 minutes in an arrest. The exceptions are for hypothermia, where it's continued until you can get them to a medical facility (the classic you're not dead until you're warm and dead); cold water drowning (I think less than around 48 degrees F -- Wikipedia says 70, but I think that's way to high...); & lightning. All can be stopped if there's obvious signs the person is dead -- lividity, rigor etc or obvious non-survivable trauma.

I was at Crabtree in '86 (???) when a number of people got hit by lightning at the hut and along the trail ridge. Supposedly one of the guys hit on the ridge had CPR done on him and he revived. Under conditions like that, it's also not absolutely clear the person's heart stopped, but it's consistent with a lightning injury. CPR might also have saved at least one or two of the people hit near Sandy Meadow north of Crabtree a few years ago. My only marginally accurate memory is that CPR was started within minutes on all those who were reported to be unresponsive. It took maybe 30+ minutes for the ranger to get there and another 30 for the first helicopter. The ranger who arrived determined that two of them were beyond being saved by CPR and told the scouts they could stop CPR. Not sure if it was CPR that actually saved the others, but I believe it was in a couple of the cases.

That's mostly to say that with the exception of lightning and, more rarely, the exceptions of cold water drowning and hypothermia, chances of survival in the backcountry with a full arrest are close to, if not actually at, 0.

As a side note, they were originally developed when we had a river drowning which required divers getting the victim then starting and continuing CPR for over an hour while a helicopter came in to do a short-haul rescue. Afterward, it was decided that was too risky for the almost certain outcome of the guy being dead. A protocol was needed so the EMT or Park Medic on scene could just stop or do so with permission of the base hospital.

I'll try to find our actual protocols with University Medical Center in Fresno and see what the times are.

George

Wilderness first aid courses now teach not to even start CPR unless it is a case of cold-water drowning or electrocution (lightning). Even then, after 10-15 minutes, you give up because you're not going to get help soon enough to do any good.

I do know of one instance where CPR was applied in the backcountry at Philmont, the big Scout Ranch out in New Mexico. A group was up on top of Baldy (12,400', tallest peak in Philmont) when a t-storm blew up and lightning struck in the midst of the group. Two were unconscious but breathing. One was down and required CPR and recovered. Our crew was in Cimmaron NM eating lunch and listened to the rangers' chatter on the radio that another staffer had with him in town.

If you look over the past 40 or so years that I've been trained on CPR (Red Cross Water Safety Instructor, BSA Lifeguard, company emergency medical team, more training sessions than I care to count), we have gone through a lot of different ratios of compressions to breaths plus whether you were ever trained for two-rescuer CPR in addition to one-rescuer CPR. The "compressions-only" rubric started being talked about in 2008 and if I remember correctly, will become the norm for AHA training this year (2010). Have to check on that one...

Alan, interesting.

One of the things that I suspect in "successful" CPR scenarios, is that the victim did not actually have a heart stoppage, but their pulse was not detected. Studies have shown that non-professionals are AWFUL at detecting a pulse (it's hard!), particularly in a person whose blood pressure is low.

That combined with the realization that most people providing CPR are not supplying compressions with sufficient vigor (broken ribs are often present with effective compressions)

I wouldn't be surprised, either, Ken. Or, could have been an issue with the victim having been stunned sufficiently that spontaneous breathing took a little while to re-start. If I had been on-site, I'd definitely have tried CPR on anyone who wasn't breathing and on whom I couldn't feel a pulse.

I definitely agree that properly-done CPR compressions are likely to damage ribs or sternum...

One thing about Philmont...Scouts out there are generally a bit better trained than your average Joe or Jane off the street. Plus, the Scouts are in the 14-20 age group where they start to be a little more responsible and take things like CPR training pretty seriously. (At least our guys do. We emphasize wilderness skills and make sure they know it's serious when you're on the trail and hours, not minutes, from even basic assistance.)