The Breath of Life? Thomas Rea MD MPH University of Washington King County Emergency Medical Services

Disclosures I receive support from the NIH, the Laerdal Foundation, and the Medtronic Foundation as part of programmatic and research activities.

Disclosures I receive support from the NIH, the Laerdal Foundation, and the Medtronic Foundation as part of programmatic and research activities. There is much to learn.

The Breath of Life? The Role of Rescue Breathing during CPR

Normal Physiology

CPR Benefits Preserve some measure of critical organ perfusion/oxygenation.

The Debate Optimal Balance of Oxygenation and Circulation Hands Only CPR CC + Rescue Breathing

A Rationale Discourse

Lay Person CPR Professional CPR

A Rationale Discourse Lay Person CPR Professional CPR Distinct expectations and training Different phase and type of arrest

Lay Person CPR

A Case for Hands Only CPR

#1. Sufficient Oxygen Reservoir at the Time of Collapse

A Case for Hands Only CPR #1.Sufficient Oxygen Reservoir at the Time of Collapse Oxygen Content Time Interval from Collapse

A Case for Hands Only CPR #2. Hands Only CPR is easier to train and implement.

A Case for Hands Only CPR % 30% 40% 20% 10% 33% 40% 28% 32% 36% Bystander CPR #2. Hands Only CPR is easier to train and implement.

#3. Ventilations are difficult to perform and produce interruptions Rigorous often repeated CPR training of laypersons A Case for Hands Only CPR Public Access Defibrillation Trial

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR During the time bystanders were prompted to provide CPR, what proportion of time was actually spent performing chest compressions? A.75% B.67% C.50% D.25%

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR During the time bystanders were prompted to provide CPR, what proportion of time was actually spent performing chest compressions? A.75% B.67% C.50%.. resulted < 30 compressions / minute D.25%

A Case for Hands Only CPR Ventricular Fibrillation #4. The Importance of Etiology and Rhythm PEA / Asystole

A Case for Hands Only CPR Survival VFPEAAsystole 50% 30% 40% 20% 10% 15% 5% 45% #4. The Importance of Etiology and Rhythm

#5. Evidence from Trials Comparing Hands Only vs CC + RB A Case for Hands Only CPR Level 1 Evidence

A Case for Hands Only CPR HO CPRCC + RB Seattle 14% 10% TANGO 9% 7% DART 14% 11% Survival #5. Evidence from Trials Comparing Hands Only vs CC + RB

Hands Only CPR CC + Rescue Breathing 1. Reservoir of oxygenated blood 2. Hands only is easier to train and implement 3.Ventilations are challenging to perform 4.Hands only favors VF resuscitation 5.Evidence from Human Trials A Case for Hands Only CPR Optimal Balance of Oxygenation and Circulation

Bipartisanship

Professional CPR Hands Only CPR CC + Rescue Breathing

A Case for Hands Only CPR Oxygen Content Time Interval from Collapse #1.Sufficient Oxygen Reservoir at the Time of Collapse

A Case for Hands Only CPR Oxygen Content Time Interval from Collapse #1.Sufficient Oxygen Reservoir at the Time of Collapse

A Case for Hands Only CPR Oxygen Content Time Interval from Collapse #1.Sufficient Oxygen Reservoir at the Time of Collapse

A Case for Hands Only CPR % 30% 40% 20% 10% 33% 40% 28% 32% 36% Bystander CPR #2. Hands Only CPR is easier to train and implement.

A Case for Hands Only CPR Professional CPR % 50% #2. Hands Only CPR is easier to train and implement.

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR 50% ….. produced < 30 compressions / minute

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR Interruptions for Rescue Breathing 30:2 Compression to Ventilation Ratio

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR Interruptions for Rescue Breathing 30:2 Compression to Ventilation Ratio

#3. Ventilations are difficult to perform and produce interruptions A Case for Hands Only CPR Asynchronous Ventilations Prior to Intubation

A Case for Hands Only CPR Ventricular Fibrillation #4. The Importance of Etiology and Rhythm PEA / Asystole

A Case for Hands Only CPR Ventricular Fibrillation #4. The Importance of Etiology and Rhythm PEA / Asystole 25% of arrests 75% of arrests

A Case for Hands Only CPR Level 1 Evidence #5. Evidence from Trials Comparing Hands Only vs CC + RB

A Case for Hands Only CPR (Empty Space) #5. Evidence from Trials Comparing Hands Only vs CC + RB

Hands Only CPR CC + Rescue Breathing 1.Reservoir of oxygenated blood 2.Hands Only is easier to train and implement 3.Ventilations are challenging to perform 4.Hands only favors VF resuscitation 5.Evidence from Human Trials A Case for Hands Only CPR Optimal Balance of Oxygenation and Circulation

Hands Only CPR CC + Rescue Breathing 1.Reservoir of oxygenated blood 2.Hands Only is easier to train and implement 3.Ventilations are challenging to perform 4.Hands only favors VF resuscitation 5.Evidence from Human Trials A Case for Hands Only CPR Optimal Balance of Oxygenation and Circulation

Hands Only is an effective approach for layperson CPR Summary

Phase and patient differences Technical experts Changing epidemiology Lack of top-level comparative evidence

A Great Debate

Summary

Normal Physiology Requires

Disclosures Curveball Beholden to the evidence RCT Bipartisanship Bystander CPR Are there persons who might benefit from ventilation? Optimize oxygenation delivery to critical tissues. Ventilations are too difficult to perform and produce interruptions in compression / circulation There is enough oxygenated blood in the reservoir so that the best strategy is to circulate. Only those with a cardiac as opposed to a respiratory cause can survive The weight of the evidence supports hands only CPR

The Breath of Life? Thomas Rea MD MPH University of Washington King County Emergency Medical Services

The Great Debate