Developed by the University of

Arizona Sarver Heart Center

Resuscitation Research Group
• Are the most common cause of death in
the United States
• Unfortunately, the first sign of
cardiovascular disease is often the last, as
the first sign is often cardiac arrest
• Since most occur out of the hospital
• Out-of-hospital cardiac arrest is a major
public health problem
 Heart
Heart Attack
Attack vs.
vs. Cardiac
Cardiac Arrest
Arrest
Heart Attack: Cardiac Arrest:
• Blockage in coronary artery • Electrical issue, heart stops
pumping
• Person usually conscious
• Person is unconscious
• Upper body discomfort
or pain • Often no previous symptoms
 Primary
Primaryvs.
vs.Secondary
SecondaryCardiac
CardiacArrest
Arrest

Primary Secondary

• Heart stops pumping • Heart stops pumping

due to lack of oxygen
• Blood in arteries full
of oxygen • Drowning, Drug
Overdose, Lung
• Unexpected Failure (severe
witnessed collapse asthma or
emphysema)
 Out-of-Hospital
Out-of-Hospital Cardiac
Cardiac Arrest
Arrest
The majority of all out of hospital
cardiac arrests are Primary Cardiac
Arrest
Unexpected, witnesses (seen or
heard) collapse in an individual who is
not responsive

Chest Compression Only CPR

Ann Emerg Med. 1997 Jul;30(1):69-75.
 What
What isis
Chest
Chest Compression
Compression Only
Only CPR?
CPR?
• A new method of resuscitation developed
through extensive research at The University
of Arizona Sarver Heart Center for primary
cardiac arrest
• Continuous forceful chest compressions to
circulate the person’s blood to their brain and
heart
• Mouth-to-mouth breaths may actually
be harmful
 Why
Why isn’t
isn’t
Rescue
Rescue Breathing
Breathing Necessary?
Necessary?
During Cardiac Arrest:
– Lungs are full of air

– Blood is full of oxygen

– Circulating the oxygenated blood is the key

 Why
WhyMight
Might“Rescue
“RescueBreathing”
Breathing”be
be
Harmful
Harmfulin
inPrimary
PrimaryCardiac
CardiacArrest?
Arrest?
• People less likely to perform

• Causes interruption of chest

compressions: stops blood flow to the
brain

• Increased pressure in the lungs and chest

decreasing blood return to the heart
Aufderheide TP et al.., Death by hyperventilation: a common and Aufderheide TP et al.., Hyperventilation induced hypotension
life-threatening problem during CPR. Crit Care Med 2004;32:S345- during CPR Circulation 2004;109:1960-5
51
 Why
Why
Chest
Chest Compression
Compression Only
Only CPR?
CPR?
• It saves more lives
• More likely to survive over:
– Doing nothing
– Traditional CPR

Bobrow, et al. JAMA October 2010

What
What Stops
Stops People
People from
from Doing
Doing CPR?
CPR?
Fear / Concern Solution
Mouth-to-Mouth Chest Compressions Only

Harming the Person Better than dead

Legal Consequences Good Samaritan Law

Won’t Perform Properly Easier to Do

Physically Unable Do Your Best / Call For Help

Coons SJ, et al. Resuscitation 80;334-340:2009 This study was designed and funded by the Sarver Heart Center
The University of Arizona College of Medicine and SHARE
 Bystander
BystanderCPR
CPRininArizona
Arizona(2005
(2005to
to2010)
2010)
Witnessed
Witnessed&&Shockable
Shockable
Out
Outof
ofHospital
HospitalCardiac
CardiacArrest
Arrest
Survival to Hospital Discharge

40%

30%

25%

20%

15% 33.7%
10%
17.6% 17.7%
5%

0%
No Traditional CCO
CPR CPR CPR
Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010
 When
When toto use
use
Chest
Chest Compression
Compression Only
Only CPR?
CPR?
Chest Compression Traditional
Only CPR CPR

• Someone who unexpectedly • Obvious Breathing Problems:

collapses, and is – Drowning
unresponsive.
– Drug overdoses

• Vast Majority
 What
What to
to do:
do:
Are You
Alright? Check: Shake & Shout

Call: 911 & send someone for

an A.E.D. (if available)

Compress: Chest compressions

at 100 Per Minute
 Are
Are They
They Breathing?
Breathing?
• Gasping is a sign of cardiac arrest
• Majority of people with cardiac arrest gasp
• Can be a sign of minimal but adequate blood flow to
the brain.
• DO NOT stop chest compressions if they gasp
 How
Howto
toDo
DoChest
ChestCompression
CompressionOnly
OnlyCPR
CPR
With the victim on the floor:
1. Kneel beside them
2. Place the heel of one hand on top of the other
3. Lock your elbows
4. Aim for the middle of the chest (on the sternum between the nipples)
5. Push hard and fast (try for 100/min.)
6. Take turns with another person when tired.
 Chest
Chest Compressions:
Compressions:
Rate
Rate and
and Depth
Depth

100 2 inches
Compressions per Minute in depth

• Allows the heart to refill • After each compression,

• Beat of “Staying Alive!!” take all weight off the
chest
 Bystander
BystanderCCO
CCOCPRCPRImproves
ImprovesChance
Chanceof
of
Survival
Survivalfrom
fromCardiac
CardiacArrest
Arrest
100%
CCO CPR
80%
Survival (%)

CPR
60%

40%
No CPR

20%
EMS Arrival
0%
0 1 2 3 4 5 6 7 8 9
Time between collapse and defibrillation (min)
Nagao, K Current Opinions in Critical Care 2009
EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008.
 What
What to
to do:
do:
Are You
Alright? CHECK Shake & Shout “Are
you all right?”

CALL 911

COMPRESS
Chest Compressions at 100 Per Minute

If available; Send for an

A.E.D.
 AEDs
AEDs
They may look different, but they all function the Same!

Open and Follow Instructions

• Turn AED ON
• Apply Pads to Bare Chest
• Plug in Pads (if necessary)
• Analyze Patient (CLEAR!)
• Push Shock to defibrillate,
if directed (CLEAR!)
• Immediately resume CPR
The
The Universal
Universal Symbol
Symbol

• Safe
• Easy
• Voice Prompted
Save your Breath…
Save a Life
 How
Howto
toDo
DoChest
ChestCompression
CompressionOnly
OnlyCPR
CPR
With the victim’s back on the floor:
1. Kneel beside them
2. Place one hand on top of the other
3. Lock your elbows
4. Aim for the middle of the chest (on the sternum between the nipples)
5. Push hard and fast (try for 100/min.)
6. Take turns with another person when tired.
Chest Compressions Only

Blood Flowing
To The Brain

Compressions + Breaths (30:2)

Pausing for
breaths means
No Blood Flow

Blood Flowing
To The Brain

Ewy GA, et al. Circulation.

2007;116(22):2525-30.
 Three-Phase
Three-PhaseModel
Modelof
ofResuscitation
Resuscitation
Percent 100
Myocardial ATP

0 2 4 6 8 10 12 14 16 18 20
Arrest Time (min)
Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8
SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest
compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.
 Bystander
BystanderCPR
CPRininArizona
Arizona(2005
(2005to
to2010)
2010)
All
Allout-of-hospital
out-of-hospitalcardiac
cardiacarrests
arrests
25%
Survival to Hospital Discharge

20%

15%
113/849
52/666
10%
150/2,900
5% 13.3%
7.8%
5.2%
0%
No Traditional CCO
CPR CPR CPR
Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010