New approach: Hands-only CPR without the mouth to mouth

By Cathy DeDe, Chronicle Managing Editor

I came across a podcast, then looked up on the American Heart Association website to discover, with some surprise, that there’s a new way of thinking about CPR, cardiopulmonary resuscitation.

Particularly for laypeople who might find ourselves with a loved one or a stranger in cardiac distress, the new protocol favors “breathless” or compression-only CPR.

In other words: No need to breathe into the victim, as learned in traditional CPR.

The breathing is part of why the thought of CPR strikes fear in many a bystander’s heart, with worries of messing up, maybe hurting the victim, or exposing ourselves to disease by putting our mouths on another person who’s possibly ill. Eliminating that, the thinking goes — more people will do CPR in an emergency.

I asked Glens Falls Hospital. They invited me to sit down with Dr. Jordan Blackwood of the hospital’s Adirondack Cardiology practice last week.

“Yes, sort of,” was Dr. Blackwood’s message. What I learned is true, but there’s more to tell, said the cardiologist.

Compression-only CPR had its beginnings in the mid 2000s, he said.

“It’s initially something that the American Heart Association did not buy into,” Dr. Blackwood said. “When you’ve done something for a really long time that’s been heavily vetted through multiple trials, you really want to make sure that it is perfect if you’re going to change it.”

However, he said, “We’ve learned over time that because of the fear, technical barriers, other things that already hamper the response from bystanders, it’s important to make CPR as simple and approachable as possible.”

The practical reality? “You are much more likely to get somebody to do CPR-only,” than to do CPR plus what Dr. Blackwood calls “rescue breathing.”

‘Stayin Alive’: Be firm & fast

“It has to be fairly aggressive,” he said of CPR. “It’s good, firm, pushes. Fast, regular, with as little interruption as possible.” While he talks, he unconsciously cups his hands, palms down, one above the other, as if to demonstrate.

Dr. Blackwood cites songs recommended to help keep the beat: “The one that everybody says in The States is ‘Staying Alive,’ by The Bee Gees.”

In Britain, he says, they use “appropriately dark humor,” suggesting Queen’s “Another One Bites the Dust.”

Search “Songs for CPR” for fun lists.

“The importance,” Dr. Blackwood says, “is the tempo has to be somewhere between 100 and 120 beats a minute. Most people don’t go too fast. Most people go too slow, and most people don’t push hard enough.

“If you look at the actual amount of chest recoil that you need for good quality CPR, it’s one to two inches of chest depression. If you try to do that on a person who’s awake, it will hurt. It’s a pretty substantial movement of the chest wall.”
‘Just do it’ or else ‘already dead’

Dr. Blackwood says, “I have several patients of mine who’ve been resuscitated by their partners or by another family member. I would say people seem to be much more willing to jump in.”

His bottom line, “Just get in there and do it, because that’s the thing that’s gonna make a difference….Get 911 on the phone, and while you’re talking to them, go ahead and start your compressions.”

What about the fear of jumping in?

Dr. Blackwood said, “Something I always say to people, an idea I have shamelessly claimed as mine, was said to me by one of my Medical Attendings all the way back in med school.

“When people say, I’m worried that I’ll get it wrong, she said to me — ‘Well…The patient’s already dead. You can’t make them any more dead.’”

Dr. Blackwood adds, “If you don’t do something, there’s nearly 100% chance they will die. Some people do survive arrest without intervention, but it is a very, very, very small percentage.

“The earlier that intervention comes, the better the chance, not just that they survive, but that they survive with an intact brain, so that they are functional person.”

“There isn’t anything to fear, because even if I do CPR not-perfectly, it probably isn’t going to make it worse.”

Better just to pump the heart

Rescue breathing itself can in fact be problematic, Dr. Blackwood says, “because there are techniques involved and some are tough to master perfectly, even when you’ve been trained, depending on what’s going on with the person.

“If you take that part out of the equation, you get rid of one potential source of errors.

“On top of that, each time you interrupt compressions to try to rescue breathe, you’re interrupting circulation to the brain. There’s no residual circulation. You are it. So as you’re doing your CPR, you’re getting some blood around
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“If you’re doing it fast enough and for long enough, then usually there’s enough blood supply to sustain people for at least enough time for emergency medical personnel to come in and help you out, to get secondary diagnostic data started, to get a defibrillator.

“If you do nothing before that, there won’t be a shockable rhythm, usually, by the time EMS gets there.

“And at that point, the prognosis becomes really, really, really poor. If you do nothing, the further it degenerates, the worse it is in terms of your ability to get them back at the back end.”

Even himself, Dr. Blackwood says, “As a cardiologist, if I’m out there in the community,” away from the medical setting, “if somebody has a cardiac arrest, I am going to only do compression,” because of the question of interrupting circulation.

In distress, he says, “the body’s kind of cool.” It’s technical, but he says simply, the body has oxygen reserves it can draw from in a distress situation — depending on physical fitness and other factors such as circulation.

‘We mostly all die the same’

Statistics list heart disease as the number-one cause of death in the world, but Dr. Blackwood clarifies.

“Because the final common pathway is cardiopulmonary arrest most of the time, cardiac disease often is cited on death certificates,” he says. “That’s not necessarily accurate.

“It’s much in the same way that if you lived through the initial phases of an earthquake, but died in a fire the earthquake started. The death was caused by the earthquake, but the mechanism by which you died was that you were burned, not crushed.”

He says, “We all die more or less in the same ways, unless we have traumatic death: Brain turns off, heart turns off, circulation is done.”

Further, Dr. Blackwood said, “Cardiac arrest is often treated as a homogenous entity, but it isn’t.

“Most of the cardiac arrests that we see aren’t from the heart itself. Most are secondary reactions from other issues.”

Cardiac arrest, he says, is “a nice way of saying, okay, something has happened that has caused the heart to stop, whether it’s what in cardiology we would call a primary cardiac arrest, meaning this is a heart problem causing the heart to malfunction, or whether it is something more secondary that is then impacting the heart.

“Ultimately, it doesn’t matter up front, but it’s important, because it explains why all CPR isn’t perfectly equal for each person.”

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