Studies Cite Lapses in CPR Methods
Two studies using new technology to monitor the course of cardiopulmonary resuscitation, or CPR, confirm long-held suspicions that even trained personnel often do not perform the life-saving procedure correctly.
In general, paramedics, nurses and even doctors perform too few chest compressions, do not push hard enough on the chest, and give the victim too many breaths, researchers report today in the Journal of the American Medical Assn.
The two studies did not enroll enough patients to determine whether such practices endangered lives, but studies have shown that the likelihood of surviving a stopped heart is directly related to the quality of CPR.
“CPR has been around for 50 years ... and now we find that it is not being done very well,” said Dr. Lance Becker of the University of Chicago Medical Center, who led one of the studies.
The studies used an experimental heart monitor-defibrillator that measured chest compressions, ventilations, pulse, and the fraction of the time when no blood was flowing.
Becker and his colleagues monitored CPR performed on 67 patients by the University of Chicago’s cardiac arrest team. Dr. Lars Wik of Ulleval University Hospital in Oslo studied CPR performed by paramedics and nurse anesthetists on 176 patients undergoing cardiac arrest outside a hospital.
The results were similar.
For physicians, a third of the compressions were too shallow; for paramedics and nurse anesthetists, two-thirds were. For both groups, breaths were given too frequently and compressions too slowly. And both groups allowed circulation to stop for longer periods than called for in medical guidelines.
The findings are similar to unpublished data from other hospitals and other locations.
Guidelines for chest compressions call for 100 to 120 compressions per minute, with a depth of about 1 1/2 inches. For ventilation, the guidelines call for two breaths for every 15 compressions before an air tube is inserted and 10 to 12 per minute after intubation.
“We didn’t expect to find perfect compliance,” said Dr. Benjamin Abella of the Chicago team, but they did not expect the number of lapses either.
The two studies “document a major problem in the treatment of cardiac arrest,” or stoppages of the heart, wrote Drs. Arthur B. Sanders and Gordon A. Ewy of the University of Arizona College of Medicine in an editorial in the same journal.
Becker said his team was testing a second-generation model of the device that not only monitored CPR progress but also gave feedback telling users how to adjust their pace to have the greatest efficacy.
