Friday, 10 March 2017

Do CPR for 30 mins before transporting cardiac arrest victims to hospital

Do CPR for 30 mins before transporting cardiac arrest victims to hospital Quite often we read about people collapsing due to a cardiac arrest. Former President APJ Abdul Kalam collapsed while he was addressing students in Shillong. He was immediately rushed to the hospital but could not be revived. More recently, Mr E Ahamed, Member of Parliament collapsed in the Parliament after he suffered cardiac arrest and passed away. Such instances bring CPR or cardiopulmonary resuscitation back into the spotlight. The first instinct is to immediately rush a person to the hospital when you see somebody collapse suddenly. But at times, a first responder CPR may help revive the person until medical help arrives or a defibrillator is available. Recently, a story was reported at WPRI News in February (Feb 16, 2017) about a major change in prehospital protocol policy in Rhode Island, USA for First Responders for the management of victims of cardiac arrest, which said: “Starting March 1, as dictated by the Rhode Island Department of Health, emergency response personnel will be required to conduct 30 minutes of cardiopulmonary resuscitation, or CPR, on cardiac arrest victims before transporting them to the hospital.” The American Heart Association (AHA) has published updated Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2015 in the journal Circulation, with some updates while continuing to emphasize on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression (avoid leaning on the chest between compressions), minimizing interruptions in compressions, and avoiding excessive ventilation. • The recommended chest compression rate have been updated to 100-120/ min from the earlier at least 100/min. • The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). The earlier recommendation was at least 2 inches (5 cm). • Chest compression should be started first before rescue breaths (C-A-B rather than A-B-C). The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths. While the updated AHA guideline has refrained from recommending a duration of resuscitation, it does state as follows: “While investigators can define neither an optimal duration of resuscitation before the termination of efforts nor which patients may benefit from prolonged efforts at resuscitation, extending the duration of resuscitation may be a means of improving survival in selected hospitalized patients.” The premise of a successful cardiopulmonary resuscitation (CPR) is earlier the better and longer the better. When you come across a victim of cardiac arrest, three simple rules must be followed: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives. Don’t stop CPR too soon … Dr KK Aggarwal National President IMA and HCFI

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