Improving the quality of CPR in the Community

 

R. Radha

M.Sc., Nursing, Dhanvantri College of Nursing, Pallakka palayam, Namakkal District.

 

ABSTRACT:

An out of hospital cardiac arrest (OHCA) is defined as cessation of cardiac mechanical activity, confirmed by the absence of signs of circulation and that which occurs outside the hospital setting (Roger VL, 2011) About 70–85% of these events have a cardiac cause. Published literature identifies acute coronary syndrome (ACS) as the most frequent cause of OHCA, particularly among elderly and coronary vasospasm as a considerable cause among young healthy individuals. It can also occur from non-cardiac causes such as trauma, drowning, drug overdose, asphyxia, electrocution and primary respiratory arrests. (Sasson C, Kellermann AL. 2010). Early cardiopulmonary resuscitation (CPR), therapeutic hypothermia and early advanced care have a crucial role in management of OHCA. Every minute lost in initiating CPR leads to 10% decrease in survival rates of the victim (Go AS, Mozaffarian D-2013) since members of the community are the first to witness OHCA, there is an increasing recognition of the need to coordinate with the community in providing emergency medical care to optimize patient survival after an OHCA. American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care describes a “chain of survival” to reduce mortality and improve survival. The “chain of survival” comprises of five elements, namely, immediate recognition and rapid access, rapid CPR, rapid defibrillation, effective advanced care and integrated post cardiac arrest care. (Travers AH- : 2010)

 

 

INTRODUCTION:

CPR knowledge and confidence to use hands-only CPR can be increased through large-scale community training. It recommendations from the American Heart Association's Emergency Cardiovascular Care Committee were released nine years ago, in April 2008. Chiefly, the goal of the recommendations was to raise the rate of bystander CPR, which the committee noted remained low in most U.S. cities at approximately 27-33 percent.

 

Definition:

Cardiopulmonary resuscitation (CPR) that is performed by a layperson who is not part of the organized emergency-response system in a community. Such a person is known as a CPR bystander. Since most cardiac arrests occur outside health care institutions, bystander CPR is an essential part of the chain of survival (Farlex and Partners-2009). The Community CPR Tracker means the AHA set some important 2020 health impact goals. By 2020, we aim to train 20 million people in the lifesaving skills of CPR. And, we want to double the out-of-hospital bystander CPR rate; from 31% to 62%. We can achieve these goals, but only with your help! To capture how many laypeople we’ve educated, we’ve created a self-service online Community CPR Tracker. This tracker will allow the AHA to collect standardized data on community CPR education activities (2016, American Heart Association)

 

Encouraging Hands-Only CPR:

"Reducing barriers to bystander action can be expected to substantially improve cardiac arrest survival rates. Reasons cited prospectively for the reluctance to perform CPR often include concerns about disease transmission related to performing mouth-to-mouth ventilation," the committee noted, adding that studies of actual bystanders found they "most often cited panic and fear of causing harm as reasons for failing to perform CPR," and the fear of infection in fact was not a prominent concern Quality components of CPR include rate, ratio, and depth and ventilation-compression ratio. The new 2010 CPR guidelines advocate a ratio of compressions to ventilations of 30:2, with a rate of at least 100 compressions per minute. Depth of compression should be at least 5 cm. Rescuers should allow complete recoil of the chest. Locally, limited information is available regarding the quality of CPR being performed for OHCA. Strategies to improve the quality of CPR include research, training, education as well as incorporating appropriate technologies that measure and feedback the quality of CPR. These technologies are at the heart of recent advances, as they now make it feasible to provide routine feedback to rescuers providing CPR, through the integration of feedback devices into training equipment, defibrillators and standalone CPR assist devices.

 

An out of hospital cardiac arrest (OHCA) is defined as cessation of cardiac mechanical activity, confirmed by the absence of signs of circulation and that which occurs outside the hospital setting. (Roger VL,2011) About 70–85% of these events have a cardiac cause. Published literature identifies acute coronary syndrome (ACS) as the most frequent cause of OHCA, particularly among elderly and coronary vasospasm as a considerable cause among young healthy individuals. It can also occur from non-cardiac causes such as trauma, drowning, drug overdose, asphyxia, electrocution and primary respiratory arrests (Sasson C, Kellermann AL. 2010).

 

Early cardiopulmonary resuscitation (CPR), therapeutic hypothermia and early advanced care have a crucial role in management of OHCA. Every minute lost in initiating CPR leads to 10% decrease in survival rates of the victim.5 since members of the community are the first to witness OHCA, there is an increasing recognition of the need to coordinate with the community in providing emergency medical care to optimize patient survival after an OHCA. American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care describes a “chain of survival” to reduce mortality and improve survival. The “chain of survival” comprises of five elements, namely, immediate recognition and rapid access, rapid CPR, rapid defibrillation, effective advanced care and integrated post cardiac arrest care.

 

Chain of survival:

The chain of survival should be initiated as soon as possible for effective outcomes.6 In developing countries with low resource settings, the early initiation of chain of survival could best be achieved by training the community in early identification and initiation of CPR for effective outcomes. Bystander assisted CPR is the real need of the hour. One of the key steps is Early CPR. The club can assist with improving early CPR training as many people in the community as we can.

 

Bystander CPR is a concept, rapidly gaining approval in many parts of the world. Bystander initiated basic life support can increase survival chances by 2–3 times. The lesser the interval between collapse to bystander CPR, the more favourable is the outcome (Yasunaga-2010) Wissenberg et al examined the temporal trends in bystander CPR rates and the survival outcomes between 2001 to 2010 in Denmark during which period various national initiatives were launched to improve bystander resuscitation rates and advanced care. There was a considerable increase in bystander CPR rates from 22.1% (2001) to 44.9% (2010) and the increase in bystander CPR rates was significantly associated with survival on arrival at hospital, 30-day survival and 1-year survival in OHCA patients (Stiell IG 2004)

 

7 CPR Steps Everyone Should Know:

Doing CPR right away can double or even triple a person’s chance of surviving cardiac arrest. Learn these CPR steps now so you know what to do if someone if ever experiencing a life-threatening emergency (Jan Wolak-Dyszyński- Aug 14, 2018)

 

 

If a person is not breathing, his or her heartbeat will stop. These CPR steps (chest compressions and rescue breaths) will help circulation and get oxygen into the body. Early use of an AED, if one is available, can restart a heart with an abnormal rhythm.

 

First, open a person’s airway to check if they are breathing (don’t begin CPR if a patient is breathing normally). Then, get help. If you are not alone, send someone to call for help as soon as you have checked breathing and have the person confirm the call has been made. While help is on the way, follow these CPR steps:

 

1. Position your hand (below)

Make sure the patient is lying on his back on a firm surface. Kneel beside him and place the heel of your hand on the center of the chest.

 

2. Interlock fingers (below)

Keeping your arms straight, cover the first hand with the heel of your other hand and interlock the fingers of both hands together. Keep your fingers raised so they do not touch the patient’s chest or rib cage.

 

3. Give chest compressions (below)

Lean forward so that your shoulders are directly over the patient’s chest and press down on the chest about two inches. Release the pressure, but not your hands, and let the chest come back up.

 

Repeat to give 30 compressions at a rate of 100 compressions per minute. Not sure what that really means? Push to beat of the Bee Gees song “Stayin’ Alive.” Don’t miss these other medical tips doctors and nurses want you to know.

 

Note: The American Heart Association recommends Hands-Only CPR (CPR without rescue breaths, which are detailed below) for people suffering out-of-hospital cardiac arrest. According to the AHA, only about 39 percent of people who experience an out-of-hospital cardiac arrest get immediate help before professional help arrives; doing Hands-Only CPR may be more comfortable than doing rescue breaths for some bystanders and make it more likely that they take action. The AHA still recommends CPR with compressions and breaths for infants and children and victims of drowning, drug overdose, or people who collapse due to breathing problems.

 

4. Open the airway (below)

 

Move to the patient’s head. Tilt his head and lift his chin to open the airway again. Let his mouth fall open slightly.

 

5. Give rescue breaths (below)

Pinch the nostrils closed with the hand that was on the forehead and support the patient’s chin with your other hand. Take a normal breath, put your mouth over the patient’s, and blow until you can see his chest rise.

 

6. Watch chest fall

 

Remove your mouth from the patient’s and look along the chest, watching the chest fall. Repeat steps five and six once. Make sure your child memorizes these CPR steps, plus these other first aid tips parents should teach their kids.

 

 

 

 

 

 

7. Repeat chest compressions and rescue breaths

Place your hands on the chest again and repeat the cycle of 30 chest compressions, followed by two rescue breaths. Continue the cycle. Aside from these handy CPR steps, here are more medical procedures you can do at home.

 

The awareness among common people is even lesser. Nielsen et al reported that fear of harming the patient further, fear of inadequate knowledge about the technique, fear of liability and concerns about transmission of infectious diseases by mouth-mouth ventilation were the commonest reasons for reluctance to act when faced with OHCA. It is necessary that CPR knowledge and adequate training be imparted to the common man. This is even more important in developing and underdeveloped countries with inadequate human and material health care resources. In such a scenario, bystander CPR would play an effective role in saving the patient through the golden hour. In adult OHCAs, bystanders performing chest compression only CPR is considered to be as effective as conventional CPR. Compression only CPR can be easily performed even by non trained bystanders (Chaudhary A- 2011)

 

Registries should be maintained to record all occurrences of OHCA, identify the neighborhood characteristics of the affected and measures taken by bystanders. All hospitals and practitioners should be encouraged to notify cases of OHCA to a common database. Telephone based emergency medical services should provide a dispatcher service to advice the bystander in initiating CPR.School based training on basic life services including CPR is a useful step in promotion of bystander CPR. Web based interactive applications have been found to be useful in mapping and application of CPR with assistance. In the era of communication revolution, smart phone user friendly applications should be developed. Widespread media campaigns and health education programmes can increase the rate of early identification of OHCA and improve willingness and confidence among public to perform CPR. Professional organizations should actively be engaged in organising training programmes for public and refresher programmes for health professionals.

 

REFERENCES:

1.      Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart Disease and Stroke Statistics-2011 Update A Report from the American Heart Association. Circulation. 2011; 123(4): e18–e209.

2.      Kobayashi N, Hata N, Shimura T, Yokoyama S, Shrinkable A, Shinada T, et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circulation Journal. 2013; 77:673–678.

3.      Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of Survival from Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81.

4.      American Heart Association, author. CPR and Sudden cardiac arrest. [August 13th 2014]. Dated May 8, 2014.

5.      Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, author. Heart Disease and Stroke statistics-2013 update: a report from the American Heart Association. Circulation. 2013; 127:e6–e245.

6.      Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, et al. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S676–S684.

7.      Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. marcus.ong.e.h@sgh.com.sg

8.      Jerry Laws, Jun 01, 2017

9.      Nielsen AM, Isbye DL, Lippert FK, Rasmussen LS. Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 21:39. Yasunaga H, Horiguchi H, Tanabe S, Akahane M, Ogawa T, Koike S, Imamura T. Collaborative effects of bystander-initiated CPR and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study. Crit Care. 2010; 14: R199.

10.   Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Ontario Prehospital Advanced Life Support Study Group et al. advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004; 351:647–656

11.   Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, , et al. Association of National Initiatives to improve cardiac arrest management with rates of Bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013; 310(13):1377–1384.

12.   Chaudhary A, Parikh H, Dave V. Current scenario: Knowledge of basic life support in medical college. Nat J Med Res. 2011; 1:80–82.

13.   Japanese Circulation Society Resuscitation Science Study Group, author. Nagao K, Matumoto N, et al. Chest-compression-only bystander cardiopulmonary resuscitation in the 30:2 compression-to-ventilation ratio era-Nationwide observational study. Circulation Journal. 2013; 77:2742–2750

14.   2016, American Heart Association

15.   Ruth Jenkinson, Lizzie Orme https://www.rd.com/health/ conditions/how-to-do-cpr/Aug 14, 2018

 

 

Received on 21.11.2019          Modified on 11.12.2019

Accepted on 31.12.2019     © A&V Publications all right reserved