Friday, October 15, 2010

Chest compressions 'vital' in CPR

Concentrating on chest compressions rather than mouth-to-mouth when giving emergency resuscitation can produce better results, says research published in The Lancet.

A study of 3,000 patients found that chest compressions alone increased chances of survival by more than 22%.

But training in how to give both chest compressions and mouth-to-mouth breaths is the best option, experts say.

The UK Resuscitation Council is due to produce new CPR guidelines next week.

Cardiopulmonary resuscitation (CPR) is a combination of chest compressions and mouth-to-mouth breaths, given in a life-threatening emergency like a cardiac arrest or heart attack.

The study, compiled by doctors from the Medical University of Vienna in Austria, looked at the survival rates of people treated by untrained members of the public taking instructions from the emergency services over the phone.

"Start Quote

If you're unwilling or unable to do full CPR then chest compressions are better than nothing."

End Quote Dr Meng Aw-Yong St John Ambulance

Dr Peter Nagele, from the department of anaesthesiology, critical care and pain therapy at the Medical University of Vienna, said that if untrained bystanders avoided mouth-to-mouth breaths during CPR, they were more likely to perform uninterrupted chest compressions.

That then increased the probability of CPR being successful.

Different techniques

The research in The Lancet involved two analyses.

The first used data from three randomised trials involving more than 3,000 patients.

It showed that chest-compression-only CPR was associated with a slightly improved chance of survival compared with standard CPR (14% v 12%).

In the second analysis of seven observational studies, researchers found no difference between the two CPR techniques.

The study authors maintain that continuous, uninterrupted chest compressions are vital for successful CPR.

Dr Jas Soar, chair of the Resuscitation Council from Southmead Hospital in Bristol, said: "Any CPR is better than no CPR. If you witness a cardiac arrest, dial 999 immediately. Those trained in CPR should follow existing guidance of 30 chest compressions followed by two rescue breaths.

"Those not trained should start compressions and follow instructions until an expert arrives," Dr Soar said.

Dr Meng Aw-Yong, medical adviser at St John Ambulance, acknowledged that rescue breaths could be off-putting.

"The current advice is that if you're unwilling or unable to do full CPR then chest compressions are better than nothing.

"The best solution, however, is for people to get trained in how to carry out chest compressions and rescue breaths so they can be the difference between a life lost and a life saved," he said.

The British Heart Foundation says that being able to do CPR more than doubles the chances of survival.

Claire O'Neill, community resuscitation programme lead at the BHF, said: "For someone who is untrained in cardiopulmonary resuscitation, doing both chest compressions and rescue breaths really can be difficult.

"We also know that uninterrupted chest compressions are very important for increasing the chance of survival. So being directed to focus solely on chest compressions could make people more willing to attempt resuscitation, which could ultimately save lives," she said.



Powered by WizardRSS | Webmaster Forum

Call to axe paediatric heart unit

The children's heart surgery unit at Oxford's John Radcliffe Hospital should close, a national review of paediatric heart centres in England has said.

Surgery was suspended there in March after four children operated on by the same surgeon died in three months.

The review will recommend that three or four other paediatric heart units out of 11 in England also stop surgery.

The aim is to improve the safety of heart operations by having fewer, more specialised centres.

"Start Quote

Pooling surgical expertise into fewer, larger centres is in the best interests of children"

End Quote Leslie Hamilton Review team member

Children's heart surgery at the John Radcliffe has been under the spotlight since it emerged that four children died there between last December and February of this year.

'Serious shortcomings'

An inquiry found that the deaths were not due to errors of judgement, but that the surgeon had not been given appropriate supervision.

It criticised the hospital trust for "serious shortcomings", in the way it had taken on more cases to try to avoid closure of the paediatric unit.

Paediatric cardiac surgery at the hospital remains suspended.

An expert group has been reviewing the work of the 11 centres across England which conduct this type of specialist surgery.

The review was launched in response to the 1990s Bristol heart babies scandal, when children having heart surgery died unnecessarily.

Its full recommendations are due early next year, but it is likely to say that the four or five smallest centres should stop carrying out operations.

This number would include the John Radcliffe cardiac centre, which it has already ruled is too small, and lacks the expertise to offer a good service to patients.

It will recommend that the Oxford children's cardiac unit stops doing surgery, but continues to offer diagnosis and pre- and post-operation care.

Leslie Hamilton, former president of the Society for Cardiothoracic Surgery and a review member, said the decision was aimed at improving the safety of heart operations.

"The NHS needs to ensure the very best outcomes for children," he said. "Children's heart surgery is complex and must be performed by highly skilled specialist surgical teams.

"Pooling surgical expertise into fewer, larger centres is in the best interests of children and their families."

The recommendation to close the Oxford surgical unit will be the subject of a public consultation. However, it is highly unlikely that children's operations there will now resume.

The John Radcliffe hospital described the news as disappointing for patients, their families and staff. But Director of Planning, Andrew Stephens, said it was not entirely surprising. "Oxford is one of the smallest centres," he said, "and the main thrust of the review is that there should be fewer, larger paediatric cardiac centres in the future."



Powered by WizardRSS | Webmaster Forum