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Forget CPR, Give CCR Instead

March 11, 2008 -- For adults who collapse after cardiac arrest, mouth-to-mouth resuscitation is dead.

A new lifesaving technique, cardio-cerebral resuscitation, is much more likely to save lives than the old cardiopulmonary resuscitation or CPR technique, an Arizona study shows.

It's a big change. Instead of using their mouths to give the "breath of life," rescuers should use their hands to keep blood moving to the hearts and brains of cardiac arrest victims, says Bentley J. Bobrow, MD, medical director of Arizona's emergency services system and an emergency physician at Mayo Clinic Hospital, Scottsdale.

"It is not cardiopulmonary, but cardio-cerebral resuscitation -- you need to feed the brain, not the lungs," Bobrow tells WebMD. "That is why the emphasis is on getting the blood flowing and not interrupting it, even for ventilation."

Stopping chest compressions -- even for mouth-to-mouth emergency breathing -- wastes precious time.

"When that person collapses, your hands are their heart," Bobrow says. "If your hands are not on their chest, they have no heartbeat."

New Advice: Don't Stop Chest Compressions

The old CPR technique called for rescuers to give 30 chest compressions followed by two quick emergency breaths into the mouth of the victim, notes Mary Ann Peberdy, director of the resuscitation program at Virginia Commonwealth University.

"It takes about halfway through that chest-compression cycle to build up a marginal pressure to the heart and brain," Peberdy tells WebMD. "As soon as you stop, that pressure almost immediately falls to zero. After giving ventilation, it takes halfway though next cycle to get the pressure back up -- so you are constantly chasing your tail."

Cardiac arrest victims have oxygen dissolved in their blood. Their immediate problem isn't getting more oxygen into the blood, it's getting that blood to the brain and to the heart.

When first responders used a professional version of the new technique, Bobrow and colleagues found, they saved three times more lives than they did with standard life-support techniques.

The new technique saved 8.6 times more lives among victims with the best chances of survival. Bobrow and colleagues -- including Gordon A. Ewy, MD, whose team developed the CCR technique -- report these findings in the March 12 issue of TheJournal of the American Medical Association. An editorial by Peberdy and colleague Joseph P. Ornato, MD, accompanies the study.

The study compared survival rates before and after emergency medical personnel from two Arizona cities were trained in the new technique.

Before the new technique, patients suffering cardiac arrest had a 1.8% chance of survival. The new technique increased the survival rate threefold, to 5.4%. Among patients whose cardiac arrest was witnessed and who got emergency shocks from a defibrillator, the survival rate increased 8.6-fold to 17.6%.