Forget CPR, Give CCR Instead

Adults Who Collapse Need Chest Compression, Not Mouth-to-Mouth

Medically Reviewed by Louise Chang, MD on March 11, 2008

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 morelikely to save lives than the old cardiopulmonary resuscitation or CPRtechnique, an Arizona study shows.

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

"It is not cardiopulmonary, but cardio-cerebral resuscitation -- youneed to feed the brain, not the lungs," Bobrow tells WebMD. "That iswhy the emphasis is on getting the blood flowing and not interrupting it, evenfor ventilation."

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

"When that person collapses, your hands are their heart," Bobrowsays. "If your hands are not on their chest, they have noheartbeat."

New Advice: Don't Stop Chest Compressions

The old CPR technique called for rescuers to give 30 chest compressionsfollowed by two quick emergency breaths into the mouth of the victim, notesMary Ann Peberdy, director of the resuscitation program at VirginiaCommonwealth University.

"It takes about halfway through that chest-compression cycle to build upa marginal pressure to the heart and brain," Peberdy tells WebMD. "Assoon as you stop, that pressure almost immediately falls to zero. After givingventilation, 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 immediateproblem isn't getting more oxygen into the blood, it's getting that blood tothe 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 didwith standard life-support techniques.

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

The study compared survival rates before and after emergency medicalpersonnel 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, to5.4%. Among patients whose cardiac arrest was witnessed and who got emergencyshocks from a defibrillator, the survival rate increased 8.6-fold to 17.6%.

How to Do CCR for Cardiac Arrest

A cardiac arrest isn't the same as a heart attack.

"A heart attack is a plumbing problem, and a cardiac arrest iselectrical," Peberdy says. "A heart attack is a block in a pipe, andunless the pipe unclogs the heart muscle will die. A cardiac arrest is a suddencatastrophic electrical problem where the heart cannot beat at all. Cardiacarrest equals sudden death. You die unless you are resuscitated."

People who suffer cardiac arrest suddenly collapse. In adults, acollapse is almost always due to cardiac arrest.

"If someone suddenly collapses, you can help, but if you do nothing,that person will almost certainly die," Bobrow says. "Activate the 911system, position the victim with head tilted back so the airway is open, andthen immediately start rapid, forceful chest compressions. Lock your handstogether one on top of the other, put the heel of the lower hand in the centerof the victim's chest, and push hard and fast, 100 times per minute. If you arelucky enough to have an AED [automated external defibrillator], attach it tothe victim and follow the commands."

Don't worry about mouth-to-mouth resuscitation or compression-to-breathratios, Bobrow says. And don't worry about pushing too hard. The chest has tobe depressed about 2 inches. Even if you crack the victim's ribs, you'll bedoing much more good than harm.

"You can't make anything worse. All you can do is help," Bobrowsays. "Keep up the compressions until help arrives. If you get tired, haveanother person take over for a while."

"The best message we can send people is, if they witness a cardiacarrest, push hard, push fast, and don't stop until the emergency responders getthere," Peberdy says.

Mouth-to-mouth resuscitation still has a role in patients with respiratoryarrest. But Bobrow and Peberdy say that the vast majority of adults whocollapse have cardiac arrest. Since cardiac arrest is rare in children youngerthan 8 years of age, rescuers should suspect respiratory arrest when youngchildren collapse. Traditional CPR is still recommended for these youngchildren.

Show Sources


Bobrow, B.J. TheJournal of the American Medical Association, March 12, 2008; vol 299: pp 1158-1165.

Peberdy, M.A. and Ornato, J.P.  TheJournal of the American Medical Association, March 12, 2008; vol 299: pp 1188-1190.

Bentley J. Bobrow, MD, emergency physician, Mayo Clinic Hospital, Scottsdale, Ariz.; medical director, Bureau of Emergency Medical Services and Trauma system, State of Arizona.

Mary Ann Peberdy, MD, associate professor of internal medicine and emergency medicine and director, resuscitation program, Virginia Commonwealth University, Richmond.

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