Talk:Cardiopulmonary resuscitation/Archive 2

Timing
How many compressions per minute? About 100 they say. Not many people have a feel for that. So perhaps the beat of songs like 'Stayin' Alive' by the BeeGees (appropriate) or 'Another One Bites The Dust' (not so appropriate) would help. —Preceding unsigned comment added by LGD3 (talk • contribs) 05:08, 6 October 2008 (UTC)


 * That might be more appropriate at WikiBooks First Aid, as that is definately a 'how to' - which Wikipedia doesn't do. OwainDavies (about)(talk) edited at 10:29, 6 October 2008 (UTC)


 * I disagree. I think that in an article about CPR the proper rhythm is worth mentioning as well as the fact that a lot of people who are teaching CPR are now using “Staying Alive” as a reference point. It depends on how you word it. --ITasteLikePaint (talk) 21:02, 10 November 2008 (UTC)


 * If you want something really innocuous at ~100bpm, "The wheels on the bus" is another good one. :-) Still, I'm forced to agree with Owain that Wikipedia is not a how to site. Jclemens (talk) 22:10, 10 November 2008 (UTC)


 * I know this is an old discussion, but is the ironic and humorous example of "Another One Bites the Dust" really appropriate here? I know that people are unlikely to consult Wikipedia in the case of an actual heart attack, but even so putting a song about sudden death in an article about increasing the odds of survival of a dying person seems pretty insensitive. Jclemens recommends "The Wheels on the Bus" as an example that many people know, and if for whatever reason you don't like that one, there are plenty more. 100 bpm is a very common rhythm; you don't have to deliberately use the worst possible example. 2605:A000:F483:4300:4C9B:1522:F8D7:FA20 (talk) 07:04, 21 June 2014 (UTC)

Procedure...
I don't understand one thing; how does the article on CPR lack the actual procedure? —Preceding unsigned comment added by 206.248.175.231 (talk) 05:33, 26 March 2009 (UTC)


 * Because Wikipedia is not a "how to" --ITasteLikePaint (talk) 06:06, 26 March 2009 (UTC)


 * It is just weird that there is info regarding differences in the procedure without the actual procedure being told to the reader first. CPR is a procedure. The article should leave the reader with knowledge of what is done during CPR and approximately how. I'm not saying to put a step by step guide, I just find it funny that I google CPR, expecting to click the first result and to leave with a general idea of how it is done. Everything is told about it except for what it actually is. —Preceding unsigned comment added by 206.248.175.231 (talk) 07:07, 29 March 2009 (UTC)


 * In addition, the other two articles Airway management and Bleeding control to the sides of CPR in the "First Aid" box at the bottom of the article leave me with knowledge of what to actually do to perform these Techniques. CPR doesn't at all. —Preceding unsigned comment added by 206.248.175.231 (talk) 07:14, 29 March 2009 (UTC)


 * I nearly had to perform CPR, and went to this Wikipedia article first, but wasted time trying to look for the procedure where there was none. Seeing as how Wikipedia is such a high-profile, trusted site and is the third result for 'CPR' under Google, Wikipedia should make an exemption and include procedure. It would save multiple lives. —Preceding unsigned comment added by 222.120.201.135 (talk) 13:12, 8 June 2009 (UTC)


 * I agree the procedure should be included, particularly as the history section contains descriptions of outdated procedures and the alternate methods section contains procedural variations. It would not make the article excessively long, it is pertinent to the explanation of what CPR means relative to outdated or alternate methods. 76.23.35.66 (talk) 04:44, 6 July 2009 (UTC)


 * Interesting, the Choking article (where Heimlich Maneuver redirects to) has a section on treatment. The section is not called 'Technique', but if Treatment detailed isn't how-to ... MornMore (talk) 08:50, 11 November 2009 (UTC)

ROSC vs Survival
This article does not really make clear the difference between ROSC and survival in the tables of CPR effectivness. Could someone clarify this so non-CPR trained idiots such as myself can understand :). JakeH07 (talk) 03:41, 10 May 2009 (UTC)


 * OK, i've put the start of an explanation in there. The upshot is that ROSC means the heart is beating again, so you've won the battle.  Survival means they actually get discharged from hospital, so you've won the war.  Very different things!  OwainDavies (about)(talk) edited at 06:12, 10 May 2009 (UTC)


 * Thanks very much, that make a lot more sense. JakeH07 (talk) 06:32, 10 May 2009 (UTC)

Section on 'Indications'
Today, User:Gak added the section below:

There are only a few situations under which CPR can reasonably be expected to have a successful outcome: unexpected cardiac arrest due to a heart attack, an adverse reaction to anesthesia, a drug overdose, or an accident like drowning or electrocution. CPR is unlikely to work in cardiac arrest due to other causes.

I've removed this again, because I feel much of this is covered elsewhere, and the source cited doesn't exactly support the position stated. The source article is about end of life care for patients with co-morbidities, and the examples given are clearly non-exhaustive as part of the article. Looking at it, i think maybe end of life care for terminal patients isn't covered very much here, and i'll try and find some info to change that, but if anyone else gets there first, i suggest maybe the 'use in cardiac arrest' section might be the place. Also, the source article talks about chances of survival to discharge of a cancer patient (2%), but doesn't state a source - we could add that info to the 'chance of surviving' section.

Thanks OwainDavies (about)(talk) edited at 18:10, 18 May 2009 (UTC)

History of CPR
"CPR has been known in theory, if not practice, for many hundreds or even thousands of years; some claim it is described in the Bible, discerning a superficial similarity to CPR in a passage from the Books of Kings (II 4:34), wherein the Hebrew prophet Elisha warms a dead boy's body and "places his mouth over his". Up until the early 19th century, however, other methods of stimulation – such as the tobacco smoke enema – were considered equally or more potent methods of resuscitation."

Removed unsuported claim, weasel word of more than 4 months, and probably "original" research. Waiting for scholarship support of the claims to restore it. 190.158.14.75 (talk) 06:55, 24 May 2009 (UTC)


 * http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/libertytrib&CISOPTR=104330&CISOSHOW=104341&REC=15
 * Look under resuscitation of the drowned. —Preceding unsigned comment added by 70.145.76.243 (talk) 22:08, 29 May 2010 (UTC)

Paper on survival in the NEJM
http://content.nejm.org/cgi/content/short/361/1/22?query=TOC -- Doc James (talk · contribs · email) 14:32, 29 July 2009 (UTC)

Interposed Abdominal Compressions
I wonder if something should be added to this article concerning "Interposed Abdominal Compressions?" (Just do a search on Google for that phrase; there's plenty out there about it.) It might just save somebody's life.

Also, although admittedly not directly related, it might be worthwhile to mention that if the person is conscious, they should perhaps take a couple of aspirin. It's a blood-thinner and has been recommended for heart attack victims. It might just save somebody's life. — Preceding unsigned comment added by 69.127.200.152 (talk) 23:54, 7 May 2010 (UTC)


 * I think the interposed abdominal compressions looks very interesting, and definitely deserves adding to the article. Not so much on the aspirin, as this is about CPR directly, and therefore patients will not be concious, but good idea on the IAC. OwainDavies (about)(talk) edited at — Preceding undated comment added 11:31, 8 May 2010 (UTC)

CPR Switch: Chest Presses First, Then Give Breaths
This article needs an improvement: Heart group flips the old "ABC" -- airway, breathing, compressions -- to "CAB"! Story --Angeldeb82 (talk) 22:57, 18 October 2010 (UTC)


 * (Repeat of my comment at ABC (medicine) I think you may have not fully grasped the outcome - patients should still have their airway opened and breathing checked prior to commencing CPR. The acronym is still valid and in the correct order.  You don't start CPR on someone who is breathing!  In either case, this is not a how to manual and the compressions first CPR has been the international standard for several years.  OwainDavies (about)(talk) edited at 06:43, 19 October 2010 (UTC)


 * I also responded to you at the ABC (medicine) article, so I won't rehash to much of it here, but the 2010 Guidelines from the AHA do not include "Look, listen, and feel." The first step is recognition, which is described as "No breathing or no normal breathing (ie. only gasping)."  The next step for Heathcare Provider level is palpating a pulse for no more then 10 seconds, no pulse, start CPR with compressions first.  After one cycle of compressions, the airway is opened and rescue breaths are given.  2010 AHA recommendations follow the pattern C-A-B.  It will be interesting to see how the rest of the international community takes this recommendation.  R mosler  | ●   14:06, 22 October 2010 (UTC)


 * Yes CPR has changed to CAB per AHA/ILCOR as Mosler mentions for most cases ( adults and children except in drowning and newborns ). The document explaining the reason is here   Doc James  (talk · contribs · email) 15:24, 22 October 2010 (UTC)

Some changes
I made some changes to the lede, utilizing a more active voice, and some changes were made to include some more nuanced facts. I was a little bold, but can explain in more detail if necessary. R mosler | ●   15:10, 22 October 2010 (UTC)

New 2010 guidelines for CPR
Here it is and I will begin the update. Feel free to join in. 

Formatted:

Doc James (talk · contribs · email) 04:29, 24 October 2010 (UTC)


 * Each section actually has its own PMID thus the first is
 * Doc James (talk · contribs · email) 04:38, 24 October 2010 (UTC)

As i have just edited, the guidance is not for 'lay' rescuers but for 'untrained' as given in the citations. They are different things. A lay rescuer (i.e. non professional) who is trained should give breaths. The specific example given in the new guidance is that telephone guided lay people with no training should use compression only. — Preceding unsigned comment added by Owain.davies (talk • contribs) 19:35, 24 October 2010 (UTC)


 * Agree and changed Doc James  (talk · contribs · email) 20:08, 24 October 2010 (UTC)

ERC 2010 guidelines
Doc James (talk · contribs · email) 16:46, 25 October 2010 (UTC)


 * The ERC are based on the ILCOR info. Thus they all agree. Doc James  (talk · contribs · email) 04:15, 6 January 2011 (UTC)

to maintain viability for defibrillation
CPR is for more than maintaining viability for defibrillation. We use if for none defibrillatable rythms. Thus would need a good ref for this change. Doc James (talk · contribs · email) 16:06, 30 November 2010 (UTC)

History
The history section says:
 * A second technique, called the Holger Neilson technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, described a form of artificial respiration where the person was laid on their front, with their head to the side, resting on the palms of both hands.

I suppose "Holger Neilson" refers to Holger Nielsen, as in the image to the right, but though the year 1911 is not entirely impossible (he was born 1866), I find it dubious as other sources indicate that his resurrection method wasn't developed till 1932.--Nø (talk) 21:00, 17 December 2010 (UTC)

History from Hopkins Medicine magazine
The Winter 2011 issue of Hopkins Medicine magazine has an article, A Dying Dog, A Slow Elevator, and 50 years of CPR that gives a richer history of CPR than what is presented in this Wikipedia article.

For example, the article explains how chest compressions began "It was 1958 ... Knickerbocker ... was working in the lab of Hopkins electrical engineer William Kouwenhoven, who’d already invented the first cardiac defibrillator ... he saw the animal’s heart unexpectedly slip into a nearly universally fatal form of ventricular fibrillation ... Normally, his lab associates would pull up the wheeled cart that carried their novel cardiac defibrillating equipment ... With the chronically sluggish Blalock elevators now standing between them and the heart cart seven floors below ... Knickerbocker decided to test one of his growing suspicions. In the preceding months of experiments—with the lab dogs hooked up to the monitors—Knickerbocker had noticed that the dogs’ blood pressure readings spiked when he was forcefully pressing electrodes to the animals’ chests prior to defibrillation. Could those simple elevations constitute actual blood flow to a dying animal’s brain? ... Knickerbocker can’t remember whether he himself began compressing the dog’s chest and then handed it off, or whether he simply asked an associate to do it. ... Knickerbocker plugged in the apparatus, greased up the paddles—asked the man doing chest compressions to back away—and administered a single shock ... Almost immediately, the dog’s heart lurched back, and then settled. Knickerbocker recalls it as “a spontaneous beat that required no substantive assistance.” ... this moment clearly launched the development of CPR’s formal use of life-saving chest compressions, a separate team of scientists was making headway with another key component to modern resuscitation. At the affiliated City Hospital in East Baltimore, anesthesiologist Peter Safar and associate James Elam were rapidly advancing the idea of using a living bystander to breathe air into the lungs of an unconscious patient confirmed in cardiac arrest. " ...

It seems reasonable that this Wikipedia history could be changed to include the year, the lab work related to the cardiac defibrillator, rationale for trying chest compressions, Guy Knickerbocker's involvement, and the serendipity of the elevators.

Thoughts? Ckrahe (talk) 02:20, 30 April 2011 (UTC)

The Evolution of Adult CPR
Imagine finding your family member lying on the floor, unconscious. You have no idea how long they have been there. You run quickly to call an ambulance. While paramedics are on their way your family member is helpless and you can’t do anything for them… or can you? Wouldn’t you want to possess the skills needed to resuscitate them? Learning CPR skills is important as it can mean the difference between life and death. However, in order to perform it correctly and effectively, you must be aware of the correct and most recent method in which to administer it.

According to the American Heart Association, 335,000 Americans die each year from sudden cardiac arrest before they reach a hospital and an astounding 80% of these heart attacks happen in the victim’s own home while family members stand by helplessly. In a situation like this the estimated survival rate is less than 5%. The American Heart Association believes that proper application of cardio-pulmonary resuscitation (CPR) can double the heart attack victim’s chance of surviving.

Cardiopulmonary resuscitation (CPR) is an emergency first aid procedure used to help someone who has lost their ability to breathe and has also lost their pulse. CPR was created in the 1950’s by Peter Safar, though there is evidence of earlier use, and was first promoted as a technique for the public to learn in the 1070’s. The American Heart Association has established standards for CPR and have recently rewritten as they now have a more conservative view of the potential outcome.

CPR is performed in much the same manner as it has been for many years, despite the fact that it produces only about 20% of normal cardiac output. In the last fifty years, very little has changed from the last chest compression and ventilation concept of resuscitation. Research shows that appropriate CPR can indeed save a life provided it is performed immediately upon victim’s collapse.

Only within the last few years has the traditional method of chest compressions together with mouth-to-mouth ventilation changed. For fifty years CPR has remained fairly consistent as opening the airway, delivering two rescue breaths and performing a series of chest compressions, pausing to deliver mouth-to-mouth ventilations and immediately resume chest compressions. Mouth-to-mouth resuscitation was the standard for reviving unresponsive victims of drowning or other medical problems long before modern CPR was developed. When CPR was created, mouth-to-mouth was an integral part of the process. Today, the elimination of mouth-to-mouth is seen as the answer to making CPR simpler to learn and follow. The new CPR guidelines replace the current A-B-C method of Airway, Breathing and Compressions. The new order is C-A-B, with Compressions being done before opening the Airway and Breathing into the victim’s mouth, as directed by the American Heart Association. We have always known that in order for CPR to be effective, compressions were important, and they still are.

The ratio of chest compression to ventilation within a cycle has seen changes within the last two decades. What had been a ratio of 5:1 for so long was changed to 15:2 in 2000. When the new recommendations came out in 2005, the ratio was changed to 30:2. Currently, the recommendation is 50:2, dropping the ventilation at the beginning of the cycle. Instead of pushing on the chest at about 100 compressions per minute you should push at least 100 compressions per minute. At that rate, 30 compressions should only take about 18 seconds to deliver.

A recent study conducted in Arizona demonstrates results that triple the survival rates for out-of-hospital cardiac arrest victims. The new approach, called Minimally Interrupted Cardiac Resuscitation (MICR), focuses on maximizing blood flow to the heart and brain through a series of coordinated interventions. It includes a series of 200 uninterrupted chest compressions, heart rhythm analysis with a single shock, 200 immediate post-shock uninterrupted chest compressions before the pulse check, early administration of the medication epinephrine ( used to stimulate the heart) and delayed placement of airway adjuncts to assist with ventilation to the lungs. Among 886 patients who suffered cardiac arrest in two cities, survival-to-hospital discharge increased from 4 of 218 patients (1.8%) in the before MICR training group to 36 of 668 patients (5.4%) in the after MICR training group.¹ Dr. Gordon Ewy, director of the Sarver Heart Center at the University of Arizona, is a long-time advocate of withholding rescue breaths from victims of witnessed cardiac arrest. In an issue of The Lancet, Dr. Ewy called for immediate changes in CPR guidelines. On March 31, 2008, the American Heart Association changed its guidelines to include hands-only CPR, focusing more attention on compressions.

Current research² shows that focus is more and more on compressions. After all, the point of CPR is to move oxygen within the body through the blood. We know we can hold our breath for 3 to 5 minutes without any brain damage to other organs or cells, but what they do need is the blood that contains oxygen moved around the body with the help of compressions. The human body has enough oxygen in the blood to last for at least four minutes without any extra oxygen being supplied. By starting compressions immediately, the transport of blood continues without interruption for the first 30 compressions before 2 breaths are given. “When the rescuer pushes hard and fast on the victim’s chest, they’re really acting like an artificial heart. That blood carries oxygen that helps keep the organs alive,” said Sayre, an emergency doctor at Ohio State University Medical Center.

Every interruption in chest compressions causes an interruption in blood flow to the brain, which will lead to brain death if the blood flow is interrupted for too long. It takes about 20 chest compressions to get blood pressure to a level that is effective. The responder should keep pushing as long and as hard as they can, alternating with others if possible every 5 cycles. An Automated Electrical Defibrillator should be in place and ready to analyze the heart as soon as possible. Ventilations should be delivered quickly in order for compressions to resume immediately.

Often times, responders are concerned with opening the airway, finding a mask or the sinking feeling of having to place a face mask over a stranger’s mouth to deliver breaths. These tasks, if done initially, take up precious time that the patient does not have, especially if the patient was already down prior to the responder’s arrival.

Statistics also say that over 80% of sudden cardiac arrests occur most commonly in the home or at work and to a loved one. Although the ambulance and hospital can provide more advanced procedures and medications, the only procedure proven to save a life is CPR, by anyone, the sooner the better.

Works Cited:
 * American Heart Association, CPR & ECC, CPR & First Aid In The News
 * http://www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomePage.jsp
 * http://www.usatoday.com/yourlife/health/medical/2010-10-18-CPR18_ST_N.htm
 * http://www.cnn.com/video/#/video/health/2010/10/18/new.cpr.guidelines.cnn?iref=allsearch
 * http://www.npr.org/templates/story/story.php?storyId=130636417
 * Mick S. Eisenberg, MD, PhD, Bruce M. Psaty, MD, PhD, Caridiopulmonary Resuscitation Celebration and Changes, JAMA, 2010; 304(1): 87-88.
 * Nichol G. Thomas E., Callaway CW, et al: Resuscitation OUtcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome.  JAMA 2008; 300 (12) 1423-1431.
 * Rebecca E. Sell, Renee Sarno, Brenna Lawrence, Edward M. Castillo, Roger Fisher,Criss Brainard, James V. Dunford, Daniel P. Davis, Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC), Resuscitation, 2010 (81): 822-825 —Preceding unsigned comment added by 206.168.41.169 (talk) 22:33, 4 May 2011 (UTC)

Adverse effects/Contraindications?
I occasionally hear about cracked ribs or organ damage as a result of chest compressions (especially when performed on the elderly). While I realize that few persons in medical fields would want to write in a popular forum anything that might increase a potential rescuer's reluctance. . .if such problems are actual, I believe an objective treatment of CPR would make note of them.

Conversely, if the notion of such problems is without foundation (or is popularly exaggerated), then it should be addressed for the purpose of setting it straight (so that potential rescuers, like myself, will not hesitate due to a false knowledge of "the dark secrets of CPR that no one wants you to know about").

If an emphasis on mouth-to-mouth was still prevalent, I would have also recommended addressing the issue of health risks to the rescuer, as that was a common concern amongst laypersons considering CPR. However, I expect that such concern might no longer be significantly common, due to the growing de-emphasis on AR.

Wikipedia is an information resource for popular use, not a medical text (obviously). Thus, the existence of inaccurate, but significantly common, popular views of a topic should, in part, inform the context (and, consequently, the direction of content) of an article (as it already has done in this one where the article addresses unrealistic media portrayals of CPR).Starling2001 (talk) 17:41, 14 March 2012 (UTC)


 * There is a risk of injury associated with CPR, but it is secondary to the risks associated with being dead. Older CPR protocols used to reflect concern over potentially causing injury to the patient by breaking ribs, etc., but the current guidelines omit such references to avoid discouraging people from attempting CPR and because the risk of causing serious injury is quite low. The bottom line is that broken ribs heal and organs can be repaired, but only if the person survives the cardiac event. There are no "dark secrets of CPR". The current ECC guidelines are available for free online and cover everything anybody needs to know about CPR.Akigawa (talk) 01:06, 25 June 2012 (UTC)


 * Actually, this is a very good point, and there is good academic literature on the subject. I will add a section on complications. OwainDavies (about)(talk) edited at 09:56, 15 September 2012 (UTC)


 * Update - I have now added a section on this, and it's quite interesting (some research indicates rib fractures in up to 97% of CPR cases, and that is certainly my experience on the ambulance). OwainDavies (about)(talk) edited at 10:33, 15 September 2012 (UTC)

In inpregnancy
"In pregnancy. During pregnancy when a woman is lying on her back the uterus may compress the inferior vena cava and thus decrease venous return.[3] It is recommended for this reason that the uterus be pushed to the woman's left and if this is not effective either roll the person 30° or consider emergency cesarean section.[3]"

Yes, I understand that the only requirement for inclusion in the Wikipedia is a reliable source. But are you seriously suggesting to first responders to do an emergency cesarean section? That is not only a stupid idea because most people have no idea how to do it, but doing after a car crash on the street or field would cause life-threatening infecctions even if done properly.

So this section should be revised because I highly doubt that a licensed doctor would read the Wikipedia to learn how to do CPR with a pregnant woman. There are really stupid people out there who would probably do it if they get the chance and then point the finger to the Wikipedia if something goes wrong. And nobody here wants to risk the government shutting down the Wikipedia, do you? 2001:5C0:1501:0:4003:3759:1B7E:2F72 (talk) 20:35, 14 September 2012 (UTC)


 * I have inserted some clarity around being a healthcare professional consideration. On a general note, Wikipedia is not a manual, and does not suggest anything to anyone.  It is an encyclopaedia, reporting on published literature.  For that reason, this page does not contain information about how to perform CPR, and this is no different. OwainDavies (about)(talk) edited at 09:53, 15 September 2012 (UTC)

Cough CPR quibble
The statement that "the first symptom of cardiac arrest is unconsciousness" is indeed sourced to a newsletter, but I'm still skeptical. Since even a single skipped beat is very noticeable, I'm thinking that going flatline for ten seconds ought to be really noticeable, unless other distractions intervene. Per VnT the statement should be left alone, unless someone here can come up with a better source that discusses the issue in better detail...? Here's hoping. Wnt (talk) 17:19, 21 October 2012 (UTC)

Wrong rate
The mentioned "rate of at least 120 per minute" is wrong, at least after the ERC guidelines (100-120/min). — Preceding unsigned comment added by 88.78.139.116 (talk) 16:49, 14 December 2012 (UTC)


 * Not wrong, in Australia at least; a one-minute cycle is 30 compressions and 2 breaths - FOUR times per minute.  This equates to something faster than 120 compressions per minute.  — Preceding unsigned comment added by 211.31.110.16 (talk) 08:17, 5 May 2014 (UTC)

Expedient advice
Some people will be visiting this page in a life or death situation. From the article "The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes" If anyone were to read the article fully, it is very likely the victim will already have irreversible damage.

Is it advisable to include a large-font, bordered section at the top with quick instructions for first-time rescuers? I could assist with this.

William Entriken / Pacific Medical Training Full Decent (talk) 19:14, 28 February 2013 (UTC)


 * I agree, although perhaps link to a section in the article which explains the procedure, or a sister project where the instructions exist already (wikibooks?) ed g2s &bull; talk 19:33, 10 July 2013 (UTC)


 * "some people will be visiting this page in a life or death situation" OwainDavies (about)(talk) edited at 08:39, 12 July 2013 (UTC)

Administering CPR to animals
Does this section need rewriting, perhaps with mention of the Reassessment Campaign on Veterinary Resuscitation? It doesn't appear to be possible to trace the only source currently cited back to any scientific studies. — Preceding unsigned comment added by Tchanders (talk • contribs) 01:07, 4 September 2013 (UTC)

When to use CPR
I have given CPR once, to a 3 year old. She choked on vomit and stopped breathing, indicated by her skin TURNING BLUE. When a person's blood circulation is no longer carrying oxygen to the skin, the skin turns blue-white. If both the heart and lungs are working, the person has pink skin. The girl turned back to pink once her air passage was open and she began breathing on her own. My Flatley (talk) 01:34, 12 December 2013 (UTC)

IOM report
http://iom.nationalacademies.org/Reports/2015/Strategies-to-Improve-Cardiac-Arrest-Survival.aspx

Should be discussed. JFW &#124; T@lk  13:29, 22 July 2015 (UTC)

looking for good readable sources
Cardiopulmonary resuscitation (CPR): First aid, Mayo Clinic Staff, Jan. 5, 2017.

and one advantage of a readable source is that I, as a non-doctor, am much less likely to make a mistake in translating it. I still want a variety of other sources, such as The American Heart Association recommendations mentioned in the first paragraph. FriendlyRiverOtter (talk) 20:09, 21 July 2017 (UTC)


 * Highlights of the 2015 American Heart Association: Guidelines Update for CPR and ECC, Acknowledgements include: Mary Fran Hazinski, RN, MSN; Michael Shuster, MD; Michael W. Donnino, MD; Andrew H. Travers, MD, MSc; Ricardo A. Samson, MD; et al., 2015. "The 2015 AHA Guidelines Update for CPR and ECC is based on an international evidence evaluation process that involved 250 evidence reviewers from 39 countries."
 * page 7:
 * "Moreover, survival rates from adult cardiac arrests of cardiac etiology are similar with either compression-only CPR or CPR with both compressions and rescue breaths when provided before EMS arrival."
 * So, compression-only CPR is good for adults, but not for children. FriendlyRiverOtter (talk) 17:26, 29 July 2017 (UTC)


 * page 23:
 * "Conventional CPR (rescue breaths and chest compressions) should be provided for infants and children in cardiac arrest. The asphyxial nature of most pediatric cardiac arrests necessitates ventilation as part of effective CPR."
 * " .  .  In 2 studies, when conventional CPR (compressions plus breaths) was not given in presumed asphyxial arrest, outcomes were no different from when victims did not receive any bystander CPR."


 * Recognition of out-of-hospital cardiac arrest during emergency calls — a systematic review of observational studies, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Søren ViereckEmail, Thea Palsgaard Møller, Josephine Philip Rothman, Fredrik Folke, and Freddy Knudsen Lippert, 1 Feb 2017 25:9, https://doi.org/10.1186/s13049-017-0350-8
 * on the subject of how good emergency dispatchers are at recognizing heart attack. FriendlyRiverOtter (talk) 17:00, 28 July 2017 (UTC)

Many readers only read a particular section, such as compression-only.
And we should accept and embrace the way people actually use Wikipedia. And the sections should be thorough, complete, and also brief, and that's the writing challenge.

For example, I thought compression-only was the new, modern way. I had no idea it wasn't good for children. FriendlyRiverOtter (talk) 18:15, 29 July 2017 (UTC)


 * Should discuss adults first (as cardiac arrest is much more common in this group) than discuss children after. It is a new way yes. Doc James  (talk · contribs · email) 21:19, 29 July 2017 (UTC)

Portrayed effectiveness section
It might be worth adding to this section a note that film and TV depictions of CPR rarely if ever depict the common after-effects of receiving CPR - specifically broken ribs and/or sternum. While you do often see recipients being taken away by ambulance or otherwise getting medical care, you sometimes see individuals recovering immediately (assuming the CPR is delivered for reasons other than cardio events), with no mention of them potentially having broken ribs. 136.159.160.8 (talk) 22:10, 18 June 2018 (UTC)


 * That doesn't surprise me. CPR is a method for trying to save someone who's nearly dead. In those situations, broken ribs are the least of anyone's worries. Anywikiuser (talk) 13:23, 24 July 2018 (UTC)

The prone illustration image/gif is not of a prone position
But I like the gif, maybe move it somewhere else? — Preceding unsigned comment added by 2A02:A18:8963:9201:B419:F44F:AE8A:F6DD (talk) 10:01, 2 July 2019 (UTC)

Length of CPR and end-tidal carbon dioxide Comment
@Carlhenrik.olander added 1987 and 2008 prospective studies on the relation between end-tidal CO2 and successful ROSC. Are they reversed?

1987 Garnett et al. study in Virginia says CO2 shows when ROSC happens, but does not predict it: 2008 Kolar et al. study in Slovenia says CO2 level after 20 minutes distinguishes completely between those who eventually reached ROSC and those who died without reaching ROSC, but I find the study hard to understand: The tables show 737 patients were measured after 20 minutes of CPR. This is the same number as the 737 who started. Surely some revived before 20 minutes, and should be omitted from the counts at 20 minutes? Study also does not say how long CPR continued beyond 20 minutes, to show if the perfect distinction is an artifact of ending CPR soon after?
 * "The end-tidal CO2 concentration began to increase immediately (within a few seconds) in all ten patients who had ROSC.... our inability to confirm tidal CO2 value has predictive value in humans"

I think that 2008 Kolar study says that among 202 patients with high CO2 at 10 minutes of CPR, all eventually reached ROSC, and that among the other 535 patients (who had low CO2 at 10 minutes of CPR), 60% died without reaching ROSC. At 20 minutes the finding was that 335 patients had high CO2, and all these eventually reached ROSC, while among the other 402 patients (with low CO2) all died without reaching ROSC.

There is an ongoing issue of how long CPR needs to last, which needs to be covered in the article, and CO2 predictions could be part of that discussion, if we understand them correctly. Most patients in each study did not get long CPR. If they had, more could have lived. In fact many patients had very short CPR, under 10-15 minutes. A nonprofit recommends 30 minutes of CPR (http://takeheartamerica.org/save-a-life-toolkits/public-lay-rescuers/cardio-pulmonary-resuscitation/ ). There are several studies with similar findings:
 * 2015 Fendler et al. study of 2006-12 patients: "Time to ROSC (minutes), mean ± SD 5.7 ± 7.3 [in healthiest decile] 20.3 ± 16.5 [in sickest decile]" Mean plus or minus a standard deviation (SD) in the sickest decile is therefore 3.8 or 36.8 minutes. A sixth of the patients would be at least one standard deviation above the mean, and a sixth at least one standard deviation below, if CPR times were a normal bell-shaped curve. Since they are not, the proportions are only approximate. Fendler et al. do not report median or distribution of CPR length given to those who died. Table e3 of Supplement: ALIGNMENT OF DO-NOT-RESUSCITATE STATUS WITH PATIENTS’ LIKELIHOOD OF FAVORABLE NEUROLOGICAL SURVIVAL AFTER IN-HOSPITAL CARDIAC ARREST JAMA https://jamanetwork.com/journals/jama/fullarticle/2442939
 * 2017 Reynolds et al. study of 2000-12 patients who had CPR in hospitals and did not survive. Most did not have long enough CPR to give them a full chance of revival. 24% of these received less than 13 minutes of CPR, before the hospital gave up on them. Only 25% had 28 minutes or more. This study, unlike most, did not report on those who did revive. DURATION OF RESUSCITATION EFFORTS FOR IN-HOSPITAL CARDIAC ARREST BY PREDICTED OUTCOMES: INSIGHTS FROM GET WITH THE GUIDELINES Resuscitation. https://www.resuscitationjournal.com/article/S0300-9572(16)30595-0/fulltext
 * 2016 Reynolds et al. study of 2007-10 patients who had CPR outside hospitals: 42 minutes of CPR needed to revive 99% of those who were revived. Median CPR given to those who died was 23.4 minutes. (Discriminatory in only counting survival of those without mental disabilities): ASSOCIATION BETWEEN DURATION OF RESUSCITATION AND FAVORABLE OUTCOME AFTER OUT-OF-HOSPITAL CARDIAC ARREST: IMPLICATIONS FOR PROLONGING OR TERMINATING RESUSCITATION. Circulation. https://pubmed.gov/27760796
 * 2016 Nagao et al. study of 2005-12 patients who had CPR in Japan, outside hospitals: 40-45 minutes of CPR needed to revive 99% of those who were revived. Median CPR given before arrival at hospital, to those who died, was 31 minutes, and they show the distribution; they do not report length of subsequent in-hospital CPR. Japanese medics are required to continue CPR until the patient revives or reaches a hospital, giving these longer times: DURATION OF PREHOSPITAL RESUSCITATION EFFORTS AFTER OUT-OF-HOSPITAL CARDIAC ARREST. Circulation. https://pubmed.gov/26920493
 * 2012 Goldberger et al. study of 2000-2008 patients in hospitals found an eighth of patients who revived needed over 30 minutes of CPR. Among patients with no pre-existing disorder, a fifth needed over 30 minutes to revive (their table 1). These findings (eighth and fifth) underestimate the potential, since only 26% of patients who did not survive had over 30 minutes of CPR, only 54% had over 20 minutes, and 16% had less than 10 minutes, so most of them did not get enough time to have a full chance of revival. The biggest benefits of long CPR were for patients initially with no heartbeat (asystole or pulseless electrical activity, PEA). Mental abilities were the same in patients who needed longer CPR as those who revived faster: DURATION OF RESUSCITATION EFFORTS AND SURVIVAL AFTER IN-HOSPITAL CARDIAC ARREST: AN OBSERVATIONAL STUDY, Lancet https://pubmed.gov/22958912 Their reply has links to comments: https://pubmed.gov/23399066
 * 2012 Nolan + Soar: editor in chief of Resuscitation summarizes Goldberger, above, "Prolonged resuscitation efforts can result in high-quality survival. If the cause of cardiac arrest is potentially reversible, it might be worthwhile to try for a little longer." DURATION OF IN-HOSPITAL RESUSCITATION: WHEN TO CALL TIME? https://pubmed.gov/22958913
 * 2016 Youness et al. Discusses case studies of patients with very long resuscitation. REVIEW AND OUTCOME OF PROLONGED CARDIOPULMONARY RESUSCITATION Critical Care Research and Practice https://pubmed.gov/26885387
 * Surprising that none of the studies seems to remove truncation bias by using a life table of revival rates minute-by-minute, which is designed to address truncation. At each minute, among patients who were still getting CPR, the ROC-PRIMED study shows the fraction who revived and lived to leave the hospital in 2007-10. https://biolincc.nhlbi.nih.gov/studies/rocprimed/?q=primed
 * 2015 European Guidelines (subject to update in 2020): EUROPEAN RESUSCITATION COUNCIL GUIDELINES FOR RESUSCITATION 2015SECTION 11. THE ETHICS OF RESUSCITATION AND END-OF-LIFE DECISIONS. Resuscitation. https://ercguidelines.elsevierresource.com/european-resuscitation-council-guidelines-resuscitation-2015-section-11-ethics-resuscitation-and-end/fulltext The following is quoted from the guidelines:
 * 88% of patients who achieved sustained ROSC did so within 30 min.[77] As a rule, resuscitation should be continued as long as VF [ventricular fibrillation] persists. Asystole [no heartbeat] for more than 20 min during ALS [advanced life support] in the absence of a reversible cause is generally accepted as an indication to abandon further resuscitation attempts [Goldberger, above, found 30% of asystole survivors needed more than 20 minutes for ROSC (7,024 of 23,158, table 1)]. However, there are reports of exceptional cases that do not support the general rule, and each case must be assessed individually...

Numbersinstitute (talk) 16:45, 23 August 2019 (UTC)