Friday, December 14, 2012

IN CPR, SIMPLEST IS BEST/

Perhaps one of the important realisation in 2012 is that in CPR ( cardio-pulmonary resuscitation ), the simpler it is, the better it is.
There were two important observational study which showed that just continuous chest compression for out of hospital cardiac arrest, is better than more sophisticated chest compression with mouth to mouth resuscitation. The immediate survival rate was much better with the former, than the latter.
This was posted much earlier.
In the Dec 12th online edition of Circulation, Dr Florence Dumas and colleagues of the Descrates University, Paris, looked into the intermediate survival rates of the patients in the last two big trials comparing out of hospital cardiac arrest resuscitation with just continuous chest compression against chest compression with intermittent assisting breathe. They traced the 2,496 patients with out of hospital cardiac arrest, who were part of the earlier two trials. 1,243 had chest compression alone and 1,253 with chest compression and rescue breathing. After 1153.2 patient years of follow-up, 2260 deaths and 236 intermediate  term survivor ( about 10% ). This is very good. Better than any that we had before, where long term survival rates was in the single digits. These survivors were also of good neurological status, able to function independently.
I am quite sure that soon the CPR guidelines will reflect this current understanding.
When negotiating with the Ministry of Health ( MOH ) on the clause pertaining to emergency medicine and resuscitation, the MOH wanted all private clinics to be like a "MASH" field hospital fully stocked with IV brannulas and resuscitation equipment. The Federation of Private Medical Practitioner's Association of Malaysia, vehemently opposed it, saying that it is not feasible for all private clinics to be fully competent with full resuscitation and that just executing a good BLS ( basic life support ) would be good enough for out of hospital cardiac arrest. They finally agreed and we are awaiting the Amendments to the PHCFS Regulations to be endorsed by the Cabinet. ( Not yet endorsed, although agreed by Minister, after 6 years ).
We have also suggested that AED ( Automatic External Defibrillator ) should be stationed at popular  public places were  people are more likely to collapse. I believe that this is being done. I saw signs of this at KLIA.
We, with the help of the St John's Ambulance, have gone around the country, running BLS classes. I suppose the future classes will be simpler. Just do continuous chest compression after failed AED ( automatic External Defibrillator ). Obviously AED improves survival.
Well, this would be a good step moving forward.


2 comments:

Mari Xaduri said...

hi,how can i contact you?do you have email?

hmatter said...

Hi Mari,

Thanks.