Page 70 - Occupational Health & Safety, June 2017

DEFIBRILLATORS & CPR
Encouraging Hands-Only CPR
A study published in Circulation last year found that CPR knowledge and confidence to use hands-only CPR can be increased through large-scale community training.
BY JERRY LAWS H
ands-only CPR recommendations1 from the American Heart Association’s Emer- gency Cardiovascular Care Commit- tee were released nine years ago, in April
2008. Chiefly, the goal of the recommendations was to raise the rate of bystander CPR, which the com- mittee noted remained low in most U.S. cities at ap- proximately 27-33 percent.
“Reducing barriers to bystander action can be ex- pected to substantially improve cardiac arrest survival rates. Reasons cited prospectively for the reluctance to perform CPR often include concerns about disease transmission related to performing mouth-to-mouth ventilation,” the committee noted, adding that stud- ies of actual bystanders found they “most often cited panic and fear of causing harm as reasons for failing to perform CPR,” and the fear of infection in fact was not a prominent concern.
Recent studies suggest the prevalence of bystander CPR remains stubbornly low, however. Writing in Emergency Medicine Australasia in April 2017, Dr. Ja- net E. Bray of Monash University’s Department of Ep- idemiology and Preventive Medicine and colleagues reported2 that their phone survey in April 2016 of adult residents of the Australian state of Victoria found that 68 percent of the 404 adults surveyed had received CPR training. Only 50 percent of them had heard of hands-only CPR, though; among those who had undergone training, the majority, 52 percent, had received their training more than five years before, and only 28 percent had received training or refreshed training during the previous 12 months.
Most who had been trained received their training in a first-aid class, and 67 percent had received train- ing as a requirement for work. The most common reasons for not having been trained were: They had never thought about it (59 percent), did not have time (25 percent), and did not know where to learn (15 percent), reported Bray, Ph.D., who is the associate director of The Australian Resuscitation Outcomes Consortium (Aus-ROC, https://www.ausroc.org.au/), and her colleagues.
They did find that more respondents were willing to provide hands-only CPR than standard CPR for strangers.
Joseph Hanson, who invented and patented medi- cal products such as a disinfecting sharps disposer
and a hands-only CPR device, cited a 2015 report by the American Heart Association in an article3 that same year for this magazine. The AHA study con- cluded 326,200 people experienced out-of-hospital cardiac arrest in the United States in 2011 and surviv- al to hospital discharge was only 10.6 percent. “Even though nearly 40 percent of out-of-hospital cardiac arrests are witnessed by a bystander, just 31.4 percent of those victims survive. Many of these deaths occur becausebystandersdonotperformCPR—asmanyas 70 percent of Americans may feel helpless to act either because they don’t know CPR or because their train- ing has significantly lapsed,” he wrote.
Sudden cardiac arrest typically is caused by an electrical disturbance in the heart that disrupts its rhythm. He explained that it is characterized by these symptoms:
■ Sudden collapse
■ No pulse
■ Not breathing
■ Loss of consciousness
A study published last year in Circulation con-
cluded that there was no impact on bystander CPR performance or outcomes from a blanket approach to community CPR education (offering one-time, compression-only CPR training to passersby at sev- en locations in Grand Rapids, Mich., in May 2014). Only 37 percent of out-of-hospital SCA cases receive bystander CPR in Kent County, Mich., the Michi- gan State University authors reported. But a second Circulation study published last year found that CPR knowledge and confidence to use hands-only CPR can be increased through large-scale community training—in this case, 15-minute group sessions re- peated in 10 Texas cities during February 2016. A total of 4,250 people were trained, and the number who re- ported they were comfortable performing hands-only CPR rose from 59 percent to 96 percent. More than 60 percent indicated they were willing to be contacted in six months to assess how much of their training they had retained, the authors found.
The Chain of Survival
AHA introduced the concept of the Chain of Survival in 1991, urging communities to adopt the principle of early defibrillation in sudden cardiac arrest cases. The links in the chain are:
1. Early Access to the emergency response system
2. Early CPR to support circulation to the heart and brain until normal heart activity is restored
3. Early Defibrillation to treat cardiac arrest caused by ventricular fibrillation
4. Early Advanced Care by EMS and hospital personnel
66 Occupational Health & Safety | JUNE 2017
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