Call and Pump – evidence for CCR

One thing we bang on about during first aid training is time on the chest when doing CPR. I find I cannot stress enough that the one thing you will do to keep someone alive is chest compressions. It makes sense – keep the blood going round and round, and enough oxygen will get to the important parts that when defibrillation and/or advanced life support get there, they’ll still be in good working order.

The guidelines from the Resuscitation Council changed in 2005 to reflect this emphasis, from 15 compressions with five breaths in between to 30 compressions with two attempted rescue breaths. Get blood going round and round. The idea is that enough air has gone in the lungs in those two breaths that the blood we’re pumping round can carry sufficient oxygen to tissues to keep it alive. The evidence (look at the reference list here, if you’re interested) suggests that this is the optimal ratio.

But we tend to go further – we say that if you don’t want to do rescue breaths, for example if the patient is covered in vomit (they will be) and you don’t have a face mask/pocket mask/(?BVM), then just bounce up and down on their chest. Get the blood going round and round. And hopefully, enough air will get in just through that motion to keep everything oxygenated.

This idea has been knocking around in the US for a fair while, where they’ve dubbed it “Call and Pump“. Call the ambulance, and get pumping. But now they’re extending this idea to professionals, to ALS crews, though renaming it “cardiocerebral resuscitation”. Get called, and pump. And it works.

Chris Kaiser, in his first post at Paramedicine 101, discusses “CCR: If you’re not doing it now, you will be“

Visitors to my blog probably know that at my ambulance service we tend to bring back a lot of codes. I talk about it a lot. Back in 2004 our medical director, Dr. Michael Kellum, got us involved in a “Demonstration Project” to bring Continuous Compression CPR or Cardiocerebral resuscitation to a rural area. Since that time, the results have been more than dramatic. Depending on what statistics you look at, we may be “Saving” almost 50% of witnessed arrests found to be in ventricular fibrillation.

I’ll let you go through the material yourself. It’s just fantastically interesting to me to have some fairly strong evidence that CCR is more effective than traditional CPR. No fancy ventilations, just get on the chest. – the ETCO2 monitoring shows that the chest compressions themselves are moving enough air in and out of the lungs to allow respiration to take place, and the emphasis on not checking for a pulse until the ETCO2 shows that ventilations are taking place spontaneously. Staggeringly, what we’ve been teaching lay people as an “it’ll do” technique is actually more effective than the status quo, even in the hands of trained professionals.

And now, finally, I have a scientific answer when that smart-arse says, “so, what’s the evidence behind continuous compression CPR?”

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Possibly related posts: (automatically generated)

• During CPR, More Chest Compressions Saves More Lives
• Compression Only CPR?
• + CPR Works Without Mouth to Mouth, Perhaps