CPR stands for Cardio Pulmonary Resuscitation. The essential action in CPR is chest compressions. Rescue breaths were a part of this protocol in the past but this has been abandoned. Current CPR is chest compressions only despite the pulmonary in Cardio Pulmonary Resuscitation. There is still some movement of air in and out of the chest with chest compressions but rescue breaths are not part of current CPR protocols.
The need or indication for CPR, specifically chest compressions is a person who is suddenly unconscious and has no pulse. The presumption is that the person is in cardiac arrest, meaning no detectable cardiac function. In addition to cardiac arrest the essential presumption is that the person has suffered ventricular fibrillation because the other option, asystole is probably a hopeless situation. Ventricular Fibrillation is potentially reversible but asystole is a much more difficult situation and should not be considered survivable.
The only effective treatment for Ventricular Fibrillation is direct current Defibrillation. It should be clear and unambiguous that this is the only treatment with any chance of success. It is common for a person mistakenly thought to be in ventricular fibrillation to be awakened with medications or chest compressions. This is quite common and contributes to the mistaken impression that anything other than direct current defibrillation will be effective in ventricular fibrillation. It won’t be. The person with Ventricular Fibrillation has two choices, direct current defibrillation or death.
Secondary Ventricular Fibrillation is when this rhythm is the terminal event in a steadily deteriorating illness. What this means is that the condition is essentially unrecoverable before the onset of Ventricular Fibrillation. Primary Ventricular Fibrillation occurs in a person predisposed to this rhythm and its onset is when the medical condition is stable without significant metabolic abnormality such as hypoxia, acidosis or poisoning. With Primary Ventricular Fibrillation a direct current defibrillation will restore circulation and immediate stability. This can be quite dramatic and can transition a person from a clinically dead appearance to a person awake, responsive and with adequate cardiovascular circulation. This is the promise of direct current defibrillation.
When a defibrillator is immediately available the best treatment for ventricular fibrillation is not CPR but immediate defibrillation. CPR classes are generally taught that the defibrillator needs to be brought to the bedside which might take a few minutes. Some situations are different. In some cases a defibrillator is already in place with hands free leads. This is not the time to do CPR as the initial step.
CPR is done in virtually every case with compressions only. CPR with breaths interspersed with compressions is now all but abandoned. Compression only CPR started during the beginning of the AIDS epidemic. At that time people suddenly became unwilling to do breaths with compressions. The science or the political science became that compressions only was the best way to do CPR. Breaths interspersed with compressions suddenly was not necessary anymore. This fulfills the social need for an effort needs to be made to resuscitate the suddenly lifeless appearance of a person.
Compressions only CPR might make sense in primary V-fib. In such cases we could expect the blood to be reasonably oxygenated and therefor the limited circulation of blood provided by compression only could be beneficial. The current reality of guidelines is that this consideration is ignored. The cause of the cardiac arrest is not considered.
In cases of near drowning we would expect that cardiac arrest would occur after profound deoxygenation of the blood. Circulating deoxygenated blood with compressions only CPR would not be helpful. Ventilation of the lungs after near drowning would be essential. It is likely that rescue breathing rather than doing compressions at all would be the best approach. Cardiac arrest in the field is the absence of a pulse usually by an untrained and inexperienced rescuer, the bystander. This does not mean that the heart is not beating only that the force of contraction does not produce a pulse that can be felt. In near drowning, we know that the primary process involves breathing and the lack of oxygen. Rescue breathing makes sense. Anything that interferes with the delivery of effective rescue breathing is likely detrimental. It is tragic that simple rescue breathing is no longer employed in near drowning, costing many lives.