Hands On Hearts, And No Stopping

The Age

Saturday May 20, 2006

AMANDA PLACE

Changes to CPR rules should increase survival rates, reports Amanda Place.

IT HAS been described as the biggest shift in emergency care of cardiac arrest in 40 years. New international guidelines are changing the way we deliver basic and advanced life support for adults, children and neonates.

When performing cardiopulmonary resuscitation (CPR), the guidelines recommend a ratio of 30 compressions to two ventilations for infants, children and adults. This is in contrast to the current Australian approach of five compressions to one ventilation. Ratios overseas have differed according to local practices.

The International Liaison Committee on Resuscitation has developed the guidelines. The committee is made up of international resuscitation organisations from the US, Europe, Canada, South Africa, Australia and New Zealand.

In response, the Australian Resuscitation Council has released updated guidelines for CPR, aiming to increase survival rates from cardiac arrest. They are simpler to teach and easier to remember. The idea is that more frequent chest compressions may result in an increased chance of survival.

Currently, less than half of cardiac arrest victims are given resuscitation from bystanders, says Associate Professor Ian Jacobs, the national chair of the ARC.

"If we can increase the number of people who are prepared to give resuscitation, we will save lives," says Professor Jacobs. "It is important to recognise that the previous recommendations for resuscitation resulted in many lives saved and should continue to be used until update training has occurred."

So how are Victoria's health workers to be educated on the voluntary guidelines? Individual health services will need to introduce programs at individual workplaces. Defibrillators will need to be reset, and checklists, policies and procedures rewritten.

Cabrini Health educator Emma Matthew is responsible for spreading the word to approximately 3000 staff in four clinical sites. A significant proportion of these are clinical staff, who will be affected by the CPR changes.

"There is universal consensus that the new CPR guidelines are the way to go, based on ethical, scientific evidence," Ms Matthew says.

"Health carers are used to regular challenging of accepted wisdom as best-practices are modified and refined to optimise patient outcomes.

"Staff have been very positive about learning the new skills, which, basically, recognise that those offering CPR have, until now, over-ventilated patients and spent too much time with hands off their chests."

Ms Matthew has been reviewing existing hospital procedures with leaders at Cabrini Health. These include director of nursing Professor Sandra Legg, director of emergency Dr Dominic Campion, medical director Associate Professor Doug Lording, pediatricians, cardiologists, anesthetists and members of the nursing executive.

An awareness campaign is soon to be introduced, and 110 staff who are Cabrini's life support assessors will be trained to educate staff.

Pay slips will contain the 30:2 message and signs near time clocks will also spread the word. Newsletters and classes with mannequins will provide information.

Cabrini Health expects the technique to "go live" at the end of May.

Results from the resuscitation project will be reviewed in conjunction with Dr Anne Gardner from the Cabrini-Deakin Centre for Nursing Research.

When discussing the use of CPR, it is still essential to consider practices that could prevent the need for such last-ditch efforts to save a life.

Ms Matthew believes the introduction of medical emergency teams (MET) to Melbourne by Professor Rinaldo Bellomo and his medical and nursing colleagues at Austin Health has had a remarkable impact on reducing the need for CPR. Professor Ken Hillman first developed the concept at Liverpool Hospital in Sydney and the idea spread around the world.

By ensuring patients are identified as being at risk of cardiac arrest, they should receive intervention well before they deteriorate and need CPR.

Four to eight hours seems to be the critical time to pick up changes in blood pressure, temperature, pulse and respiratory rates, which can signal trouble ahead. Regular, frequent monitoring appears to be the key, together with calling the MET when abnormalities are observed.

Published results in The Medical Journal of Australia in 2003 showed the impact of intervention. Professor Bellomo and his colleagues managed to reduce cardiac arrests by 65 per cent and reduce deaths from cardiac arrest by 56 per cent.

"The beauty is, if you intervene early, you can avoid needing to do CPR," Ms Matthew says.

But for those times when a patient requires CPR, the new guidelines are easy to remember and apply.

In other changes to CPR, pulse checks have been dropped. Instead, first-aiders need to look for signs of life - conscious state, movement or breathing - before providing two ventilations. Whereas compressions would stop after a minute to check the patient's response, the new rule is to keep going until medical help arrives.

The ARC has given health services until the end of 2006 to implement the changes.

© 2006 The Age

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