Question: What are your thoughts on CPR with ventilations vs. continuous chest compression CPR? - Student PCP
Great question! As you know, CPR is not a delegated act, and Base Hospitals are not tasked with medical oversight of chest compressions. Therefore, while we may have varying opinions as to CPR methods, since this is a BLS skill, paramedics are mandated to follow the current guidelines from the Heart and Stroke Foundation of Ontario (HSFO). These guidelines are included in the booklets we provide for certified paramedics within the Southwest region. HSFO Guidelines are usually based upon the American Heart Association Guidelines last released in 2010.
A link to the entire guidelines can be found here:
Specifically for CPR, the overview in Part 4 can be found here:
In Part 4: CPR Overview (Travers et al 2010) page S677, the guidelines state: "Chest compressions are the foundation of CPR. All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims. Because of their importance, chest compressions should be the initial CPR action for all victims regardless of age. Rescuers who are able should add ventilations to chest compressions. Highly trained rescuers working together should coordinate their care and perform chest compressions as well as ventilations in a team-based approach".
Specifically relating to compression only CPR, the authors support a phased strategy depending upon the level and training of the provider. They go on to state: "Opening the airway (with a head tilt€“ chin lift or jaw thrust) followed by rescue breaths can improve oxygenation and ventilation. However, these maneuvers can be technically challenging and require interruptions of chest compressions, particularly for a lone rescuer who has not been trained. Thus, the untrained rescuer will provide Hands-Only (compression-only) CPR (ie, compressions without ventilations), and the lone rescuer who is able should open the airway and give rescue breaths with chest compressions. Ventilations should be provided if the victim has a high likelihood of an asphyxial cause of the arrest (eg, infant, child, or drowning victim). Once an advanced airway is in place, healthcare providers will deliver ventilations at a regular rate 1 breath every 6 to 8 seconds (8 to 10 breaths/minute) and chest compressions can be delivered without interruption."
Since the publication of these guidelines in 2010, more literature has been published looking at the role of compression only CPR and it is possible that these guidelines when revised in 2015 may look different€¦who knows!