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CPR becomes simpler! Great news!

Medical students being taught intubation by James DuCanto

Medical students being taught intubation by James DuCanto

I just did my ALS refresher recently and it was good to hear how evidence based teachings and research has improved outcomes in cardiac arrest. We were still taught the current Australian guidelines which include a 30:2 compression to ventilation ratio for adults with interruption of < 5 secs for ventilations during switching of compression provider, when no advanced airway was in place. The teaching was if advanced airway in place then asynchronous ventilations were to be delivered 10/minute, to be timed during release phase of compression, say every 7th compression.

Now just today a large RCT from USA seems to indicate that we can simplify things further, regardless of advanced airway or not.

Here is the study in NEJM
Trial of Continuous or Interrupted Chest Compressions during CPR

What this study seems to indicate is that survival to hospital discharge is no better between continuous CPR with asynchronous ventilations ( no interruption to compressions) versus the CPR with interrupted compressions to allow synchronised ventilations.

In fact in some analaysis of the data, the group that got continuous CPR did a bit worse. There are some limitations to the data interpretation though so please read the whole open access article carefully.

IMPORTANT TO NOTE : In this study, once 3 cycles of CPR done and advanced airway in place then all test patients were given asynchronous ventilations and continuous compressions. So IN FACT, this study confirms the current Australian ALS teaching. Having said that, since no significant survival advantage to the continuous compressions group ( who got continuous compressions completely for entire resuscitation) compared with the interrupted compression group, then logically I can see no benefit in doing this abritrary strategy of advanced airway determined continuous vs interrupted compression.

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