1. Developed by the University of Arizona Sarver Heart Center Resuscitation Research Group

2. Are the most common cause of death in the United States Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often cardiac arrest Since most occur out of the hospital Out-of-hospital cardiac arrest is a major public health problem

3. Blockage in coronary artery Person usually conscious Upper body discomfort or pain Electrical issue, heart stops pumping Person is unconscious Often no previous symptoms Heart Attack vs. Cardiac Arrest Heart Attack : Cardiac Arrest:

4. Primary vs. Secondary Cardiac Arrest Heart stops pumping Blood in arteries full of oxygen Unexpected witnessed collapse Secondary Heart stops pumping due to lack of oxygen Drowning, Drug Overdose, Lung Failure (severe asthma or emphysema) Primary

5. Out-of-Hospital Cardiac Arrest The majority of all out of hospital cardiac arrests are Primary Cardiac Arrest Unexpected, witnesses (seen or heard) collapse in an individual who is not responsive Chest Compression Only CPR Ann Emerg Med. 1997 Jul;30(1):69-75.

6. What is Chest Compression Only CPR? A new method of resuscitation developed through extensive research at The University of Arizona Sarver Heart Center for primary cardiac arrest Continuous forceful chest compressions to circulate the person’s blood to their brain and heart Mouth-to-mouth breaths may actually be harmful

7. Why isn’t Rescue Breathing Necessary? –Lungs are full of air –Blood is full of oxygen –Circulating the oxygenated blood is the key During Cardiac Arrest:

8. Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest? People less likely to perform Causes interruption of chest compressions: stops blood flow to the brain Increased pressure in the lungs and chest decreasing blood return to the heart Aufderheide TP et al.., Death by hyperventilation: a common and life-threatening problem during CPR. Crit Care Med 2004;32:S345- 51 Aufderheide TP et al.., Hyperventilation induced hypotension during CPR Circulation 2004;109:1960-5

9. Why Chest Compression Only CPR? It saves more lives More likely to survive over: –Doing nothing –Traditional CPR Bobrow, et al. JAMA October 2010

10. What Stops People from Doing CPR? Coons SJ, et al. Resuscitation 80;334-340:2009This study was designed and funded by the Sarver Heart Center The University of Arizona College of Medicine and SHARE Mouth-to-Mouth Harming the Person Legal Consequences Won’t Perform Properly Physically Unable Chest Compressions Only Better than dead Good Samaritan Law Easier to Do Do Your Best / Call For Help Fear / ConcernSolution

11. 40% 30% 25% 20% 15% 10% 5% 0% 17.6%17.7% 33.7% Survival to Hospital Discharge No CPR Traditional CPR CCO CPR Bystander CPR in Arizona (2005 to 2010) Witnessed & Shockable Out of Hospital Cardiac Arrest Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010

12. When to use Chest Compression Only CPR? Obvious Breathing Problems: –Drowning –Drug overdoses Someone who unexpectedly collapses, and is unresponsive. Traditional CPR Chest Compression Only CPR Vast Majority

13. What to do: Compress: Chest compressions at 100 Per Minute Call: 911 & send someone for an A.E.D. (if available) Are You Alright? Check: Shake & Shout

14. Are They Breathing? Gasping is a sign of cardiac arrest Majority of people with cardiac arrest gasp Can be a sign of minimal but adequate blood flow to the brain. DONOTDO NOT stop chest compressions if they gasp

15. How to Do Chest Compression Only CPR With the victim on the floor: 1.Kneel beside them 2.Place the heel of one hand on top of the other 3. Lock your elbows 4. Aim for the middle of the chest (on the sternum between the nipples) 5.Push hard and fast (try for 100/min.) 6.Take turns with another person when tired.

16. Chest Compressions: Rate and Depth Allows the heart to refill Beat of “Staying Alive!!” After each compression, take all weight off the chest 100 Compressions per Minute 2 inches in depth

19. Bystander CCO CPR Improves Chance of Survival from Cardiac Arrest 100% 80% 60% 40% 20% 0% Time between collapse and defibrillation (min) 0 1 2 3 4 5 6 7 8 9 Survival (%) Nagao, K Current Opinions in Critical Care 2009 EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008. EMS Arrival No CPR CPR CCO CPR

20. What to do: COMPRESS Chest Compressions at 100 Per Minute CALL 911 Are You Alright? CHECK Shake & Shout “Are you all right?” If available; Send for an A.E.D.

21. AEDs They may look different, but they all function the Same! Open and Follow Instructions Turn AED ON Apply Pads to Bare Chest Plug in Pads (if necessary) Analyze Patient (CLEAR!) Push Shock to defibrillate, if directed (CLEAR!) Immediately resume CPR

22. The Universal Symbol Safe Easy Voice Prompted

23. Save your Breath… Save a Life

24. How to Do Chest Compression Only CPR With the victim’s back on the floor: 1.Kneel beside them 2.Place one hand on top of the other 3. Lock your elbows 4. Aim for the middle of the chest (on the sternum between the nipples) 5.Push hard and fast (try for 100/min.) 6.Take turns with another person when tired.

26. Ewy GA, et al. Circulation. 2007;116(22):2525-30. Blood Flowing To The Brain Blood Flowing To The Brain Chest Compressions Only Compressions + Breaths (30:2) Pausing for breaths means No Blood Flow

27. Three-Phase Model of Resuscitation Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8 02468101214161820 Arrest Time (min) Circulatory Phase Electrical Phase Metabolic Phase 0 100 Myocardial ATP Percent

28. SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.

29. 25% 20% 15% 10% 5% 0% 5.2% 7.8% 13.3% Survival to Hospital Discharge No CPR Traditional CPR CCO CPR 150/2,900 52/666 113/849 Bystander CPR in Arizona (2005 to 2010) All out-of-hospital cardiac arrests Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010