Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
Cardiac Arrest: Chest Compressions Alone Work Better, Studies Suggest
#1
Ini dia, disalah satu thread tadi tiba tiba berkembang kemasalah cpr, ini dia yg gue maksud, pada kasus cardiac arrest lebih baik chest compresion dilakukan terus menerus, nah karena ada yg baru selesai ACLS atau mungkin ada sp jantung atau residen jantung disini, kira kira artikel ini benar ngga?

mari di baca sama sama

Cardiac Arrest: Chest Compressions Alone Work Better, Studies Suggest

ScienceDaily (Jan. 4, 2008)
— Two large-scale studies published in the journal Circulation, report that the chances of surviving cardiac arrest are no better -- and may be worse -- when bystanders perform mouth-to-mouth breathing than if they press on the chest without interruption.
In part because of the hesitance of bystanders to initiate CPR, survival rates following out-of-hospital cardiac arrest have remained dismal and virtually unchanged despite several changes of the CPR guidelines over the past four decades. In the two latest studies, research groups from Sweden and Japan compared survival rates of cardiac arrest victims after bystanders used either traditional CPR with mouth-to-mouth breathing or Chest-Compression-Only CPR.

Both studies found no statistically significant difference in survival rates. The Swedish study, led by Katarina Bohm, RN, of the South General Hospital in Stockholm, analyzed outcomes of nearly 10,000 cases, while a team led by Taku Iwami, MD, at Japan's National Cardiovascular Center in Suita, Japan, looked at the outcomes of 4,900 cases of witnessed out-of-hospital cardiac arrest. Robert Berg, MD, professor of pediatrics at the UA College of Medicine and a member of the Sarver Heart Center Resuscitation Research Group, co-authored the latter study.

"These independent findings confirm what our Resuscitation Research Group and others have found," says Gordon A. Ewy, MD, director of The University of Arizona Sarver Heart Center, where Continuous-Chest-Compression CPR without mouth-to-mouth breathing was pioneered. "To rescue someone who suddenly collapses for no apparent reason, mouth-to-mouth breathing makes no sense."

Shortly before the two latest observational studies were published, Dr. Ewy and his colleagues reported the results of a laboratory study suggesting that cardiac arrest patients face better odds of survival if they receive continuous chest compressions than if treated with standard CPR, in which chest compressions are interrupted by mouth-to-mouth breaths.

"Studies have shown over and over again that four out of five bystanders would not do CPR because of the mouth-to-mouth part," says Dr. Ewy, who has commented on the two new studies in an invited editorial published in the same issue of Circulation. "If people don't have to worry about the so-called rescue breathing, they are much more likely to actually do CPR on someone who needs it. This fact alone is the key to saving more lives. If someone calls the emergency medical services and does nothing, the individual has almost no chance of surviving."

Earlier this year, the then-largest study comparing survival rates of cardiac arrest victims in the light of the kind of rescue efforts performed by bystanders concluded that chances of leaving the hospital alive were actually higher for patients who received Continuous-Chest-Compression CPR (Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study; Lancet 2007:369:920-926).

Dr. Ewy says, "It is interesting that Continuous-Chest-Compression CPR, a technique that has not been advocated or taught and is most often performed by individuals not trained in CPR, results in similar survival as the guidelines-advocated approach, on which millions of hours and millions of dollars have been spent teaching and advocating."

He adds that mouth-to-mouth ventilation is disadvantageous in cases of sudden cardiac arrest for three primary reasons. "A person whose heart suddenly stops, for example because of a heart attack, was breathing normally only seconds earlier so there is plenty of oxygen in the blood. The important thing is to move the blood around, and this is only possible by uninterrupted chest compressions. During CPR, blood flow to the brain and the heart is so marginal that stopping for anything, including ventilation, is harmful to the brain. In addition, research has shown that forced ventilation, including mouth-to-mouth breathing, increases the pressure in the patient's chest, which in turn inhibits blood flow back to the heart."

Journal References

Ewy et al., Improved Neurological Outcome With Continuous Chest Compressions Compared With 30:2 Compressions-to-Ventilations Cardiopulmonary Resuscitation in a Realistic Swine Model of Out-of-Hospital Cardiac Arrest; Circulation, Nov 2007; 116: 2525 -- 2530

Ewy G. A., Continuous-Chest-Compression Cardiopulmonary Resuscitation for Cardiac Arrest. Circulation. 2007;116:2894-2896

Iwami et al., Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest Circulation. 2007; 116:2900-2907

Bohm et al, Survival Is Similar After Standard Treatment and Chest Compression Only in Out-of-Hospital Bystander Cardiopulmonary Resuscitation. Circulation. 2007;116:2908-2912

Link asli
Code:
http://www.sciencedaily.com/releases/2007/12/071226230920.htm

yuk mari kita diskusi, siapa tau bisa menambah pengetahuan kita bersama.
[Image: aliensign.jpg]
Reply
#2
ohya untuk tambahan informasi, teman teman bisa kesini

journal sesuai dengan pembahasan diatas

1. nemu free di
Code:
http://circ.ahajournals.org/cgi/content/full/116/22/2525

2. nemu free di
Code:
http://circ.ahajournals.org/cgi/content/full/116/25/2894

3. nemu free di
Code:
http://circ.ahajournals.org/cgi/content/full/116/25/2900

4. nemu free di
Code:
http://circ.ahajournals.org/cgi/content/full/116/25/2908

Dan mungkin yg bisa menjadi bacaan menarik
New Concepts of Cardiopulmonary Resuscitation for the Lay Public
Code:
http://circ.ahajournals.org/cgi/content/full/116/25/e566
[Image: aliensign.jpg]
Reply
#3
Chest compression without mouth2mouth?? wah.. ini baru yah? yg gua tau yg trakhir diratain 15-1 untuk penolong 1 & 2.. duh.. sepertinya perlu pencerahan ilmu lagi neh...
It's Mine: Predator Cue - Tipe 4K2 Customized with Ebony
[Image: cue1x-1.jpg]
_________________________________________________________________________
Pure Ebony unstained forearm with Batik Wood Rings & Genuine Leather Grip
Reply
#4
gw pernah baca...
gw juga dapat artikel dari Purdue BioEngineering (di alumni newsletter gw), kalau mereka justru lagi penelitian mengenai compressionnya di perut/ulu hati selain di jantung. Secara teori, justru katanya kompresi di sana darah yang keluar dan sirkulasi itu % nya lebih besar dibandingkan kompresi jantung.
lalu gw juga pernah baca satu artikel kalau cell tubuh kita sendiri sebenarnya tidak langsung mati setelah 5 menit tidak ada supply oksigen. Yang sebenarnya terjadi adalah cell tubuh kita seperti menutup diri dari luar dan berusaha bertahan hidup dengan resources yang tersisa. Setelah 1 jam barulah cell tersebut mati. Tetapi orang yang telah lewat dari 5 menit tidak dapat di revive dengan cpr biasa karena cell tersebut apabila menerima oksigen secara berlebih akan langsung mati pada saat dia masih menutup diri. Jadi harus secara step by step dan ini masih memungkinkan orang yang jantungnya telah berhenti diresucitasi selama < 1 jam.

bagi gw sendiri (maklum bukan dokter), itu semua masih dalam tahap edukasi dan American Heart Association sendiri belum menyatakan pendirian mereka untuk hal2 tersebut.
Nanti yah gw cari artikelnya moga2 aja ketemu... sorry sekarang lagi sibuk...
Reply
#5
Quote:Chest compression without mouth2mouth?? wah.. ini baru yah? yg gua tau yg trakhir diratain 15-1 untuk penolong 1 & 2.. duh.. sepertinya perlu pencerahan ilmu lagi neh...
[post=152=693]
yup bro, karena kemaren ada yg baru kelar acls gue mau confirm apakah di acls sudah mengunakan ini?karena elo baca aja dari artikelnya itu, di bilang kan kalau memang benar akan mubazir buang buang uang untuk pelatihan selma ini.
nah karena itu lah gue bawa ni barang kesini, plus dengan journalna jadi bisa di baca dan di bahas, menurut elo gimana bro?

Quote:gw pernah baca...
gw juga dapat artikel dari Purdue BioEngineering (di alumni newsletter gw), kalau mereka justru lagi penelitian mengenai compressionnya di perut/ulu hati selain di jantung. Secara teori, justru katanya kompresi di sana darah yang keluar dan sirkulasi itu % nya lebih besar dibandingkan kompresi jantung.
lalu gw juga pernah baca satu artikel kalau cell tubuh kita sendiri sebenarnya tidak langsung mati setelah 5 menit tidak ada supply oksigen. Yang sebenarnya terjadi adalah cell tubuh kita seperti menutup diri dari luar dan berusaha bertahan hidup dengan resources yang tersisa. Setelah 1 jam barulah cell tersebut mati. Tetapi orang yang telah lewat dari 5 menit tidak dapat di revive dengan cpr biasa karena cell tersebut apabila menerima oksigen secara berlebih akan langsung mati pada saat dia masih menutup diri. Jadi harus secara step by step dan ini masih memungkinkan orang yang jantungnya telah berhenti diresucitasi selama < 1 jam.

bagi gw sendiri (maklum bukan dokter), itu semua masih dalam tahap edukasi dan American Heart Association sendiri belum menyatakan pendirian mereka untuk hal2 tersebut.
Nanti yah gw cari artikelnya moga2 aja ketemu... sorry sekarang lagi sibuk...
[post=152=695]

humm itu udah di bahas bro kalau gue ngga salah di tahun 2006, yup alasannya karena sirkulasi di abdoment lebih banyak daripada di chest.
Kalau mengenai matinya sel ketika tidak mendapatkan O2 nah itu seperti artikel di atas bicarakan dan di journal nya, yg paling di takuti adalah untuk jaringan syaraf karena dia ngga bisa regenerasi, nah 5 menit itu waktu yg lama, dan afaik hanya 3 menit kita punya space waktu untuk syaraf CMIIW, nah pada artikel ini yg di bahas tu begini, dalam darah masih ada O2 yg cukup, nah bagaimana mendelivernya, ya itu dengan chest compress, jadi menurut artikel ini, yg paling penting bagaimana caranya agar O2 yg sudah ada bisa sampai ke end organ, toh di dalam darah masih ada O2 yg cukup untuk kebutuhan jaringan. jadi pompa yg berhenti itu yg di bantu, nah sedangkan kalau ada interupt buat mouth to mouth kerja kita membantu pompanya berkurang, kurang lebih kasarnya begitu.

Yup kalau itu gue setuju, terutama untuk bayi kenapa bayi bisa lebih lama bertahan dari orang biasa? karena mereka masih terbiasa dengan O2 yg hanya ada dalam darah, dan jaringannya masih bisa menerima O2 dalam jumlah sangat sedikit di bandingkan orang dewasa, itu penyebabnya kenapa bayi bisa lebih lama bisa bertahan tanpa bernafas, dan karena itu pula kenapa kalaubayi kita resusitasinya bisa lebih lama daripada orang dewasa, nah ini yg menjadi bahasan nya bro, di titik manakah waktu paling tepatnya? dimana orang dewasa bisa dianggap bisa survive kalau di lakukan compresi terus menerus tanpa mouth to mouth nya. dan apakah survival ratenya meningkat? kalau dari peneltian diatas (baca journal yg gue kasih) nah disana di bilang memang ada peningkatan, cuman kan blom ketauan sampai kapan tu orang hanya di compresi, setidaknya itu gue tangkap. kekeke karena itu dibawa kesini biar bisa diskusi, kan kalau lebih banyak kepala yg mikir dan baca, lebih banyak juga yg bisa kita tahu kan bro Big Grin
[Image: aliensign.jpg]
Reply
#6
ups gue salah ternyata yg via abdominal bukan 2006 tapi 2007 september
ini lengkapnya

New CPR Promises Better Results By Compressing Abdomen, Not Chest
ScienceDaily (Sep. 10, 2007) — A biomedical engineer at Purdue University has developed a new method to perform cardiopulmonary resuscitation that promises to be more effective than standard CPR because it increases nourishing blood flow through the heart by 25 percent over the current method.
A new technique is desperately needed because conventional CPR has a success rate of 5 percent to 10 percent, depending on how fast rescuers are able to respond and how well the procedure is performed. For every one minute of delay, the resuscitation rate decreases by 10 percent.

In other words, at 10 minutes, the resuscitation is absolutely ineffective," said Leslie Geddes, Showalter Distinguished Professor Emeritus in Purdue's Weldon School of Biomedical Engineering. "Any medical procedure that had that low a success rate would be abandoned right away. But the alternative is not very good, either: Don't do CPR and the person is going to die."

Geddes has developed the first new CPR alternative, called "only rhythmic abdominal compression," or OAC-CPR, which works by pushing on the abdomen instead of the chest.

There are major problems with standard CPR," Geddes said. "One is the risk of breaking ribs if you push too hard, but if you don't push hard you won't save the person. Another problem is the risk of transferring infection with mouth-to-mouth breathing."

The new CPR method eliminates both risks, Geddes said.

Findings will be detailed in a research paper appearing this month in the American Journal of Emergency Medicine, published by Elsevier Inc. The paper was authored by Geddes and his Purdue colleagues Ann E. Rundell, assistant professor of biomedical engineering, biomedical engineering doctoral student Aaron Lottes, and basic medical sciences graduate students Andre Kemeny and Michael Otlewski.

In standard chest-compression CPR, which has been in practice since the 1960s, the rescuer pushes on the chest and blows into the subject's mouth twice for every 30 chest compressions. However, the risk of infection is so grave that many doctors and nurses often refuse to administer mouth-to-mouth resuscitation. In one 1993 study of 433 doctors and 152 nurses, 45 percent of doctors and 80 percent of nurses said they would refuse to administer mouth-to-mouth resuscitation on a stranger.

This is the real world that nobody knows about, and it's a sobering thought," Geddes said.

OAC-CPR eliminates the need to perform mouth-to-mouth resuscitation.

The American Heart Association requires that rescuers administering CPR push with enough force to depress the chest 1 and a half to 2 inches at a rate of 100 times per minute.

"To depress the chest 1.5 to 2 inches takes 100 to 125 pounds of force," Geddes said. "So you have to push pretty hard and pretty fast, and two people are needed to perform it properly. One blows up the lungs and the other compresses the chest. And when the one who's compressing the chest gets tired, they change positions."

OAC-CPR requires only one rescuer.

Instead of two breaths for every 30 chest compressions, the new procedure provides a breath for every abdominal compression because pushing on the abdomen depresses the diaphragm toward the head, expelling air from the lungs. The release of force causes inhalation.

Researchers have known since the 1980s that pushing on the abdomen circulates blood through the heart. The idea was originated by Purdue nursing doctoral student Sandra Ralston, Geddes said.

She made the remarkable observation that if you pushed on the abdomen after each chest compression you could double the CPR blood flow," he said. "So I started thinking, what would happen if you just pushed on the abdomen and eliminated chest compression entirely?"

The procedure provides a new way to effectively perform "coronary perfusion," or pumping blood through the heart muscle, which is critical for successful resuscitation because the heart muscle is nourished by oxygenated blood, Geddes said.

Unfortunately, in standard chest-compression CPR, blood sometimes flows in the wrong direction, which means the coronary blood flow goes backward, bringing de-oxygenated blood back into the heart muscle," Geddes said. "This retrograde flow reduces the likelihood of resuscitation."

Findings showed that OAC-CPR eliminates this backward flow.

The Purdue researchers compared coronary artery blood flow during standard chest-compression CPR with the flow resulting from only abdominal compression CPR. Findings showed that using the new method and pushing with the same force recommended for standard CPR provided 25 percent more blood flow through the heart muscle without retrograde flow in the coronary arteries.

The researchers followed the standard recommended by the American Heart Association, pushing with 100 pounds of pressure 100 times per minute.

With OAC-CPR, you really don't have to press as hard or as often, but we followed the American Heart Association standard to avoid possible criticism from people who could have said we didn't observe the standard," Geddes said.

Another benefit of OAC-CPR is that it eliminates rib fractures, which are commonly caused by compressing the chest. Rib fractures cause the chest to recoil more slowly, but effective CPR requires that rescuers wait until the chest recoils fully before compressing.

Geddes created a wooden "pressure applicator" that resembles a scaled-down version of a baseball home plate. It is contoured so that it can be used to compress the abdomen without pushing on the ribs. However, a rescuer could push with the hands to perform the procedure if no applicator were available.

Abdominal organs contain about 25 percent of the total blood volume in the body.

You can squeeze all of that into the central circulation when you press on the abdomen," Geddes said.

Whether the procedure gains widespread acceptance depends on whether other researchers can duplicate the results.

In research, you publish data and then the scientific community looks at the data and tries to duplicate it to verify that it works," said Geddes.

The research was funded by the Purdue Trask Fund.

Adapted from materials provided by Purdue University.

diambil dari
Code:
http://www.sciencedaily.com/releases/2007/09/070905155141.htm
[Image: aliensign.jpg]
Reply
#7
gw dulu mustinya milih biomed ya...hiks...
waktu gw masuk Purdue, biomednya baru dimulai, freshman engineers pada di lobby suruh masuk biomed tapi pada gak mau... abis yang dipromosiin waktu itu bikin implant dan prosthesis...

waktu lulus, biomednya Purdue dah kerja sama ama WHO dan negara2 Afrika untuk bikin segala macam...Terakhir temen gw bikin system untuk penanganan gizi buruk dan pengobatan aids di kenya...projectnya mereka keren2...

project kita di industrial engineering cuman disuruh gambarin layout yang optimum buat new assembly line...
Reply
#8
tapi dengan berbagai macam "coba" seperti abodemen compression, chest compression only etc... tetapi saja tidak meningkatkan survival ratenya...

Gw inget baru sekitar Agustus 2007 gw dikasih data graphnya kalau survival ratenya di US sendiri masih sekitar 5-10% saja. Dengan teknik CPR yang paling awal survival ratenya sekitar 1-2% lalu dengan perkembangan teknick CPR pelan2 meningkat hingga 5-10%, tetapi 10 tahun terakhir tidak ada perubahan dalam survival rate tersebut walaupun teknik CPR dan penelitian lainnya (waktu CPR) dan lain lainnya telah banyak maju...

Dalam beberapa hal, gw rasa ini juga dikarenakan masyarakat awam sendiri tidak diberikan pelajaran untuk CPR. Padahal pada saat seseorang memerlukan CPR dan dengan jangka waktu hanya 5 menit... kemungkinan adanya seseorang yang mengerti CPR memberi pertolongan adalah umm... hampir 0%.

Di US dan Canada setahuku mereka memberikan pelajaran CPR dasar pada murid2 sekolah, tetapi katakanlah hanya sekali, apakah sebenarnya itu cukup? Karena paramedic sendiri kan kalau menangani CPRnya setahun tidak sampai sekali pun tentu pada saat diperlukan mungkin kemampuannya sudah berkurang, apalagi masyarakat awam (makanya musti pada beli boneka Laerdal buat latihan CPR hehehe, becanda yah, gw gak lagi promosi!).

Di Canada ada satu group university students yang mengembangkan alat yang sangat menarik menurutku. Yaitu sarung tangan CPR, kalau dilihat kegunaannya, ini bisa sangat membantu dalam meningkatkan survival rate, karena orang awam dengan pengetahuan CPR yang pas2 an akan diberikan instruksi bagaimana CPR yang benar, sudut dan kedalaman kompresi. Kalau setiap kantor ada sarung tangan CPR, gw rasa sangat menolong tingkat survival rate...
Reply
#9
wah bro gue kirain elo biomed ^_^ di indo baru FKUI yg buka. dan itu pun baru mulai.

Yup gue setuju sama elo, karena pada dasarnya masyarakat awam sendiri tidak diberikan bekal informasi yg cukup seperti post gue yg pertama, ada tu link yg untuk orang awam. dan mereka di sarankan harus apa. Karena CPR sendiri kan harus ASAP ^_^
Nah itu dia bro, makanya ada yg comment di artikel itu menyebutkan pelatihan selama ini bisa sia sia, kalau saja tehnik tidak di perbaik dalam waktu singkat.
Gue rasa selama ini orang awam tidak mau CPR karena perkara mouth 2 mouth nya itu, kalau cantik yg mungkin aja pada berebut ^_^ biasa bro mereka masih takut dengan penuralan berbagai macam penyakit pada saat ini. malahan jujur aja, ada beberapa petugas medic (petugas ya jadi paramedic dan doctornya) yg sebenarnya keberatan untuk mouth to mouth, jadi mereka ngga akan kerja kalau ngga ada ambu bag. Jadi gue rasa wajar masyarakat umum masih banyak yg ngga mau.
Humm kalau paramedic kayaknya ngga juga bro, kalau paramedic puskesmas yg ngga punya UGD mungkin, tapi kalau paramadic UGD gue rasa minimal 1 minggu sekali kalau banyak kasus ^_^ kalau ngga banyak kasus 1 bulan sekali, nah klau sudah dibawah 1 bulan 1 kali misalnya 6 bulan skali, pasti tu bro skillnya akan menurun apalagi kalau sudah 1 thn 1 kali =_=!!
glove? wah gue baru denger tu bro, itu untuk apa? untuk pelatihan atau untuk apa ni, ada keywordnya? jadi pegen tahu saya.
[Image: aliensign.jpg]
Reply
#10
http://seattlepi.nwsource.com/national/3...ource=mypi

Salah satu hasil dari "trials"nya di Arizona, katanya chest compression doank memberikan peningkatan 40% kemungkinan selamat...
Reply


Possibly Related Threads…
Thread Author Replies Views Last Post
  [ask help] Cardiac Case Study Nawainruk 1 4,446 Monday, 30 June 2008, 19:53
Last Post: asbud

Forum Jump: