Taking the mouth-to-mouth out of CPR - @ JEMS.com

Taking the mouth-to-mouth out of CPR

Abdominal compressions could improve survival, Purdue engineer says


Shari Rudavsky | | Tuesday, September 11, 2007

While cardiopulmonary resuscitation can save the life of a person having a heart attack, it's far from a perfect technique.

It has a low success rate, with estimates suggesting it works 5 percent to 20 percent of the time. Patients can suffer cracked ribs. And patients or rescuers can contract infections from the mouth-to-mouth contact.

Now Leslie Geddes, a Purdue University biomedical engineer, has developed an alternative method he says will solve all these problems.

The method, termed "only rhythmic abdominal compression," involves pushing on the abdomen, not the chest, and dispenses with the mouth-to-mouth contact of traditional CPR.

Could this replace traditional CPR one day?

"Absolutely," says Geddes, the Showalter Distinguished Professor Emeritus in Purdue's Weldon School of Bioengineering.

Still, that day could be some years and several studies down the road.

Geddes and colleagues have tested the technique only on pigs, never humans. Their results appear in a forthcoming issue of the American Journal of Emergency Medicine.

Unlike traditional CPR, which gives two breaths by mouth for every 30 compressions, this technique produces a breath for every compression by creating downward pressure on the diaphragm, delivering more air.

The method also results in 25 percent more blood flow through the heart than CPR and eliminates the possibility that the blood could flow in the wrong direction, one of the reasons that CPR sometimes fails.

"This is really not replacing CPR but improving it," said Dr. Raymond Fish, a research professor at the University of Illinois at Champaign-Urbana, who trained as an emergency room physician and is familiar with Geddes' work. "He has some really good ideas, but people in the past just haven't put it together and said, 'How can we improve this?' "

Other researchers have suggested that abdominal compression be done in conjunction with standard chest compression CPR, but no one has proposed doing abdominal compression alone, said Mark Mattes, a Clarian respiratory therapist who serves on the American Heart Association's emergency cardiovascular care committee.

Every five years, the American Heart Association reviews its CPR guidelines, Mattes said. The last revision was done in 2005.

"Any time someone comes out with some new research, it piques our interest," Mattes said. "We have not had an opportunity to review it and take it through our scientific process, but I am sure it is something we will take a very close look at."

Other experts agree that more work is needed, including studies on humans, before this method will displace standard CPR.

"The concept behind this is a good one in terms of increasing blood flow while doing CPR, while doing away with the need for mouth to mouth," said Dr. Brian Bigelow, a cardiologist with The Care Group. "Right now I would just be sure that people realize this is an extremely preliminary study that hasn't been reproduced anywhere."

While Geddes says his technique can be done using the hands only, he also has developed a device he calls the "home plate." This wooden applicator fits below the rib cage and makes it easier to apply uniform force.

Eventually, he said, he hopes to make the home plate sensitive enough to tell rescuers whether they're applying sufficient force. After that, he envisions petitioning the government to allow researchers to test the device.

But Geddes also recognizes that his challenge lies in persuading others to accept that this radical departure from standard CPR might actually work better.

"The problem is going to be educating people of the value of this thing," he said. "That's human nature; we're all that way, including me. If it's outside our experience, we don't think about it."

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Related Topics: Leadership and Professionalism, Industry News, Cardiac and Circulation, Provider Wellness and Safety, Research, Training

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