Removing the main obstacle to giving CPR

Aaliyah Williams, 11, gets instruction on how to perform hands-only CPR during last year’s Lowcountry Heart Walk.

I’ll never forget running on the crest of the Cooper River bridge one weekend day and coming upon the scene of an overweight, middle-aged man lying on the walkway. A woman less than half his size was performing CPR on him.

That woman turned out to be a friend of mine who works in health care. She and a nurse had taken turns doing CPR while first responders were on their way.

After they arrived, I asked her if she was OK and she hedged, admitting to me that she wanted to wash her mouth out. I sympathized with her and have often wondered if I had the stomach to breath into a stranger’s mouth with mine.

My friend, who didn’t get the man’s name or contact information, suspects that the man did not survive what she thinks was a massive heart attack.

But the memory of that incident sticks in my mind every time I hear about CPR.

Apparently, I’m not alone in being squeamish about mouth-to-mouth.

Steve Traverso, community CPR manager for the American Heart Association’s mid-Atlantic affiliate, says that one of the most common reasons that bystanders don’t perform CPR is the fear of putting their mouth on a stranger’s mouth.

That’s why, for a few years now, the association has been promoting hands-only CPR, particularly for “lay rescuers” or bystanders since 2008.

Traverso says CPR with rescue breathing is preferred for victims of choking, drowning and asphyxiation, as well as children and infants, and is still taught in AHA-credentialed training courses such as Heartsaver, Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support courses.

But for lay rescuers responding to a heart attack, sufficient medical and scientific evidence showed that hands-only CPR is effective at saving lives for a number of reasons. Notably, lay rescuers or bystanders were more willing to do the procedure, which is effective at circulating the existing oxygen in an adult’s bloodstream.

“Hands-only CPR allows a lifesaving action without the need for rescue breathing,” says Traverso of the standard for lay rescuers adopted by the heart association as an update to its Emergency Cardiovascular Care Guidelines.

Hands-only CPR basically involves placing both hands over the sternum and doing two-inch deep compressions at the rapid rate of 100 per minute. (See accompanying box and video for more.) It is recommended for use by people who see a teen or adult suddenly collapse in an “out of hospital” setting, such as at home, at work or in a park.

“When a victim’s chest is compressed two inches, the air is naturally forced out of their lungs. When the chest is allowed to rise, the lungs once again fill with air. This process, called passive ventilation, does allow for some oxygenation of the blood to help sustain life,” says Traverso.

The American Red Cross also is promoting hands-only, or what it calls “Citizen CPR,” and that it is ideal to teach at short presentations, such as “lunch and learn” programs, according to Jennifer Heisler, regional communications officer for the Red Cross Palmetto South Carolina region.

“People are not as aware of the hands-only method as they should be,” she says.

Traverso says that since 2010, the heart association has been working hard to spread the word about hands-only CPR through partners, programs and the media.

“In my time with the AHA (heart association) I’ve seen a tremendous increase in the level of awareness around hands-only CPR and I work every day to continue to make communities aware,” says Traverso.

A couple of years ago, doubts were cast by national media reports on the effectiveness of CPR, noting studies showing poor survival rates by those with OHCA (out-of-hospital cardiac arrest).

Among the studies cited was a heart association meta-analysis in 2009 that stated: “Survival from OHCA has not significantly improved in almost three decades, despite enormous efforts in research spending and the development of novel drugs and devices. The aggregate survival rate recorded across various populations, is between 6.7 and 8.4 percent.”

However, some media reports acknowledged accurate figures are hard to determine because studies generally look at specific populations.

Some even noted the effectiveness may have hinged on the reluctance to do CPR and lack of training in it among the reasons.

Dr. David French, associate professor of emergency medicine at the Medical University of South Carolina, says CPR and defibrillation are “the only interventions that have been shown to be effective in restoring a heart beat, but they need to be done as early as possible after the heart stops.”

French has been working with the heart association, all area hospitals and local emergency responders to improve cardiac arrest survival.

Among those efforts include creating a locator database of all the AEDs, or automated external defibrillators, in the area, which the partnership hopes to roll out in May.

Part of the education efforts are aimed at high schoolers.

French says the partnership currently has a pilot program with Wando High School’s health education staff to train more than 1,000 freshman students in hands-only CPR.

Meanwhile, the heart association is working to get a bill passed by South Carolina lawmakers requiring high school students to receive instruction in CPR.

The bill, currently H-3265, was unanimously approved by the House Education & Public Works Committee last week and is expected to be placed on the calendar today for a full vote, coming possibly as soon as Wednesday, according to Yarley Steedly, the state director of government relations for the heart association.

While the bill has broad bipartisan support with more than 20 co-sponsors, as well as the backing from 10 organizations, Steedly was cautious about the possibility of it passing.

“I do not want to speculate on the chances of passage as there are a number of variables that can come into play at any minute during the legislative process. With that being said, the bill is in a favorable position early in the session so there is plenty of time for the bill to pass if any unexpected developments were to occur.”

If it passes, Steedly says it only requires that students be taught hands-only CPR, which includes hands-on practice with a manikin, a life-sized anatomical human model used in education. The method does not require a credentialed instructor.

“If the school wanted to take it a step further and teach CPR for certification, which includes the rescue breathing technique, then they could do that, but it would require the instructor also be certified in CPR,” says Steedly.

Reach David Quick at 937-5516.