11/29/2016
Increasing Survival with only 2 rescuers
Unavoidable pauses in compressions:
1. When giving the 2 breaths after each set of 30 compressions
2. When the rhythm is checked or while the AED is Analyzing the heart’s rhythm
3. Clearing and Pressing the flashing Shock button.
4. Moving a patient out of danger or so you can perform chest compressions
5. Placing a board under the patient to create a hard surface
6. Putting in a advanced airway
7. Switching Rescuer positions when fatigued
In the 2010 AHA guidelines BLS Healthcare Providers were expected to go 2 minutes or 5 cycles of CPR at the right rate and depth. Those who did were awarded an AHA Healthcare Provider completion card. 2015 AHA Guidelines have changed. Research has shown that the average single rescuer fatigued after the first 30 compressions. The same depth as they did at the start of the two minutes decreased. This caused less oxygenated blood circulation to the heart and brain.
Now rescuers are encouraged to go 2 minutes or 5 cycles before switching and to switch sooner if needed or fatigued. The AHA tells us to minimize time off the chest to less than 10 seconds at a time; with more focus on high quality CPR.
This is great; except, if there is more times that a rescuer is needing to switch over the length of the code.
Every time two people switch there is a lag in compression to the accepted time of less than 10 seconds.
Every second counts, even these couple seconds in between switching compressors. If you just switch after 2 minutes only… this is perfect time for the AED to do “It’s” rhythm analyses. The new BLS Provider video tells us the AED can take between 5 – 15 seconds to analyze the heart's rhythm. This gave rescuers plenty of time to switch. After timing hundreds of students during code team scenarios. Some students take anywhere from 2-7 seconds to switch. Some students can go the full two minutes at the correct rate and depth. Others need to switch sooner. Thus creating less survival according to the Chest Compression Fraction (CCF).
The chest compression fraction (CCF) is the proportion of time that chest compressions are performed during cardiac arrest. A CCF of at least 60% is recommended, and a goal of 80% is often achievable with good teamwork.
With the use of two stopwatches…
Start one stopwatch as soon as you give scenario to the team and no pulse is detected. Let it run continuously for length of the code.
The second stopwatch is started and stopped when chest compressions are not being performed on the chest. Giving the recorder a number of seconds counted for pauses in chest compressions.
When code ends subtract the number of seconds paused during chest compressions from the overall code length time. Then divide this number into the amount of the code length time. This gives you real time feedback and the overall % of time compressions were preformed and an indication for survival of a patient for out of hospital discharge a patient will receive.
I had a student that fatigued in the middle of 30 compressions. I watched another student rescuer take over the number where the student stopped without any hesitation or interruption in chest compressions. “It clinked at that moment!!!” Why not! The students continued performing the ration is still 30:2 but took over each other’s numbers when switching. Increasing a higher CCF than they would have had they not taken over each other’s numbers…. It is very hard to explain without showing you. At first it seemed wrong ….this is not taught in the video. But after adopting this for 2 rescuer techniques and seeing the higher survival and the feedback from students is amazing!! Adopting this method has added some other added benefits as well.
The fatiguing 1st (student) Rescuer finishes their 30th compression. States loudly, “Switch!” Then gets ready to start chest compressions. 1st (student) Rescuer continues to perform chest compressions soon after the 2nd (student) Rescuer is done giving the two breaths using the bag mask and is able to take over the position of chest compressor.
The 2nd (student) Rescuer gives 2 breaths; then quickly gets into the proper position for chest compressions and leans in and takes over for the fatigued 1st (student) Rescuer who is still performing chest compressions.
1,2,3,4, The 2nd (student) Rescuer; starts counting out loud and starts performing chest compressions where the 1st (student) Rescuer left off /following the last number stated out loud by 1st (student) Rescuer for the compression performed. 5, 6,7,8,9,10-30.
If the numbers are not taken over like this…adding 3-5 sec for each time it takes rescuers to switch between compressions. Which lowers survival rate…
A Code time of 4 min is the typical amount of time in the hospital where 2 rescuers may have to perform CPR before Code team arrives and takes over….
(Unavoidable Pauses in compressions is only 40 seconds total in 4 minutes with the use of a AED 20 sec for breaths and 20 sec for two rounds of analyzing)
83% chance of survival (2 rescuers performing CPR for 4 minutes)
AED is turned on. AED pads are placed while compressions are being performed until
AED states Analyzing CLEAR Patient for analyzing…Compressions are stopped and Patient is cleared for only 10 seconds
AED states ….Shock Advised or No Shock is advised
Immediately begin chest Compressions after the shock is delivered or the AED states “No Shock advised”
Charging
Compressions are resumed immediately.
Shock light flashes indicating shock is fully charged and ready.
Patient is cleared
Shock button is pressed and delivered.
Compressions are resumed immediately.
• During the code the rescuers continued to perform chest compressions while the AED was charging... After shock button light flashes; the patient is cleared. The Shock button is pressed and delivers a shock. The Compressing rescuer hovers above patient safe and ready to resume chest compressions immediately after "Shocking” is delivered.
• An Open Airway was maintained the entire time compressions were being performed
• Breaths were given over only for 1 sec each with just enough breath to make the chest rise.
• Roles and Responsibilities we immediately established by the team leader. Clear communication and Good team dynamics were accomplished. Everyone knew their limitations and communicated it.
83% chance of survival (2 rescuers preforming CPR for 4 minutes)
ROSC or Code team arrives and takes over…..
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.(Fatigued Rescuer) “Switch”2 sec (paused) for breaths. 1,2,3,4,5,6,7,8,9,10, 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.“Switch” 10 sec pause AED analyzing Shock advised1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths (fatigued Rescuer) “Switch”1,2,3,4,5,67,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30. 2 sec (paused) for breaths (fatigued Rescuer) “Switch” 1,2,3,4,56,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30.2 sec (paused) for breaths Switch” 10 sec pause AED analyzing Shock advised
