Cardiopulmonary resuscitation (CPR) is the major discovery of last century that has saved many lives over the years. In spite of this , there has been lot of debate over the exact methodology adopted .The much published techniques of Basic cardaic life support (BCLS) which is in vogue for over 2 decades has failed to deliver the results as one would have expected.
The main reason identified was , the protocol seemed too complex and people hesitated to do the mouth to mouth breathing in a stranger. Many were not confident about doing proper chest compression and inter spaced with breathing support.( The ratios of chest compression : ventilation 30:2 /15: 2 tend to be too cumbersome in an emergency !)
Many of the potential resuscitators preferred to become silent spectators !
The world bodies ACC/AHA/ILCOR has been watching this evolving pattern and behaviour . Mean while when we looked into the data of survivors of cardiac resuscitation , we realised even an improper and inadequate CPR had some positive effect on survival . How was this possible ?
There have been innumerable instances of individual and institutional reports about many lives that have been saved simply by compressing the chest after cardiac arrest or at least kept the person alive and breathing to be taken for advanced cardiac life support.
This simple experience has since become strong evidence when Lancet got it published in 2007 . Subsequently the ILCOR/ACC have also adopted a new advice namely compression only CPR
Read complete ILCOR recommendations http://circ.ahajournals.org/content/vol112/24_suppl/
Excerpts from the above article reproduced
Compression-Only CPR
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest.In surveys healthcare providers well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation . Some animal studies and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR .
If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR
Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths .
Final message
In this world of hi tech life support devices like LV assist systems, implantable defibrillators robotic surgery , it is heartening to note a pair of human hands can save a human life or at least sustain a life till the advanced emergency service reach the patient.
The fact that hands can act as a artificial heart lung machine at least for few minutes could be the greatest invention for the mankind by the mankind.
* Note of caution
Under ideal conditions both chest compression , proper airway , and assisted breathing is always better than simple chest compression .This blog wants to convey the point chest compression alone could also be a effective CPR measure .
References
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60451-6/abstract
Newyork times reports chest compression only CPR
Click below to read the article .
http://www.nytimes.com/2007/03/17/health/17cpr.html
Dr.S.Venkatesan MD 
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