Cardiocerebral Resuscitation (CCR): The Next Form of Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) has had a gloried run as one of the cornerstones of emergency medicine. For many decades it has been promoted and accepted as one of the main ways to resuscitate people in emergency situations until proper medical care is instituted. Elements of CPR have been officially accepted as far back as the year 1740. (1) However, this may change as researchers have discovered a better way to carry out resuscitation. It is known as Cardiocerebral resuscitation (CCR) and may soon officially replace CPR.

First of all, let us see how both CPR and CCR are carried out and how they are different.

Cardiopulmonary Resuscitation: CPR involves doing the following:

– Chest Compressions: The rescuer places the palms of his or her hands over the center of the victim’s chest. He or she compresses the chest by pushing down and then letting go. This is carried out about 30 times before breaths are given.

– Rescue Breaths: The rescuer places his or her mouth over the victim’s open mouth and blows air into it while pinching the victim’s nose shut. He or she should watch to see that the chest rises and falls with each breath given. This is called mouth-to-mouth breathing. For every 30 compressions, the rescuer gives 2 breaths.

The above are continued alternately until help arrives.

Cardiocerebral Resuscitation: CCR is also known as Continuous Chest Compressions (CCC) and is carried out as follows:

– Chest Compressions: The rescuer compresses the victim’s chest in the same way as described under CPR. About 100 compressions should be carried out per minute.

Thus, CCR removes the need to administer mouth-to-mouth breathing.

Advantages of Cardiocerebral Resuscitation over Cardiopulmonary Resuscitation

1. Improved Survival Rates: The aim of resuscitation is to keep blood flowing to vital organs such as the brain until adequate medical care arrives. CCR has been found to be more effective at this because it provides a continuous blood flow and pressure. Pausing to give rescue breaths causes the blood flow and pressure to drop which could be lethal. (2) Also, giving breaths counteracts the effect of chest compressions by reducing the amount of blood returning to the heart. (3) This results in less blood being available for chest compressions.

Since CCR eliminates these negatives of CPR, it more beneficial in certain patients such as those with cardiac arrest and ventricular fibrillation. (4)(5) It also reduces the incidence of neurological deficits in patients. (5)

In any case, cardiocerebral resuscitation has been to shown to be at least as effective as CPR.

2. Simpler: CPR requires alternating chest compressions with rescue breaths. Removing the need for the rescuer to give breaths makes resuscitation easier and more straight-forward to perform. (3)

3. More Effective: According to Dr. Amal Mattu, a professor of emergency medicine at the University of Maryland Medical Center, rescuers tend not to carry out good chest compressions if they are focused on trying to provide rescue breaths. Their chest compressions may be too slow. (3) Cardiocerebral resuscitation prevents this.

4. Makes Rescuers More Willing to Help: Many people are unwilling to perform mouth-to-mouth breathing as part of CPR especially if the victim is unknown to them. Thus, many medical researchers advocate that CCR should be promoted as the standard for resuscitation outside hospital settings to improve the chances that bystanders will be willing to do so. (6)

Nevertheless, knowledge of traditional CPR is invaluable because about 10 minutes or so after initiating CCR, patients begin to require rescue breaths. The breaths should be given after each 100 compressions. Also, CPR may be better in respiratory arrest. (6)

Sources:

1. History of CPR: American Heart Association

http://www.americanheart.org/presenter.jhtml?identifier=3012990

2. Sarver Heart Center: Be a Lifesaver

http://www.heart.arizona.edu/publiced/lifesaver.htm

3. CPR and CCR Medical Techniques – The Trouble with CPR: Popular Mechanics

http://www.popularmechanics.com/science/health/med-tech/reevaluating-cpr-as-a-life-saving-technique

4. Cardiocerebral Resuscitation Improves Survival of Patients with Out-of-Hospital Cardiac Arrest

http://www.town.madison.wi.us/fire/forms/CCP%20Kellum%20et%20al.pdf

5. CPR with Chest Compression Alone or with Rescue Breathing

http://prod.nejm.org/doi/full/10.1056/NEJMoa0908993#t=article

6. Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation: Gordon A. Ewy, MD

http://circ.ahajournals.org/cgi/content/full/111/16/2134