Bystanders shouldn’t give ‘kiss of life,’ says MDA

Health Scan: guidelines say compression-only cardiopulmonary resuscitation should be used when a heart stops beating.

Magen David Adom is preparing for its adoption of soon-to-be-published guidelines from the American Heart Association that bystanders should use compression-only cardiopulmonary resuscitation when somebody’s heart stops beating. For years, first-aid courses have taught mouth-to-mouth artificial respiration (which is best performed with a manual pump by a well-trained person) to push air into the lungs, and not only pressing the chest to get the heart to restart.
Now a study published in the Journal of the American Medical Association (JAMA) by Dr. Bentley Bobrow of the Arizona Department of Health Services and colleagues reports outcomes of CPR by bystanders who saw a person collapse and whose heart stopped beating. The researchers found in the study of nearly 4,500 cardiac-arrest patients, that survival rates for those who received compressiononly CPR from laymen was 13.3%, 7.8% for those receiving conventional CPR and 5.2% for those with no CPR.
Compression-only CPR improved the chances for survival by 60% compared to conventional CPR or no CPR.
“Among patients who received bystander CPR, the proportion with compression-only CPR increased significantly over time, from 19.6% in 2005 to 75.9% in 2009,” the researchers asserted. “Overall survival also increased significantly over time: from 3.7% in 2005 to 9.8% in 2009.”
Natan Kudinsky, head of MDA’s training department, told The Jerusalem Post that he believed its medics and volunteers would be advised to continue using CPR with artificial respiration, but that passersby would not; instead, they would be encouraged to use compression-only CPR. Hadassah University Medical Center anesthesiologist and resuscitation expert Prof. Yoel Donchin added that many passersby are reluctant to perform CPR if it involves mouth-to-mouth resuscitation out of fear that they might catch some disease. Thus CRP without ventilation is better than no resuscitation at all.
REDUCING REHOSPITALIZATION Israeli hospital patients are kept in wards for an average of only four days, shorter than in most Western countries. This is not because Israeli doctors have some magic touch that makes patients get better faster, but because of a serious shortage of hospital beds, forcing a “warm bed” policy. Now a study carried out at Assaf Harofeh Medical Center in Tzrifin has found that too- short hospitalizations often lead to patients having to return for more hospital care for the same illness. Fully 26% of the elderly in the past three months were rehospitalized at Assaf Harofeh. This causes a heavy economic burden on the health system. In the US, a quarter of the expenses of health insurance companies is spent on rehospitalization; that comes to $14 billion a year.
But research abroad has found that almost half of all rehospitalization can be prevented if erroneous diagnoses are not made the first time; and if there were no unsuitable treatment, premature discharge, lack of a discharge program and poor communication among the hospital, family and their doctors.
The Assaf Harofeh study included 100 patients with an average age of 69 who were admitted for the second time within a short period after first being in the internal medicine department. The patient, a relative and a hospital nurse provided the reasons for the rehospitalization. The nurses mostly blamed the patient’s failure to take medications, stress, anxiety, poor advice and the lack of followup by the doctor in the community.
The researchers recommended that the hospital teams prepare a checklist of information for the patient and his family; that the community nurse be contacted by a hospital nurse and inform her about the discharge and what more had to be done, including a personal visit within 48 hours, and ensuring that the discharge recommendations be carried out. They also suggested that a new staff position – discharge nurse – be established to improve the planning and implementation of discharge to reduce the number of rehospitalizations.