Cardiac Arrest: Stick to Chest Compressions
by Dr. V.P. Nair
The Straits Times Singapore - 15 March 2007

Dr Andy Ho raised a few heartbeats with his article, "CPR may not be the best option" (ST, March 12, 2007), on the value of cardio-cerebral resuscitation (CCR) versus cardio-pulmonary resuscitation(CPR).

I wish to relate a real-life experience during the Prime Minister's National Day Rally at the Indoor Stadium in 1998, when Mr S.D. Maniam collapsed, followed by fits and loss of consciousness. i was seated a few rows behind him when i realised he was in cardiac arrest.

He was pulseless and I immediately started rapid chest compressions. He survived. He was later taken to hospital, where an ECG confirmed an acute heart attack. A coronary angiogram done later confirmed severe coronary-artery disease. He then underwent successful triple-vessel coronary-artery bypass surgery.

Today, 19 years after CCR and subsequent definitive therapy, Mr Maniam is hale and hearty.

The heart-warming moral of this 1998 experience: CCR is the best modality of treatment in a cardiac arrest.

There has been plenty of discussion on the effecs and methodology of CPR versus CCR.

The time-honoured CPR underwent dramatic changes from the initial five to two, meaning five chest compressions to two mouth-to-mouth respiration (occasionally mouth-to-nose respiration), about four decades ago, to 15 to two, and, recently, 30 to two, and now, 100 to zero, meaning 100 chest compressions to zero or no mouth-mouth respiration.

The compressions remain at 1.5 to 2 inches, or 4 to 5 cm depth.

In my humble opinion, Singapore should change the guidelines, to do CCR for all cardiac-arrest patients at a rate of roughly 100 compressions per minute till definite medical help arrives. This will certainly save more lives.

Interruption of chest compressions even for a seconds, such as to do mouth-to-mouth respiration, will impede blood flow to central circulation, such as the heart and the brain. Moreover, CCR will save one from getting incidental cross infections.

With enough proof from the United Sates and Japan, which saw an enhanced survival rate of 300 per cent with CCR, this methodology must be seriously considered.

However, CPR still has a place for resuscitation of the lungs in cases of drowning or drug overdose.

- Dr. V.P. Nair, Cardiologist