A bit of googling shows it is widely discussed and was once in CPR guidelines (but isn't any more). https://pubmed.ncbi.nlm.nih.gov/34034775/ is a recent randomized trial that found no improvement.
That's what they taught us in Boy Scouts. Very first step is to get help.
Have someone call 911 (or whatever number in your country) immediately. If nobody is nearby start yelling.
Only one time in my life have I had to perform CPR (was already too late) but it is amazing how much of what I learned when I was 11 years old stuck with me.
Get help, check airway for obstructions...etc. Most importantly...take a CPR class sometime in your life and do what they say. The "ABC" of airway, breathing, circulation they taught us may not be current advice.
Sidenote: Don't be too hard on yourself if you don't save a life...even the pros say unless the patient is young/healthy you likely won't.
Edit: The feeling when the pros actually show up (in the case where I was doing CPR within minutes) is one of the biggest reliefs I have had in my life. Even knowing CPR...you feel helpless until they show up. And once they do ask immediately if they need you. If not...get out of the way.
Some experts believe that some situations may see better outcomes if circulation is prioritized over respiration. Most experts agree that it is still best to teach ABC.
(CPR instructor, paramedic, instructor) - all outcomes are better with CAB. Circulation first, or only.
Two main reasons: 1: blood can remain somewhat perfused with oxygen for about 8 minutes - but needs to circulate, 2: as a rough rule of thumb, your chance of survival goes down about 10% for every minute that you need compressions but aren't getting them.
> The "ABC" of airway, breathing, circulation they taught us may not be current advice.
The version taught in Australian first aid classes is DRSABCD: check for (D)anger, check for patient (R)esponse, (S)end for help, (A)irway, (B)reathing, (C)irculation.
On a whim, I did EMT-B training a few years ago. Part of that course is a responder-level CPR cert. Through muscle memory, one of my fellow students jumped on scene during the evaluation, and the first thing she did was instruct a bystander to "Call 911!"
A co-worker once went into cardiac arrest and, thankfully, survived due to another co-worker performing CPR. I held the affected co-worker's head while the CPR was being performed.
Just being in a high stress environment doesn't avoid the basic problem of reverting to training in extremely urgent situations. And when said training doesn't exist most people don't perform very well. It goes both ways--my wife is not one that fares well under stress, but one day she dislocated her finger. To her own amazement she calmly put it back--because she knew how and it's something she had experience with doing for others.
Fire drills are about ensuring everyone knows what to do, they aren't done enough to make people revert to training when there's a fire.
Also, in most places, calling 911 for a cardiac arrest will result in the dispatcher staying on the phone with you and doing telephonic CPR coaching (dispatchers typically work in pairs - one is talking to you on the phone, and the other has the phone in one earpiece, but the other is radio, so they're dispatching units while listening, and doing call-taking notes between them.
I remember doing a fire drill once at work - we all headed down the emergency staircase and every single one of us missed the big sign on the door saying EXIT and ended up down in the basement - even those of us who were the floor marshalls.
A great wakeup call for what can go wrong even if all the right signage is in place, and how easy it is to just trust the person in front of you assuming they know what they are doing. As the parent says, fire drills exist for a reason.
> I don't know if the author of this post had any medical credentials.
In his defense, this is written on his personal blog where (quite possibly) many readers already have some reason to trust his advice. And while I'm not sure what counts as appropriate credentials, on his linked HN bio (https://news.ycombinator.com/user?id=bookofjoe) he claims to be a "Retired (38 years in practice) neurosurgical anesthesiologist". He also links to a lot of Google Scholar papers on medical topics for which he is a co-author.
(Oops, beaten by Dan, but I'll leave it up anyway. While I agree with Dan that you might have phrased it a bit better, I did think it was a fair question.)
I once killed a kitten and then brought it back from the dead with CPR.
It was a stray that showed up, was covered in fleas. I decided to bathe it and it didnt occur to me that cold/room temp water would not be good for it. It was fighting but I just assumed it didnt like the water. Then it just went limp.
Quickly googled CPR cat, saw something in the (pre-AI) preview thing about blow into its nostrils (the chest was quite surprisingly inflating like a balloon without much force), and just started doing that while poking/pinching its heart area. Some amount of time later - could have been 5 seconds or 45 - it sputtered back to life.
I found it a foster shortly after. I have significant allergies to cat hair, scratches etc...
This information is outdated, wrong, and DANGEROUS.
Lifting the legs (aka shock position) has no effect and has been taken out of most first-aid guidelines for a reason.
The post also mentions "60 times a minute" when doing CPR. This is WAY to slow. Ideally you should push down 100-120 times a minute. If you do it 60 times a minutes you will not be able to generate enough blood pressure and the blood will not circulate - which is the goal of CPR.
The most important things you can do for someone during a cardiac arrest is:
- Call 911 / call for help
- Do CPR
- If there is an AED nearby - get someone to fetch it, turn it on and follow instructions
For the love of god, do not just stand there with the legs in the air.
If you want to learn CPR, the Disque Foundation allows you to take the class for free and attests to be aligned with the current ILCOR protocol (you might catch minor discrepancies). Before you pay them though, know that for certification some institutions will require an AHA or ARC issued certificate.
Better yet take a first aid and CPR course every 2 years from now until they tell you that you are physically unable to do it anymore. It isn't fun, but it also only takes a few hours and if you ever need it you will want plenty of by standers around who jump in to help until emergency services arrive.
This is the sign for you to go sign up for a CPR course.
It's pretty straight-forward to learn and it's worthwhile.
I'm not sure who this post is for. If you find the advice in the post helpful, then go take a BLS course. The AHA one is very good.
Just reading this post that is essentially suggesting to treat cardiac arrest with Trendelenburg position isn't going to do much even compared to the very low chances of a ROSC even with an AED and quality compressions.
To the extent the advice is to do anything other than go take a short BLS course this post seems almost irresponsible. I don't care who is suggesting it.
My honest, and objective as possible opinion is that this post is actively dangerous. Doing CPR at 60 compressions / minute is not resuscitating anybody. And if your patient has pulmonary edema, ICP etc., if they were breathing or at any hope of resuscitation... not any more.
I know the author is a physician, and I am/was merely a paramedic - but everything in that post was debunked 20+ years ago as not improving outcomes (or worse), leading me to think that was when they retired... or last did CE.
Although I suspect you also know this, just given the use of "ROSC".
My 45 year old gf went from saying she wants to skip work and go to the doctor, to passing out into a wall within 10 minutes. She went into full cardiac arrest and went into the wall so hard she broke the drywall with her head.
I called 911, ran outside to get the address while it rang, and after 30+ seconds answer I g questions and answering questions (which felt like 2+ minutes at the time), they had me start CPR. Never taken a class before.
Paramedics arrived 7 minutes later.
They used an automated chest compression machine, shocked her many times, and got some kind of signal.
Arrived to the ER still in code blue.
Turns out it was a SCAD event. 90% of women that have one die even if they get cpr.
Somehow my gf made it, and was released to home 3 days later after 2 days in the ICU. She had a stent installed within an hour of getting to the ER.
The fire department put together a reunion with the dispatcher, me, my gf, the firefighters that arrived first and did the whole thing, and the EMT team, because they say it’s not often someone survives full cardiac arrest outside a hospital.
> The fire department put together a reunion with the dispatcher, me, my gf, the firefighters that arrived first and did the whole thing, and the EMT team, because they say it’s not often someone survives full cardiac arrest outside a hospital.
Witnessed and early compressions saved her life.
Depending on where you are in the country, even then, your chances of survival vary greatly based on where you are. NY? 11%. Detroit? 7%.
Want to survive? Have your out of hospital arrest witnessed, early compressions and defib, and have it happen in Rochester County MN, King County WA, Pierce County WA or Thurston County WA, where the numbers are in the 40s generally, and those four counties typically are the top 4, though in varying order year to year.
In many cases, what happens is that your normal sinus rhythm degenerates into a shockable rhythm (VF/VT, with an AED, paramedics may manually shock other rhythms), and then, from there, into other worse rhythms (PEA - pulseless electrical activity, asystole) which are generally much harder to come back from. Even with multiple shocks, or ROSC (return of spontaneous circulation), re-arrest is very common, because we've only really "rebooted" the heart, not solved the underlying problem, which is why the other factor in cardiac arrest survival of those origins is "door to balloon time" (i.e. from arrival in the ED to a stent being placed in the cath lab).
Stented within an hour is excellent - the current "gold standard" is still <90m, though most leading hospitals are (and should, it's already more the case in Europe) pushing for D2B of <60m.
If CPR is the best option available, they will tell you that and walk you through how to do it properly.
They will also ask you relevant questions that would normally be obvious, but might not be if you are in a panic like "are they laying in the street and might be run over? First drag them off of the road before starting CPR", etc...
Not a physician. Paramedic with 14 years experience, teaching, and a Masters in Biomed Sci. Though it's a few years rusty, so forgive a little hiccup if there is.
There is so much wrong with this post, that I actually flagged it.
> (on the chest, hard, 60 times a minute)
What? You need about 100-120 times per minute to have any hope of building up any venous pressure to perfuse tissue. You lose that within seconds of stopping compressions and it takes time to build up.
This is absolutely not what you should be doing. The physiology works, but generally on people with a pulse.
> By doing so you increase blood return to the central circulation — the heart and lungs, where it's needed to restore spontaneous heartbeat — from the periphery, where it's irrelevant for survival in a circulatory crisis.
This is not basic physiology, it's inaccurate in many ways. Much arrest, regardless of cause, is an electrical issue, hence defibrillation as one of the two markers towards potential survival "early access to defib and effective chest compressions". (Also, think of defib as rebooting the heart, not jump-starting it). Getting blood to the cardiac muscle (better hope there's no tamponade) is doing very little in itself to restart the heart - I can push oxygenated blood around your body all day with excellent compressions but it's not kicking you out of asystole.
> The best part is that you can't do any harm.
I mean, it absolutely can. For one, laypeople are notoriously "not great" at diagnosing cardiac arrest in all but the most obvious cases, in which case survival odds are poor. That's why we tell people to begin compressions if the patient is unresponsive. It's hard enough to teach new EMTs to reliably find a weak/thready carotid pulse or the absence thereof.
Better hope your patient doesn't have spinal injuries. Better hope your patient doesn't have pulmonary edema, better hope your patient isn't having a stroke or other issues around intracranial pressure.
Stop fucking around with urban legends and debunked theories (once upon a time, for hypovolemic shock, a variation of this was used) and get on the chest. Shitty chest compressions are better than none.
This is so ... problematic and simplistic, and doesn't actually solve the problem.
41 comments
[ 5.3 ms ] story [ 13.0 ms ] threadHave someone call 911 (or whatever number in your country) immediately. If nobody is nearby start yelling.
Only one time in my life have I had to perform CPR (was already too late) but it is amazing how much of what I learned when I was 11 years old stuck with me.
Get help, check airway for obstructions...etc. Most importantly...take a CPR class sometime in your life and do what they say. The "ABC" of airway, breathing, circulation they taught us may not be current advice.
Sidenote: Don't be too hard on yourself if you don't save a life...even the pros say unless the patient is young/healthy you likely won't.
Edit: The feeling when the pros actually show up (in the case where I was doing CPR within minutes) is one of the biggest reliefs I have had in my life. Even knowing CPR...you feel helpless until they show up. And once they do ask immediately if they need you. If not...get out of the way.
https://www.redcross.org/take-a-class/resources/articles/abc...
Some experts believe that some situations may see better outcomes if circulation is prioritized over respiration. Most experts agree that it is still best to teach ABC.
Two main reasons: 1: blood can remain somewhat perfused with oxygen for about 8 minutes - but needs to circulate, 2: as a rough rule of thumb, your chance of survival goes down about 10% for every minute that you need compressions but aren't getting them.
The version taught in Australian first aid classes is DRSABCD: check for (D)anger, check for patient (R)esponse, (S)end for help, (A)irway, (B)reathing, (C)irculation.
To which the evaluator responded, "You are 911"
I write more about the whole process here: https://x.com/alexpotato/status/2094412327785316661
Some key takeaways:
- I had taken CPR many times before
- I watched the entire even unfold from watching co-worker walk in to seizure like symptoms to not breathing to urinating on themselves
- I essentially "froze"
- This was despite having years of working in high stress environments (sports tournaments/SRE on a trading floor)
- I was literally overcome by events and could not process what was happening (despite the prior training and dealing with outages etc etc)
I HIGHLY recommend that everyone, at a minimum, watch a video on how to perform CPR. Even better, take a class.
And even if you take a class, practice on a couch cushion every once in a while.
It's just like with 911:
there are stories of people in an emergency dialing 411 b/c they were overwhelmed.
In other words, fire drills exist for a reason and the same concept can be used for CPR.
Fire drills are about ensuring everyone knows what to do, they aren't done enough to make people revert to training when there's a fire.
I remember doing a fire drill once at work - we all headed down the emergency staircase and every single one of us missed the big sign on the door saying EXIT and ended up down in the basement - even those of us who were the floor marshalls.
A great wakeup call for what can go wrong even if all the right signage is in place, and how easy it is to just trust the person in front of you assuming they know what they are doing. As the parent says, fire drills exist for a reason.
Why am I holding their legs in the air?
Well I read it on hacker news once.
Hacker news, oh it collates techy/stem blog posts and articles.
I don't know if the author of this post had any medical credentials.
I can see why it doesn't look like they knew what they were writing about.
In his defense, this is written on his personal blog where (quite possibly) many readers already have some reason to trust his advice. And while I'm not sure what counts as appropriate credentials, on his linked HN bio (https://news.ycombinator.com/user?id=bookofjoe) he claims to be a "Retired (38 years in practice) neurosurgical anesthesiologist". He also links to a lot of Google Scholar papers on medical topics for which he is a co-author.
(Oops, beaten by Dan, but I'll leave it up anyway. While I agree with Dan that you might have phrased it a bit better, I did think it was a fair question.)
It was a stray that showed up, was covered in fleas. I decided to bathe it and it didnt occur to me that cold/room temp water would not be good for it. It was fighting but I just assumed it didnt like the water. Then it just went limp.
Quickly googled CPR cat, saw something in the (pre-AI) preview thing about blow into its nostrils (the chest was quite surprisingly inflating like a balloon without much force), and just started doing that while poking/pinching its heart area. Some amount of time later - could have been 5 seconds or 45 - it sputtered back to life.
I found it a foster shortly after. I have significant allergies to cat hair, scratches etc...
Lifting the legs (aka shock position) has no effect and has been taken out of most first-aid guidelines for a reason.
The post also mentions "60 times a minute" when doing CPR. This is WAY to slow. Ideally you should push down 100-120 times a minute. If you do it 60 times a minutes you will not be able to generate enough blood pressure and the blood will not circulate - which is the goal of CPR.
The most important things you can do for someone during a cardiac arrest is: - Call 911 / call for help - Do CPR - If there is an AED nearby - get someone to fetch it, turn it on and follow instructions
For the love of god, do not just stand there with the legs in the air.
CPR: https://disquefoundation.org/cpr-first-aid-aed-certification...
BLS: https://disquefoundation.org/bls-certification-renewal/
It's pretty straight-forward to learn and it's worthwhile.
I'm not sure who this post is for. If you find the advice in the post helpful, then go take a BLS course. The AHA one is very good.
Just reading this post that is essentially suggesting to treat cardiac arrest with Trendelenburg position isn't going to do much even compared to the very low chances of a ROSC even with an AED and quality compressions.
To the extent the advice is to do anything other than go take a short BLS course this post seems almost irresponsible. I don't care who is suggesting it.
I know the author is a physician, and I am/was merely a paramedic - but everything in that post was debunked 20+ years ago as not improving outcomes (or worse), leading me to think that was when they retired... or last did CE.
Although I suspect you also know this, just given the use of "ROSC".
I called 911, ran outside to get the address while it rang, and after 30+ seconds answer I g questions and answering questions (which felt like 2+ minutes at the time), they had me start CPR. Never taken a class before.
Paramedics arrived 7 minutes later.
They used an automated chest compression machine, shocked her many times, and got some kind of signal.
Arrived to the ER still in code blue.
Turns out it was a SCAD event. 90% of women that have one die even if they get cpr.
Somehow my gf made it, and was released to home 3 days later after 2 days in the ICU. She had a stent installed within an hour of getting to the ER.
The fire department put together a reunion with the dispatcher, me, my gf, the firefighters that arrived first and did the whole thing, and the EMT team, because they say it’s not often someone survives full cardiac arrest outside a hospital.
Witnessed and early compressions saved her life.
Depending on where you are in the country, even then, your chances of survival vary greatly based on where you are. NY? 11%. Detroit? 7%.
Want to survive? Have your out of hospital arrest witnessed, early compressions and defib, and have it happen in Rochester County MN, King County WA, Pierce County WA or Thurston County WA, where the numbers are in the 40s generally, and those four counties typically are the top 4, though in varying order year to year.
In many cases, what happens is that your normal sinus rhythm degenerates into a shockable rhythm (VF/VT, with an AED, paramedics may manually shock other rhythms), and then, from there, into other worse rhythms (PEA - pulseless electrical activity, asystole) which are generally much harder to come back from. Even with multiple shocks, or ROSC (return of spontaneous circulation), re-arrest is very common, because we've only really "rebooted" the heart, not solved the underlying problem, which is why the other factor in cardiac arrest survival of those origins is "door to balloon time" (i.e. from arrival in the ED to a stent being placed in the cath lab).
Stented within an hour is excellent - the current "gold standard" is still <90m, though most leading hospitals are (and should, it's already more the case in Europe) pushing for D2B of <60m.
If CPR is the best option available, they will tell you that and walk you through how to do it properly.
They will also ask you relevant questions that would normally be obvious, but might not be if you are in a panic like "are they laying in the street and might be run over? First drag them off of the road before starting CPR", etc...
There is so much wrong with this post, that I actually flagged it.
> (on the chest, hard, 60 times a minute)
What? You need about 100-120 times per minute to have any hope of building up any venous pressure to perfuse tissue. You lose that within seconds of stopping compressions and it takes time to build up.
This is absolutely not what you should be doing. The physiology works, but generally on people with a pulse.
> By doing so you increase blood return to the central circulation — the heart and lungs, where it's needed to restore spontaneous heartbeat — from the periphery, where it's irrelevant for survival in a circulatory crisis.
This is not basic physiology, it's inaccurate in many ways. Much arrest, regardless of cause, is an electrical issue, hence defibrillation as one of the two markers towards potential survival "early access to defib and effective chest compressions". (Also, think of defib as rebooting the heart, not jump-starting it). Getting blood to the cardiac muscle (better hope there's no tamponade) is doing very little in itself to restart the heart - I can push oxygenated blood around your body all day with excellent compressions but it's not kicking you out of asystole.
> The best part is that you can't do any harm.
I mean, it absolutely can. For one, laypeople are notoriously "not great" at diagnosing cardiac arrest in all but the most obvious cases, in which case survival odds are poor. That's why we tell people to begin compressions if the patient is unresponsive. It's hard enough to teach new EMTs to reliably find a weak/thready carotid pulse or the absence thereof.
Better hope your patient doesn't have spinal injuries. Better hope your patient doesn't have pulmonary edema, better hope your patient isn't having a stroke or other issues around intracranial pressure.
Stop fucking around with urban legends and debunked theories (once upon a time, for hypovolemic shock, a variation of this was used) and get on the chest. Shitty chest compressions are better than none.
This is so ... problematic and simplistic, and doesn't actually solve the problem.
If you want more information: https://www.erc.edu/media/p5ymaeej/gl2025_layperson_book_ipd...