"in-suspension" CPR ??

The 2000 character limit in the new Create Topic window is ridiculous!! Multi-post OPs, here we go...

I've always assumed that it's not an option to do CPR while in suspension. Of course, proper CPR requires a relatively flat and not too jagged surface to lay the victim on and also an indeterminate length of time available since, once started, you're supposed to keep going until unassisted pulse and breathing start again consistently and durably (unlikely) or until you hand the victim over to specialized services. Of course, alone on a ledge in the middle of a wall, there are going to be limits to how long you can keep this up but my main question is whether a temporary emergency CPR could be administered while both victim and rescuer are suspended in their harnesses.

In a situation where the leader is dangling unconscious after a fall beyond half-rope height on a reasonably straight-up pitch, the fastest self-rescue options involve variations on the theme of counterbalanced climbing/lowering. Unless there's a convenient mid-pitch ledge, this means that the first time the rescuer reaches the victim will be while they are both in suspension. A cursory assessment can be done as soon as both are securely backed-up to an intermediate anchor. Some emergency first aid may be applied as well, if necessary: dealing with an important hemorrhage, clearing airway, inserting (and taping in place) an OPA, pushing a few breaths into the victim if he has a pulse but is still not breathing after inserting the OPA (again: unlikely).

However, if you can't find a pulse, could it be possible to perform some emergency chest compressions right there and then? In this situation, I can think of only 2 ways to push on the victim's chest that would not simply bounce the two partners away from each other:

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(part II)

1) If the rescuer positions himself behind the victim so that his own body will be the backing surface behind the victim. In this position, the chest compressions would have to be something similar to the Heimlich maneuver, with the rescuer "hugging" the victim and pushing one fist (backed by the other hand) hard into the victim's sternum.

2) The rescuer would have to loop a couple of webbing slings around both his and the victim's upper body (over the shoulders and under the armpits and crossed to keep in place), leaving just enough space between the two to deliver a face-to-face compression.

I really don't know if either approach would actually do anything since neither would allow the standard hand position (heel) for the compression or have the weight of the rescuer's upper body behind it, as in normal CPR (although the second approach  should come close). In any case, it's clear that the first approach would be heavily  depend on the respective sizes and strengths of rescuer and victim whereas the second would be more awkward and time-consuming to set up but might work for a rescuer who is significantly smaller than the victim.

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(part III)

Google searches for a variety of keywords relating to this hypothetical approach haven't turned up anything. Has anyone had a chance to try something like this on a CPR dummy before? Even if it could work, it's obviously not something that could be sustained over a long time, especially with suspension trauma making its rapid progress in addition to everything else. At best, I imagine that it would involve delivering a few breaths (mouth-to-mouth) and a limited number of compressions prior to resuming the self-rescue procedure. While it's best to keep up CPR once started, it's acceptable to stop and resume later (ie asap) if necessary. If the in-suspension CPR does have the potential to get some oxygen into the blood and deliver the blood to vital organs, it might  tide the victim over until proper CPR can be administered on a ledge or the ground, especially if the fall was high on the pitch and it already took you a few minutes to get to the meetup point and getting the victim back to the ledge will most likely take several more.

Does anyone have additional info or constructive comments on this?

Doing CPR on a traumatic full arrest is pretty pointless and is done more for the rescuer or partner to make them feel like they did something.   Traumatic full arrests have about a .0009% chance of recovery.   Medical full arrest is another animal and should receive aggressive chest compressions until relieved by first responders or until yet exhausted.   I have performed CPR on both medical and traumatic arrests hundreds of times and have never seen a traumatic gain and keep a pulse.

Not really, no. Even in ideal conditions - flat surface, safe conditions, freedom of movement for the rescuer, emergency services arriving shortly - CPR is extremely unlikely to be helpful. If your climbing partner is hanging in their harness and breathless/pulseless due to a traumatic injury in a fall (or rockfall, etc), the extremely unpleasant reality is there's nothing you can do for them. 

As a longtime paramedic, I agree with the above two comments.

The most recent research on CPR is showing that unless compressions are close to perfect, they're pretty worthless. In suspension, "good" compressions are all but impossible. And since they will be muscular-driven in nature (as opposed to skeletal-gravity under normal circumstances) the rescuer will tire before the first cycle of compressions is even completed.  Further, coronory perfusion pressure starts dropping after a 10 second interruption in compressions. Just a small readjustment of a prussik foot loop could take you 1-2 minutes.

And Kevin above is correct - there is no hope in resuscitating a traumatic arrest. A medical arrest... maaaaybe, but that assumes a rapid rescue and short wait times to definitive care.  The odds of resuscitating a even a medical arrest in the wilderness are essentially zero.

Conclusion: Don't even bother with CPR for a traumatic arrest no matter where you are. Don't waste your energy on CPR in a wilderness (e.g. the Wind Rivers) setting. You will need your strength to perform self rescue. If the victim is already pulseless and in respiratory arrest, they are dead. The only benefit to even a short round of CPR is maybe to help you cope with survivor's guilt long into the future. It's morbid, but it's the truth.  Somewhere like the Gunks, where rescue is only minutes away, get the victim to flat surface and perform rapid compressions (100/minute) to a depth of 1.5 inches until relieved.

A traumatic cardiac arrest in a rescue situation is a fatality.

Scott O wrote:

A traumatic cardiac arrest in a rescue situation is a fatality.

This. The only exception would be if you were at a roadside crag close with a good conventional EMS system. In this case, get the victim to the ground ASAP, begin CPR afterwards. If someone survived something like this, I'd be national news.

So anyone going to argue that by the time you reach a hanging climber in medical arrest there's a snowball's chance? 

Stats for elapsed times of collapse to receiving compressions and from collapse to receiving defibrillation show precious little time for any reasonable chance of survival, and that's assuming an AED (or paramedic with Manual defibrillator) is available.

So, do you have an AED in the first place? and if so, how long is all of this going to take until the AED is administered? Chances are slim in ideal conditions. I don't see that snowball's chance in a real climbing scenario.

Is trauma from the fall what caused arrest? Sorry, he's dead.

Did a medical condition cause the arrest and then the fall? GET THEM DOWN, then start CPR. Bad CPR is not much better than no CPR, and you're not going to get good, suspended CPR without a litter. Once you start CPR current protocol from most wilderness medicine training is until a pulse is regained, handed off to a higher level of care, it becomes unsafe for the rescuer, or half an hour of continuous pulse-less CPR has been preformed. Even in the medical situation, chances of regaining a pulse without defribulation are statistically insignificant, and with defib within the first ten minutes, still not good. But a medical condition so severe as to cause cardiac arrest will rarely come on so suddenly and with so few symptoms that you shouldn't have your partner down to the ground, and ideally on their way to the ER, BEFORE they arrest.  

A heart attack with warning signs is a different thing that a sudden arrest. Indeed you are right about dealing with heart attack symptoms, but arrest is a different story, and the point of the OP.

(you are also right that the best thing is to get them down if possible and give it a try, but the reality of survivability of treating someone suspended in arrest whether trauma or medical is nil.)

Please also be aware that it's about 50/50 whether you'll see those heart attack warning signs prior to death from arrest. google "sudden cardiac death":

"Sudden cardiac death (SCD) is a sudden, unexpected death caused by loss ofheart function (sudden cardiac arrest). It is the largest cause of natural death in the U.S., causing about 325,000 adult deaths in the U.S. each year. SCD is responsible for half of all heart disease deaths."

I agree with all of the above concerns about traumatic arrest and doing CPR in physically difficult situations. I don't mean any disrespect to the OP but since you sound quite interested: my guess is that you haven't done quality compressions on a real patient under the supervision of someone experienced in CPR. Once you have, I think you'll see how difficult it would be to do compressions on a wall. Even in a bed makes the compressions harder than on the floor. From behind, as you started to compress you'd lose all mechanical advantage once you compressed just a tiny amount, because the patient's body would block your arms. In my very limited experience with the Heimlich, it is much harder to do than compressions.

I would just caution about telling first responders not to do CPR in certain situations (ie traumatic arrest). Did the patient start seizing a minute or two after they hit their head and go into hypoxic arrest? Did they get struck by lightning, arrest, and take a fall in which they weren't injured?

If you have ANY doubt as to why the patient arrested, do CPR.

Optimistic wrote:

If you have ANY doubt as to why the patient arrested, do CPR.

Sure, if you can do CPR safely and effectively, no reason not to. But rigging up slings and squeezing them in a bear hug from behind is not CPR. 

Optimistic wrote:

If you have ANY doubt as to why the patient arrested, do CPR.

And remain optimistic!

Em Cos wrote:

Sure, if you can do CPR safely and effectively, no reason not to. But rigging up slings and squeezing them in a bear hug from behind is not CPR. 

Yep, just as I said in my post.

mountainhick wrote:

And remain optimistic!

None too easy in this nightmare scenario.

I agree with the previous posted comments. I'm a WEMT and Wilderness Medicine Instructor.  CPR for Cardiac Arrest from a traumatic injury is going to be hopeless on a wall.  You also can't do CPR without a firm surface.  

The one scenario that I can think of where immediate "still on the wall" CPR could be effective would be a lightning strike. Thats about the only situation I can think of in which you could resuscitate a patient without an AED (and I still don't know the real world effectiveness of this). But you would still need a firm surface to press against.  If you are hanging as well, you aren't going to get a worthwhile compression. 

Generally in wilderness medicine we say that you can stop CPR after 30 minutes (rather than the "keep on going until EMS arrives" mentality of urban first responders). 

As far as a heart attack, the best thing you can do is share pertinent medical history with your partner before climbing.  And carry baby aspirin in you're first aid kit.  I would still attempt CPR on this person, but you'd have to be in a position to be able to do so.

It is the nightmare scenario.

Aahh. 10 000 character limit now. Much better.

Thanks all for the comments. I know that this is a long shot at best.

The only CPRs I've ever had the chance to do have been on practice dummies. I assume that these don't make it easy for the trainees or there'd be no point in them so I assume that I have some idea of what it takes to do it right. As I said, I haven't had the opportunity to try options 1 or 2 on a dummy but, based on my experience with those, it didn't seem so outlandish that option 2 might work well-enough for a short while just to tide the victim over (sort of like doing quick, sharp push-ups). As for option 1, it's clear that if it worked at all, it would only be for a big rescuer on a smaller victim.

I understand why we might naturally assume that the cardiac arrest must be the result of trauma from the fall. However, in situations where the victim isn't obviously and majorly mangled (obvious broken neck, major/rapid exsanguination, etc.), I wouldn't automatically conclude that CPR would be useless. If the victim wore a helmet, major head trauma can occur and lead to cardiac arrest without obvious mangling of the helmet itself or other parts of the victim's body. Conversely, spectacular-looking limb fractures and blood-smeared wounds could have resulted from the fall while the fall itself was caused by a medical event. The fall-catching pro being well above half-rope height means that the fall likely occurred around at least 2/3 rope height. I can't imagine that, based on what I might have seen and heard from that distance, I would be able to tell for sure if my leader's fall was purely accidental or not.

As for getting the victim down fast, in this situation, that's obviously much easier said than done. On a second pitch, even with specialized help on its way to the bottom and even if, for the sake of speed, you're willing to take the risk that the top pro might pop while you're CB climbing/lowering (of if that pro is a solid bolt), it will still be a few minutes (easily 4-5) before you get both the victim and yourself down to the first belay and that's unlikely to be ideally-suited for a textbook CPR. It would then be about as long again before you can lower the victim to the bottom and, hopefully, into the hands of others waiting there.

This is far from a wilderness scenario but, even then, you're clearly within the time frame where some measure to tide the victim over, if it worked (even less than ideally), could make a difference, whereas focussing solely on getting the pulseless victim into the hands of specialized services at the bottom would make it much more likely that this will be a body recovery rather than a rescue or that the prognosis, if the victim survives, will be significantly worse. That's why I was hoping for some sort of stopgap measure. Of course, it would have to have a half-decent chance of being effective to justify spending a minute or two on it, given the urgency of the situation. I'm just not convinced that we can write off any such measure without ever having tried it. Maybe I'd only be assuaging my own conscience with this but, on the other hand, I can imagine how I'd feel if it turned out that this was purely a medical arrest and that some CPR partway down might have made for a much better outcome.

jktinst wrote:

Aahh. 10 000 character limit now. Much better.

Thanks all for the comments. I know that this is a long shot at best.

The only CPRs I've ever had the chance to do have been on practice dummies. I assume that these don't make it easy for the trainees or there'd be no point in them so I assume that I have some idea of what it takes to do it right. 

I promise I'm not trying to give you a hard time, but I thought exactly the same thing...until I did chest compressions on a real patient.  Unless your partners are mostly in their mid-90's, as many of my patients are, you're going to be quite surprised at how much work it is.  You might want to volunteer on a rescue squad or in an ER if you want to see what it's like, and hopefully that's the only time you'll ever encounter it.

jktinst wrote:

As for getting the victim down fast, in this situation, that's obviously much easier said than done. On a second pitch, even with specialized help on its way to the bottom and even if, for the sake of speed, you're willing to take the risk that the top pro might pop while you're CB climbing/lowering (of if that pro is a solid bolt), it will still be a few minutes (easily 4-5) before you get both the victim and yourself down to the first belay and that's unlikely to be ideally-suited for a textbook CPR. It would then be about as long again before you can lower the victim to the bottom and, hopefully, into the hands of others waiting there.

Take a self rescue course and get back to us about that kind of speed. I don't know anyone who could get an unconscious patient down that fast unless it's a simple lower no higher off the deck than 1/2 rope length, i.e. lower straight to the ground.

 focussing solely on getting the pulseless victim into the hands of specialized services at the bottom would make it much more likely that this will be a body recovery rather than a rescue or that the prognosis,

Realistically, without compressions initiated for 5-10 minutes of shenanigans, game's over.

 I can imagine how I'd feel if it turned out that this was purely a medical arrest and that some CPR partway down might have made for a much better outcome.

Rest assured, it wouldn't.