Talk:Cardiopulmonary resuscitation/Archive 1

message: Most of this page looks like it was copied directly from the external link. There are probably copyright issues. Bummer. -- Merphant
Changes July 27 look good - thanks philb
:I've emailed Columbia University about this. -Smack 20:16, 10 Aug 2003 (UTC)
replies: text: Outcome of the above email to Columbia not reported here.  I assume that means they're okay with it.  But even if we don't know that for sure, I would not favour trying to remove copyrighted parts of the text unless anyone really makes a fuss.  There is too much risk of messing it up in the process.  This is lives we could be talking about.  --Trainspotter 00:11, 12 May 2004 (UTC)
thread_title: Untitled

message: I've removed some external links added by an anonymous user (68.7.15.227). They were removed by me, then added by the user again. As far as I can tell they are links to commercial sites and as the user has contributed only those links to wikipedia, I think they are just spam.
If the user wishes to add them to the page again could they please explain here their justification for doing so? Tjwood 17:48, 10 Jun 2004 (UTC)
replies: text: Someone just added a link to Atlantic Life Safety, a training company.  Noticed this during RC patrol, because they also added another ad-type article.  CPR experts, please decide if this should stay in.  Thanks. --John Nagle 03:59, 14 August 2006 (UTC)
thread_title: Commerical external links

message: I've tried to contribute something about calling for help since I though the section was not very complete, but I realised that the article was organised quite differently than I though. Perhaps we have different systems depending on countries...  Do you systematically call for an ambulance when you have an uncounscious patient ? This is what we are trained to do here... Also, we never interrupt CPR unless asked by a physician (typically, patient dead :( ) or by the rescuer who's in charge of the defibrillation (for analysing, shoking, or stoping the CPR if the defibriallation has been successful). Sorry if I've been messy ! Rama 12:03, 29 Nov 2004 (UTC)
replies: text: I recently took a Norwegian Red Cross first-aid course, and we were told not to be afraid to call the emergency number. In fact, the Norwegian Red Cross has a campaign going currently to try to get people to call ambulances earlier. So yes, it's probably a good idea to call for help when a person loses consciousness, perhaps unless you know what's wrong with him or her. Ask an expert. --Safe-Keeper 23:54, 10 June 2007 (UTC)
thread_title:  Call for help 

message: What would you people think about something like this : 
*   Always put a pregnant woman in recovery position on her left side to avoid potentially lethal conpression of the inferior cava vein.
*  Do not put a conscious patient while back injuries in recovery position.
*  The rescuer can use his knees to secure the patient's head while administrating oxygen
To be used with parcimony, of course. Just an idea... Rama 09:45, 2 Dec 2004 (UTC)
replies: text: Wikipedia:Wikipedia is not a how-to manual. I really think these icons distract from the flow of the text. JFW | T@lk 13:57, 2 Dec 2004 (UTC)
replies: text:  Good point... perhaps for the more indicated for . Rama 16:00, 2 Dec 2004 (UTC)
replies: text: Did you move it there?  I moved content from first aid to here, and then later to Wikibooks, i think its a good idea! JamieJones 15:42, 28 December 2005 (UTC)
thread_title:  Icons system proposal for all first aid-related articles 

message: As far as I'm concerned, the recent changes to this article are not NPOV. The re-write is biased very much towards one specific teaching method of CPR which would not be considered correct by many. (In the UK, CPR teaching specifically states that a layperson should NOT check pulse []). The article used to acknowledge that teaching methods differed, but this has been removed in favour of a specific method of training.
Also, you say that the process I would know as "rescue breathing" is called "insulfation", yet I can't find insulfation (or insulphation) in either Dictionary.com or the Oxford English Dictionary, and there are only 47 references to insulfation on the entire web according to Google ([]), so I'm changing this to "rescue breathing".
I don't have much time to alter this article right now but I will be trying to get it back to an NPOV whilst retaining as many of your edits as possible.
:Please remember to sign your comments on the talk page. It's most helpful to other editors, and it helps us know when you left your comment. WP:NPOV should have very little to do with an article about resuscitation, since both the US and UK participate in ILCOR. MoodyGroove 22:25, 29 January 2007 (UTC)
thread_title:  NPOV 

message: Should the majority of yhis article even exist? All of the stuff that is instructive really shouldn't be here. It even says so here:What Wikipedia is not - Kilo-Lima 16:39, 30 September 2005 (UTC)
replies: text: Go ahead and slash away. This article should cover the principles of CPR (circulation and oxygenation), not the way it is done. JFW | T@lk 00:30, 2 October 2005 (UTC)
replies: text: Sections of this article is a how-to, and should be moved to [[Wikibooks:First Aid where is belongs. I'll see what I can do. Since not the entire article is a how-to, I don't think the transwiki process is appropriate. -- Egil 15:55, 29 October 2005 (UTC)

text: Thanks for the feedback.  I'll try moving the CPR how-to type stuff.  What is a transwiki process?  Let me know about any further edits. JamieJones 14:53, 26 December 2005 (UTC)

text: I read it over, and in the "myths" part i think it does a good job of explaining several times that cpr is a part of resuscitation; and since the r in cpr stands for resuscitation, i don't think the article is confusing.JamieJones 15:41, 28 December 2005 (UTC)

text: good call, i'll look for some references JamieJones 15:41, 28 December 2005 (UTC)

text: Strongly Disagree - Wikipedia is not an instruction manual, nor does it need to link to one at the top of the page.  The first action for anyone witnessing cardiac arrest is calling an ambulance.  The ambulance controller will talk them through CPR - far more effective than running back to your computer screen.  I can't imagine anyone looking up CPR in wikipedia as the first thing they do if someone they know collapses. Owain.davies 09:47, 17 June 2007 (UTC)

text: Like Owain, I must disagree in the strongest possible terms. A lot of good work has been done to rid this article of the how-to, and to put it back in at this stage would be a travesty. And adding a link (especially one so prominent) would be, as well as breaking policy, contrary to the spirit of all the work that's been put in, and would in any case just look tacky. --John24601 21:25, 17 June 2007 (UTC)
thread_title:  Wikipedia IS NOT instructive 

message: Just cleared up the "hypothermia seems to protect..." bit; also added a reference.
I think the image should be changed; a photograph of actual people demonstrating/doing CPR would be clearer. Eilu 13:06, 13 January 2006 (UTC)
replies: text: Agreed. These hand drawn pictures, while good amatuer representations, cheapen wikipedia. Photos or no images at all. Bigbrisco 22:09, 10 March 2007 (UTC)
thread_title:  Small Edits and a Suggestion 

message: Please stop.  Rescue breating is used on drownings; the Canadian Red Cross First Aid Program (which I teach) does not include the abdominal thrusts you describe.  And neither do many swim programs.  Please stop putting it in, whoever you are...to others, as i am new to wikipedia, how does one deal with this to avoid a "revert war"?  Looks like it's this person: 69.158.140.43 
JamieJones  talk 18:32, 13 January 2006 (UTC)
replies: text: I agree with you that many drowning patients require ventilation and compressions - and the Red Cross did make the change to remove abdominal thrusts in favour of compressions.  However, the real question is this: When do you find a patient who is not breathing, but still has a pulse?  The answer is, it's unlikely, as a patient with breathing will soon loose their pulse.  However, in the interim, it is possible, and, of all scenarios, the easiest and perhaps most common to imagine is a person who just recently drowned, say, they were found less than 2 minutes after their breathing stopped.  Someone keeps hijacking the rescue breathing page with regard to this issue; and the same on this page, I think.  Anyway, I think we agree then that most regulations (and from my experiences, definitely the red cross) does NOT have us pumping water from drowning patients...just performing rescue breathing/cpr as necessary after a primary survey.  Thanks for responding John24601. JamieJones  talk 21:45, 14 January 2006 (UTC)
replies: text:  UK lay-person first aiders no longer distinguish between cardiac and respiritory arrest in the unconcious patient (see UK Resuscitation Council 2005 guidelines), so I think it's a bit of a moot point. Are you from the US? I believe that over there they're still teaching pulse check (that's been out since 2000 over here, in favour initially of "signs of circulation" [breathing, coughing, twitching etc..], and now we teach to just start full CPR as soon as a lack of normal breathing [ie/ anything other than breathing both in and out regularly] is established. The position of healthcare professionals attempting BLS has been a bit poorly thought out, there is some inclusion of pulse-check, but AFAIK no talk of what to do in the case of that revealing a respiratory arrest. As for choking guidelines (which I would say should be applied to patients in which drowning has caused an airway occlusion), if patient concious then encourage to cough, if they can no longer cough then alternate 5 backslaps with 5 abdominal thrusts (this is, in effect, the early stage of respiritory arrest - the patient isn't actually breathing but they are concious and upright; so I guess this is basically what you're saying, although in a slightly different way), once unconcious lower to floor and begin compressions at 30:2 immediately, simultaneously calling for an ambulance (if you're on your own you can give CPR for 1 min before calling ambulance in the case of drowning only). There is no indication in the Resuscitation UK 2005 guidelines to provide any kind of specific care other than full CPR for an unconcious drowned patient. --John24601 21:38, 24 January 2006 (UTC)
replies: text: American Heart Association ECC guidelines are based on ILCOR, same as everybody else. MoodyGroove 15:18, 27 January 2007 (UTC)
thread_title:  Who keeps reverting that part about drowning 

message: This ip 198.176.160.18 vandalized the CPR page.  I reverted.  Should I do anything else? JamieJones  talk 19:17, 8 February 2006 (UTC)
thread_title: Vandal

message: This needs a reference otherwise it should be removed.  It's unsubstantiated and awkward in the text. JamieJones  talk 23:35, 1 March 2006 (UTC)
replies: text: Moving the football player injury here until reference is cited.
JamieJones  talk 12:39, 3 March 2006 (UTC)
thread_title:  Football player injury 

message: Agree with edit by JamieJones. CPR alone has a near 0% chance of success (only likely to work in cases of witnessed arrest due to hypoxia secondary to choking). The statistic removed (2-15% success for out of hospital CPR), is infact the statistic commonly quoted for the survival to hospital discharge rate of pre-hospital cardiac arrest, and therefore is a measure of the success of an entire resus attempt, from the moment the casualty is found and CPR begun to the moment they leave hospital.. in many cases the cardiac arrest is often not reversed pre-hospital, the CPR just helps to keep the body going until the person gets to hospital and receives ALS, so the "success rate" for CPR alone is almost 0, even though it does play a central part in a successful overall resuscitation. This is yet another example of why I think that CPR and resuscitation should have very seperate pages... --John24601 21:21, 2 March 2006 (UTC)
thread_title:  Re:- Success rate 

message: People keep adding all kinds of their favourite first aid links here.  Could we set something up to prevent this?  JamieJones  talk 04:57, 12 July 2006 (UTC)
thread_title:  Links 

message: External Cardiac Compression, CPR, and heart massage seem to be closely related. It would be useful to have some information on the other two as well. Rl 13:40, 25 July 2006 (UTC)
replies: text: They are related, to the extent where nobody agrees on exactly what the differences are. In my book ECC=the physical act of compressing the chest; heart massage = physically squeezing the heart (which to me implies that the chest has been opened up by a surgeon), and CPR = the combination of ECC and expired air ventilation (mouth to mouth). --John24601 16:03, 26 July 2006 (UTC)
replies: text:  That seems to make sense also in the light of what I read so far (and that I found somewhat confusing previously). Thank you! Of course that means that my creating a redirect from heart massage pointing here is misleading at best, and that the one article pointing there (2000 Italian Grand Prix) didn't really mean a heart massage, but ECC or CPR. Rl 07:40, 27 July 2006 (UTC)
thread_title: ECC, CPR, heart massage

message: I made the flow chart when I was taking a Bronze Med class taught by the Canadian Lifesaving Society, and I am certified CPR B. If changes need to be made, please e-mail me and I'll make them, or send you the original so you can edit in OmniGraffle. Jmatt1122 03:57, 27 July 2006 (UTC)
replies: text: I'm not sure about Canada, but it certainly does not reflect current practise in the UK or USA (or any other country I am aware of), integrating the adult/child/infant sequences also makes it look overly complicated to the point where I'm not sure it's useful. Bearing in mind that Wikipedia is not a how-to, I think it may be better, on the whole, to leave it out. --John24601 06:52, 27 July 2006 (UTC)
replies: text: Heh, it sure drives the point home that "simplifying CPR for laypersons" should be a priority. I think the flowchart is a useful illustration, but it needs a caption addressing John's concerns. Rl 07:44, 27 July 2006 (UTC)

text: John, What do you feel are changes that need to be made to the chart? What is current practice in the UK or USA in comparison to procedure described in this chart? Also, seperation of Child/Adult is required, because compression/breathing ratios are different. I think that also compression depth should be included, but this may complicate it further. Please post feedback to changes that should be made, or inaccuracies in the procedure. This should be as universal as possible. Also, a caption or somthing describing that this chart should not be used as a sole purpose of training, but the person should seek a professional if they wish to learn CPR.--Jmatt1122 17:03, 27 July 2006 (UTC)

text: http://www.resus.org.uk/pages/blsalgo.pdf <- That is the flowchart produced by the Resuscitation Council (UK). It is identical in content to that produced by the European Resuscitation, which in turn is pretty much identical to that agreed on by the International Liason Committee on Resuscitation (ILCOR), which is the world body of experts in resuscitation. That algorithm says adult, however children and babies should be done exactly the same, with a few modifications (1/3 chest depth compression as opposed to 4-5cm in adults; 5 initial rescue breaths before compressions, 1 minute of CPR before calling an ambulance) if they can be remembered - if not, lay rescuers should use the adult sequence. Remember also that this article is on cardiopulmonary resuscitation (see discussion above of exactly what that is), not on basic life support for lay rescuers (which is what the flowchart is) - a fine line, but one that needs adressing. --John24601 18:18, 27 July 2006 (UTC)

text: So do you believe that this chart should be removed, or modified? And I don't understand why the Canadian Lifesaving Society hasn't changed procedure. Do you know of any other countries that follow 15:2? Also, I have been taught that children require 5:1 with a smaller depth (1-1½" as compared to the adult 1½-2"). Also, my certification is very recent. I don't understand why Canada would be different than almost everywhere else. --Jmatt1122 18:49, 27 July 2006 (UTC)
replies: text:  The guidelines were agreed and published in europe in November 2005. Here in the UK, most training organisations are switching over this month, although some did it as far back as January, and some are still to do it. I guess the situation is pretty much the same worlwide. Certainly, though, by the end of this year there should be nowhere which is teaching the old guielines, which contained 15:2 for adults and 5:1 for children. As for whether there should be a flow chart - my personal opinion is no, but if there is one it should be on a Basic Life Support page, and not the CPR page. --John24601 19:36, 27 July 2006 (UTC)

text: Does anyone use Mac OS X and OmniGraffle so that I can send them the original, and changes can be made, in accordance with new standards? Either that, or post what exactly should be changed, so I can change it, and add it to the Basic Life Support page, and delete it from here, depending on the decision reached here. --Jmatt1122 21:16, 27 July 2006 (UTC)
replies: text: Yes, it needs updating, as the protocols have changed.  Regardless, it is essentially how to, or at best, not encyclopedic entry about CPR.  Your chart shows all the steps in an emergency.  I belive it should stay removed; better still, move it to wikibooks.  For more info, see What Wikipedia is not. JamieJones  talk 04:42, 31 July 2006 (UTC)
replies: text: Also see "Individual general-knowledge how-tos are being moved from Wikipedia to Wikibooks". JamieJones  talk 04:46, 31 July 2006 (UTC)
thread_title: Flow Chart = Good?

message: Since people take oxygen from the air when they breathe and then exhale carbon dioxide, how does blowing carbon dioxide into a person provide them with oxygen?  If anyone could explain that I'd appreciate it.DXRAW 08:28, 11 October 2006 (UTC)
replies: text: Yes, when you do CPR you yourself are not "holding your breath" and the O2 depletion of the air you breath out is minimal. Atmospheric air contains 20% oxygen and the air you breath out during CPR contains at least 17-18% so it is breathable air. I will refrain from giving the pig-feeding analogy in the interest of good taste.--Justanother 15:08, 20 October 2006 (UTC)
thread_title:  Question Moved From article 

message: Does anyone know what this sentence is supposed to mean? I think it needs to be rewritten but I'm not sure enough of its meaning to do it myself. Natalie 22:42, 30 October 2006 (UTC)
replies: text: It's the last sentence of the first paragraph in the "Importance" section.Natalie 22:43, 30 October 2006 (UTC)
replies: text: I suppose the editor wanted to spell out where CPR fits in the first-aid mnemonic of ABC. ABC article could use some help too. Happy editing. --Justanother 22:59, 30 October 2006 (UTC)

text:  That sounds to me like something which was developed by an individual trainer in order to teach, it's certainly not something I've ever heard of before. In any case, in several places it does not reflect current practise - opinions anybody before I remove it? --John24601 08:38, 16 November 2006 (UTC)
replies: text:  Not only is it not current, but its not even a good mnemonic. AAAABC is much easier to remember. With the "new" CPR standards, it now stands for Area Awake Ambulance Airway Breathing Compressions (you can also add D and E depending on what level you're teaching, but as the page is CPR, we'll stick to AAAABC) Mike.lifeguard 19:56, 16 November 2006 (UTC)
thread_title:  "We talk about first aid ABC." 

message: The article currently states "A patient cannot be pronounced dead before he has been brought back to a normal temperature by appropriate means."  So a person frozen in ice for fifty years cannot be pronounced dead?  What if the patient were brought back to a normal temperature by inappropriate means?  He "cannot be pronounced dead" according to the law of which country?  Jimp 23:58, 22 January 2007 (UTC)
replies: text: Regardless of how the patient is rewarmed, the mantra is that the patient isn't dead until the patient is "warm and dead." It's meant to remind the health care professional that hypothermia is a reversible cause of cardiopulmonary arrest, and resuscitative efforts should not be discontinued until the patient is rewarmed. I suppose it doesn't really apply to prehistoric men trapped in the polar ice cap. MoodyGroove 00:23, 23 January 2007 (UTC)
replies: text: It makes sense put that way.  I wonder how the sentence might be reworded to convey this. Jimp 04:21, 23 January 2007 (UTC)
replies: text: I don't think doctors will try to resuscitate a caveman. They are not idiots. Doubtful the subject would ever see a hospital, archaeologists would claim the body. Why are we even discussing something this ridiculous? 24.57.60.54 14:25, 14 March 2007 (UTC)
thread_title:  Cannot be pronounced dead 

message: I completed a CPR class my hometown (Danville, CA) offered in the quarterly town event & activity guide. The card I now carry in my wallet states CPR and AED For Lay Rescuers in the Community and Workplace. Also, the card notes that my training is based of the 2005 Science & Guidelines  and the instructor is certified to teach me the material through ASHI or American Safety & Health Institute.
Since I was looking to share what I just learned, I made an addition to section 3, which is titled CPR training. Below is the quote of what I added.
  
Another acceptable variation that is taught is known as ABCD which stands for Airway, Breathing, Circulation, and Defibrillation. ABCD is the more common shortform to be taught in elementary, middle, and high schools in America.
The first sentence is repeated exactly as how the instructor said it.
The second sentence is not based on something i can verify. I added it so as not to seem like I was casting the other shortforms to the junk pile. Personally the comment makes sense because ABCD would be simplier because every student in the US education system has learned the alphabet....  If removal of second sentence is the consensus....  then sobeit.  Im okay with that. Sfcollegeguy 06:57, 23 January 2007 (UTC)
thread_title:  Newly certified in CPR and ready to share what I was taught 

message: Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H. "Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group." Resuscitation. 1993 Aug;26(1):47-52.   
Incorrectly performed bystander CPR might compromise survival of the cardiac arrest patient. We therefore evaluated the outcome in 3306 out-of-hospital primary cardiac arrests of which 885 received bystander CPR. bystanders performed CPR correctly in 52%, incorrectly in 11%, 31% performed only external chest compressions (ECC) and 6% only mouth-to-mouth ventilation (MMV). The initial ECG in cases without bystander CPR was ventricular fibrillation in 28% (95% confidence interval: 27-30%); 45% (41-50%) and 39% (29-48%), respectively when bystander CPR was performed correctly or incorrectly; 43% (37-49%) when only ECC was applied and 22% (11-33%) when only MMV was practiced. Long term survival, defined as being awake 14 days after CPR, was 16% (13-19%) in patients with correct bystander CPR; 10% (7-14%) and 2% (0-9%), respectively when only ECC or only MMV was performed; 7% (6-8%) when no bystander was involved; 4% (0-8%) when bystander CPR was performed incorrectly. Bystander CPR might have a beneficial effect on survival by maintaining the heart in ventricular fibrillation by ECC. A negative effect of badly performed bystander CPR was not observed compared to cases which had not received bystander CPR. 
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Gallagher EJ, Lombardi G, Gennis P. "Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest." JAMA 1995 Dec 27;274(24):1922-5.   
OBJECTIVE--To examine the independent relationship between effectiveness of bystander cardiopulmonary resuscitation (CPR) and survival following out-of-hospital cardiac arrest. DESIGN--Prospective observational cohort. SETTING--New York City. PARTICIPANTS--A total of 2071 consecutive out-of-hospital cardiac arrests meeting Utstein criteria. INTERVENTION--Trained prehospital personnel assessed the quality of bystander CPR on arrival at the scene. Satisfactory execution of CPR required performance of both adequate compressions and ventilations in conformity with current American Heart Association guidelines. MAIN OUTCOME MEASURE--Adjusted association between CPR effectiveness and survival. Survival was defined as discharge from hospital to home. RESULTS--Outcome was determined on all members of the inception cohort--none were lost to follow-up. When the association between bystander CPR and survival was adjusted for effectiveness of CPR in the parent data set (N = 2071), only effective CPR was retained in the logistic model (adjusted odds ratio [OR] = 5.7; 95% confidence interval [CI], 2.7 to 12.2; P < .001). Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02). After adjustment for witness status, initial rhythm, interval from collapse to CPR, and interval from collapse to advanced life support, effective CPR remained independently associated with improved survival (adjusted OR = 3.9; 95% CI, 1.1 to 14.0; P < .04). CONCLUSION--The association between bystander CPR and survival in out-of-hospital cardiac arrest appears to be confounded by CPR quality. Effective CPR is independently associated with a quantitatively and statistically significant improvement in survival.
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Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. "Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation." Am J Emerg Med 1985 Mar;3(2):114-9.   
Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.
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Wik L, Steen PA, Bircher NG. "Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest." Resuscitation 1994 Dec;28(3):195-203.    
To evaluate the influence of quality of bystander cardiopulmonary resuscitation (CPR) on outcome in prehospital cardiac arrest we consecutively included patients with prehospital cardiac arrest treated by paramedics in a community run ambulance system in Oslo, Norway from 1985 to 1989. Good CPR was defined as palpable carotid or femoral pulse and intermittent chest expansion with inflation attempts. Outcome measure was hospital discharge rate. One hundred and forty-nine of 334 patients (45%) received bystander CPR. The discharge rate after good BCPR (23%) was higher than after no good BCPR (1%, P < 0.0005) or after no BCPR (6%, P < 0.0005). There was no difference between no good and no BCPR (P = 0.1114). There were no differences in paramedic response interval between the groups, but the mean interval from start of unconsciousness to initiation of CPR (arrest-CPR interval) was significantly shorter in the group receiving good bystander CPR (2.5 min, 95% confidence interval (CI): 1.7-3.3 min) than no good CPR (6.6 min, CI: 5.2-8.0 min) or no bystander CPR (7.8 min, CI: 7.2-8.4 min). Bystanders started CPR more frequently in public than in the patient's home (58 vs. 34%, P < 0.0005). Good bystander CPR was associated with a shorter arrest-CPR interval and improved hospital discharge rate as compared to no good BCPR or no BCPR.
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Swor RA, Jackson RE, Cynar M, Sadler E, Basse E, Boji B, Rivera-Rivera EJ, Maher A, Grubb W, Jacobson R, et al. "Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest." Ann Emerg Med 1995 Jun;25(6):780-4.    
STUDY OBJECTIVE: To assess whether bystander CPR (BCPR) on collapse affects initial rhythm and outcome in patients with witnessed, unmonitored out-of-hospital cardiac arrest (OHCA). DESIGN: Prospective cohort study. Student's t test, the chi 2 test, and logistic regression were used for analysis. SETTING: Suburban emergency medical service (EMS) system. PARTICIPANTS: Patients 19 years or older with witnessed OHCA of presumed cardiac origin who experienced cardiac arrest before EMS arrival between July 1989 and July 1993. RESULTS: Of 722 patients who met the entry criteria, 153 received BCPR. Patients who received BCPR were younger than those who did not: 62.5 +/- 15.4 years versus 66.8 +/- 15.1 years (P < .01). We found no differences in basic or advanced life support response intervals or in frequency of AED use. More patients initially had ventricular fibrillation (VF) in the BCPR group: 80.9% versus 61.4% (P < .01). The interval to definitive care for ventricular tachycardia (VT)/VF was longer for the BCPR group (8.59 +/- 5.3 versus 7.45 +/- 4.7 minutes; P < .05). The percentage of patients discharged alive who were initially in VT/VF was higher in the BCPR group: 18.3% versus 8.4% (P < .001). In a multivariate model, BCPR is a significant predictor for VT/VF and live discharge with adjusted ORs of 2.7 (95% CI, 1.7 to 4.4) and 2.4 (95% CI, 1.5 to 4.0), respectively. For those patients in VT/VF, BCPR predicted live discharge from hospital with an adjusted OR of 2.1 (95% CI, 1.2 to 3.6). CONCLUSION: Patients who receive BCPR are more often found in VT/VF and have an increased rate of live discharge, with controls for age and response and definitive care intervals. For VT/VF patients, BCPR is associated with an increased rate of live discharge.
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Bossaert L, Van Hoeyweghen R. "Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest. The Cerebral Resuscitation Study Group." Resuscitation 1989;17 Suppl:S55-69; discussion S199-206.   
Prevalence of bystander CPR and effect on outcome has been evaluated on 3053 out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33% of recorded cases (n = 998) by lay people in 406 cases (family members 178, other lay people 228) and by bystanding health care workers in 592 cases (nurses 86, doctors 506). Family members and lay people mainly applied CPR in younger CA victims at public places, roadside or at the working place. Sudden infant death syndrome (SIDS) and drowning are highly represented. Health care workers performed CPR mainly in older patients, at public places or at the roadside and especially in case of cardiac or respiratory origin. CA caused by trauma/exsanguination and intoxication/metabolic origin received less bystander CPR (23% resp. 22%). Cardiac arrests receiving bystander CPR are more frequently witnessed and have a shorter access time to the emergency medical service (EMS) system and shorter response time of basic life support (BLS). Advanced life support (ALS) response time is significantly longer. In witnessed arrests of cardiac origin receiving bystander CPR a significantly better late survival was observed. In non-witnessed arrests of cardiac origin early and late survival are significantly higher in patients receiving bystander CPR. In CA events where response time of ALS exceeds 8 min, the beneficial effect of bystander CPR is most significant. Furthermore no deleterious effect of bad technique or inefficient bystander CPR can be demonstrated.
_________________________________________
 
Jackson RE, Swor RA. "Who gets bystander cardiopulmonary resuscitation in a witnessed arrest?" Acad Emerg Med 1997 Jun;4(6):540-4. 
OBJECTIVE: To identify characteristics associated with provision of bystander CPR in witnessed out-of-hospital cardiac arrest cases. METHODS: An observational, prospective, cohort study was performed using cardiac arrest cases as identified by emergency medical services (EMS) agencies in Oakland County. MI, from July 1, 1989, to December 31, 1993. All patients who sustained a witnessed arrest prior to arrival of EMS personnel were reviewed. RESULTS: Of the 927 patients meeting entry criteria, the 229 patients receiving bystander CPR were younger: 60.9 +/- 14.7 vs 67.9 +/- 14.7 years (p < 0.01). Most (76.6%) cardiac arrests occurred in the home. In a multivariate logistic model, only the location of arrest outside the home was a significant predictor of receiving bystander CPR [odds ratio (OR) 3.8; 99% CI 2.5, 5.9]. Arrests outside the home were associated with significantly improved outcome, with 18.2% of out-of-home and 8.2% of in-home victims discharged from the hospital alive (OR 2.5; 99% CI 1.4, 4.4). CONCLUSION: Patients who have had witnessed cardiac arrests outside the home are nearly 4 times more likely to receive bystander CPR, and are twice as likely to survive. This observation emphasizes the need for CPR training of family members in the authors' locale. This phenomenon may also represent a significant confounder in studies of out-of-hospital cardiac arrest and resuscitation. —The preceding unsigned comment was added by MoodyGroove (talk • contribs) 15:13, 27 January 2007 (UTC)
thread_title: How often is bystander CPR initiated?

message: http://www.webmd.com/heart-disease/news/20070316/CPR-mouth-to-mouth-not-much-help?print=true
CPR without mouth-to-mouth, chest compression only, might be better in some cases
FYI: ILCOR makes CPR standards for a reason. Please don't confuse people - the standard revision cycle is enough. Mike.lifeguard 13:47, 24 March 2007 (UTC)
replies: text: I say include it. It's not just one study, we've known this for a long time and reference is made to it in, for example, the Resuscitation Council UK guidelines. There are known to be a number of experts involved in  the latest round of ILCOR who wanted to give compression only CPR greater prominence. We're not here to tell people how to resuscitate someone, we're here to educate them on the subject of resuscitation: the concern of potentially confusing someone by highlighting research which could be said to contradict official guidelines should not be a consideration here. --John24601 11:47, 26 March 2007 (UTC)
replies: text:  The article should present what CPR *is*. There are specific standards which do not include compression-only CPR, namely those from ILCOR. The average reader doesn't want to sift through the research to decide anything about CPR (and shouldn't). We have experts for a reason, and if they change the standards to include compression-only CPR, then the article would have to be changed. Until then, there's no need for the behind-the-scenes discussion, or research which the experts decided wasn't enough to advocate compression-only CPR. We should really be deferring to their judgment, and our article should reflect their decision as to what constitutes CPR. As I say, it doesn't currently include compression-only CPR, and when/if it does, the article would be changed. Mike.lifeguard 13:23, 26 March 2007 (UTC)
replies: text:  You're quite right that material included should be notable, and not merely some backstreet research project somebody dreamed up. However, making the final recommendation of ILCOR is not the only test of notability. The issue of compression only CPR has been discussed at length in the resuscitation community (including the ILCOR deliberations), is the subject of a number of research studies (not just this one), has been covered widely in the media recently, and, furthermore, is infact mentioned in the Eurpoean Resuscitation Council Guidelines (which come from ILCOR, although I'm not sure if this is a regional variation, as I don't practice in North America - perhaps someone there could inform me). ILCOR is a consensus body, and in reaching a consensus certain things will be left out or given less prominence, this does not mean that they're not notable --John24601 16:25, 26 March 2007 (UTC)

text:  Sorry I must have glossed over that they're included in the European Resuscitation Council Guidelines. That is a regional variation - they're not used in North America, and to do so would open you up to liability. For the record, I'm against including this since it wouldn't meet the standards here, which are set by the same body which sets standards for Europe (so far as I'm aware). I suppose if you had a disclaimer to that effect it would be ok. Nevertheless, I think it complicates matter unnecessarily at best, and is dangerously misleading at worst. Mike.lifeguard 01:17, 27 March 2007 (UTC)
replies: text:  Intrigued, I took a look. There is actually extensive mention of compression only CPR in the north american guidelines, far more than there infact is in the European ones. See , which was the journal article in which the 2005 guidelines were first circulated in North America. I don't think it needs to be made clear that it's not in the guidelines, nor is a disclaimer required: the purpose of this article is to educate people on resuscitation, not to teach them how to do it - there is a difference, but one worth maintaining. --John24601 08:55, 27 March 2007 (UTC)
thread_title:  important to note 

message: "CPR is a practical skill and needs professional instruction followed up by regular practice on a resuscitation mannequin to gain and maintain full competency." doesn't need citation. I simply hope everybody knows how important it is to continue practicing it now and then not to forget. Lives kan be lost if one forgets how to do, or feels uncertain how to do it.Mortsggah 05:02, 4 May 2007 (UTC)
thread_title:  Citation on followup 

message: I have left a note for Ioldanach over his edits, as it seems to be original research, in the absence of any reference (also, parts of it don't quite make sense to my reading).  If i don't get a response, I think I'll be forced to change his edit back.  Can anyone else shed light on that edit?
Owain.davies 05:47, 4 May 2007 (UTC)
replies: text: It is true, so I believe. The conventional theory has always been that in cardiac arrest cells become deprived of oxygen and then die. New research has shown that it is infact the re-oxygenation of cells which kills them, and so there have been some trials done regarding slow reoxygenation. However, I've only seen it reported in the media , I haven't seen any journal articles or solid research findings. One would presume, however, from the tone of the news article, that there are some somewhere, perhaps we should be looking for them. I think for now it's probably right that it stays out of the main article, until we can get something a bit more solid together. I think we also need to have a think about which article it's best placed in: I'd be tempted to put it in Cardiac arrest or a generic article on Resuscitation, but there again my views on CPR vs Cardiac Arrest vs Resuscitation have never had much support round here, so maybe we'll find a consensus on something quite different! --John24601 08:52, 4 May 2007 (UTC)
thread_title:  Edits by Ioldanach  

message: When attempting to edit the page, I get this message from Wikipedia (translated from Norwegian):
The page you attempted to edit was blocked by the spam filter. This is most likely caused by a link to an external site.
The following text is what activated the spam filter: [Link to defibrillatorhub dot com]
I was attempting to add this to the top of the article: IMPORTANT: Neither this article, nor the WikiBooks how-to, is a substitute for proper training from a certified instructor. Since Wikipedia can be edited by anyone, there may be errors. CPR is never guaranteed to save someone's life - in fact, success rates of CPR alone range from 0-5%. When practicing CPR, be sure not to compress anyone's chest, as you may severely injure them.
--Safe-Keeper 23:51, 10 June 2007 (UTC)
replies: text: I'm not sure I quite understand what's happening. But in any case, we don't need a disclaimer. --John24601 06:24, 11 June 2007 (UTC)
thread_title:  Filter? 

message: I propose merging Cardiocerebral Resuscitation into cardiopulmonary resuscitation as it is simply a variation in protocol from standard CPR.  I think that the merge should take place because:
*Both the cardiac and pulmonary systems are still engaged during 'CCR', but the tidal volume in the lungs is generated by the movement of the chest (or 'gasping').  
*The definitive paper on this (Ewy, 2004) specifically refers to the technique as "the new cardiopulmonary resuscitation"
*It was already mentioned in the CPR article, but i shall make it a bit clearer to make it easier for anyone looking for it, after which i feel we will have no need of the article.  
*If the technique does gain widespread acceptance, it does seem unlikely that the naming protocol will change, and i think most people will continue to call it CPR
Anyone have an opinion on this? Owain.davies 08:17, 16 June 2007 (UTC)
replies: text: I think they should remain separate. Cardiocerebral resuscitation is non-standard, and shouldn't be intermingled with ILCOR/AHA protocols - that would be inordinately confusing. The point is that the technique hasn't gained widespread acceptance; it should be kept clearly separate from the current standards as presented in the CPR article. Also the Cardiocerebral Resuscitation itself is sadly lacking. Mike.lifeguard 22:58, 23 June 2007 (UTC)
replies: text:  Given what you've just said, I think it's entirely appropriate to merge CCR into here, with a redirect from there. Once again, wikipedia is not here to provide instruction or to present the "official" view, we are here to write about the subject of resuscitation, and CCR is a big part of that. The fact that the existing CCR is so small surely indicates that it (at least at the moment) does not deserve its own page, and would be better off here.--John24601 14:59, 24 June 2007 (UTC)
replies: text: Taking in to account general opinion, articles now merged.  I think this makes the main article  a better, more rounded reference source! Owain.davies 05:41, 6 July 2007 (UTC)
thread_title:  Merge Cardiocerebral Resuscitation in to article 

message: Introduction has been changed to be more general.  Specifically, the emphasis on first aid has been removed.  CPR is primarily a medical procedure that was practiced in hospitals before it was modified as a first aid procedure.  I've added a "first aid" heading for the discussion of CPR in first aid.  Most of the original content is still in the article, just moved.
"Rescue breathing" and "Mouth to mouth" are both layperson's terms (and only used in some regions) and have been replaced with "artificial respiration", the more general and international term.
"Training" was a bit of a mess (a lot of redundancy and unreferenced facts), but I tried to fix it up a bit.  I also moved it under "First aid" as this section mainly refers to layperson training, not professional training.  It still needs work.  Some statistics would be nice too.
"Cardiocerebral resuscitation" and "self CPR" have both been moved to "controversy".  Also, the content of "Cough CPR" has been altered to better reflect the current evidence and expert consensus.  Of course, the section should continue to site the opinion of dissenters as this is an important controversy.Monobeg 04:33, 26 June 2007 (UTC)
thread_title: Edits by Monobeg

message: I've just removed an edit by this user, which consisted of "However, before CPR is performed you must check for a pulse. If a person has stopped breathing but still maintains a steady heart rythmn rescue breaths may be all that is needed. Chest compressions in such a case could interfere with normal cardiac rythmn.". 1) Pulse check has been shown to have tremendously poor sensitivity and specificity for cardiac arrest, when performed by almost anybody, and internationally agreed guidelines (at least in the western world - Asia have I believe taken a different view) have therefore removed or de-emphasised it 2) There is no evidence of the harm of chest compression in respiratory arrest, and infact some experts have suggested it may be helpful. Whilst there is a theoretical risk of inducing a lethal arrythmia in a patient in solo respiratory arrest, there are to my knowledge no documented cases of this actually happening 3) Wikipedia is not a how-to. The article does, however, contain some information on pulse-checking and why it is no longer the preferred diagnostic criterion, and this user, if they are interested, is absolutely welcome to add to that information. I think this would be a particularly good idea if they have any experience with CPR protocols developed by bodies other than ILCOR, as they may be able to offer some explanation for differences between the approaches: this is an area which is not adressed at all in the article. --John24601 22:09, 4 July 2007 (UTC)
replies: text: Agree! Owain.davies 05:52, 5 July 2007 (UTC)
thread_title:  Reverted edits by 146.235.130.52 

message: Many people use Wikipedia as a first source of information, and are likely to use this article if they need to conduct CPR.
The first action for anyone witnessing cardiac arrest is calling an ambulance.  
It was decided above not to include a link to a CPR instruction manual at the top of this article.  However, it is possible that in the stress of the moment someone will come to this page and forget that calling 911 is the appropriate action.  As such, it seems reasonable to add an instruction to call 911 if the reader is in an emergency situation.  Something like, "If you are in an emergency situation, dial 911 immediately.  This article is not intended to provide instruction."  Can somebody do this?  142.151.169.167 16:39, 29 July 2007 (UTC)
thread_title:  Instruction Call 911 

message: I didn't think I should go ahead and archive a talk page without discussing it first. Just thought that this talk page was getting rather long and archiving would be beneficial. See How to Archive -- MacAddct1984 18:30, 17 August 2007 (UTC)
replies: text: good idea, go ahead. Owain.davies 21:03, 17 August 2007 (UTC)
thread_title:  Consensus to Archive CPR Talk 

message: Aren't the success rates of CPR skewed due to the population it's often used on? Meaning, CPR is rarely given on healthy teens, 20 or 30 year-olds. CPR is primarily used on the elderly or those with a pre-existing heart condition (i.e. heart disease). Therefore, their survival rate is already drastically lower than normal. -- MacAddct1984 13:53, 18 August 2007 (UTC)
replies: text: That has not been my experience at all. I have observed more bystander CPR performed on young people, on those rare occasions they experience a sudden cardiac death. Paradoxically, younger people have less collateral circulation. They are not necessarily easier to resuscitate. Generally speaking, survival rates are abysmal due to failures in a community's chain of survival, and bystander CPR is only a small part of those failures. When you say "drastically lower than normal" you have to define "normal" and that's not easy to do, even for epidemiologists. MoodyGroove 14:32, 18 August 2007 (UTC)
replies: text: Have to agree here.  Most elderly or infirm patients (high risk group) will die at home, with nobody able or willing to perform CPR on them.  For younger patients, they are much more likely to be out in public, where there is a greater chance of CPR being performed.  Have a look at some of the journals linked from the Prevalence and effectiveness section for more info on this. Owain.davies 19:03, 18 August 2007 (UTC)
thread_title:  Skewed success rates? 

message: Then prove the notability, Owain.davies. The AutoPulse is a lot better known in the U.S. I've never heard of those other devices. MoodyGroove 19:05, 18 August 2007 (UTC)
replies: text: Are you now happy with the notability of the devices in this section?  I think we now have a good balance between commercial links and references.  Owain.davies 18:45, 23 August 2007 (UTC)
thread_title: Automated CPR devices

message: These comments:
:The autopulse device does have its problems as seen here, in the case of Riverside County Has Suspended Use of AutoPulse Jacket, where a 77yo man was subjected to the autopulse and later died from cracked ribs and internal injuries. The autopulse is purely mechanical, and so with no feedback will actually be detrimental to patient safety. Often called thumpers, these devices have been around for 40years, and will soon be phased out. Another autopulse trial against manual cpr here noted that the autopulse was harmful compared to manual CPR with the survival rate dropping from 10% with manual CPR to 6% with the autopulse.
were removed from the article because they give undue weight to anecdotal experiences with the device and do not conform to Wikipedia's neutral point of view policy. Please see the AutoPulse article for a more balanced review of the available evidence. MoodyGroove 13:00, 23 August 2007 (UTC)
thread_title: Comments about [[AutoPulse]] removed from article

message: I will question the first sentence, CPR is used for people who "lost" pulse, not just Cardiac Arrest. October 20 2007 Kullwarrior  —Preceding unsigned comment added by 68.149.170.5 (talk) 21:57, 20 October 2007 (UTC)
replies: text: FYI, those mean the same thing. "Has lost their pulse" is colloquial language for "Is in cardiac arrest" – Mike.lifeguard | talk 23:03, 20 October 2007 (UTC)

text: American Heart Association protocols (based on the 2005 ILCOR protocols, I believe) also call for CPR in paediatric bradycardia. Given that CPR can be used even when a pulse is present but too weak to be felt, I'm happy with "cardiac arrest" given that this article is not intended to be overly technical. Andrewjuren(talk) 23:53, 20 October 2007 (UTC)

text: It is also called for during Ventricular Tachycardia (Where it goes pulseless), as there is no blood being pumped round the body anyway...  —Preceding unsigned comment added by 172.206.95.11 (talk) 12:04, 15 March 2008 (UTC)
replies: text: On reflection, this could be misleading, as you do use CPR for ineffective heat beats (such as in babies with a pulse < 60, for instance.  I'll give the wording some thought. OwainDavies (about)(talk) edited at 12:18, 16 March 2008 (UTC)
thread_title: First Sentence

message: I've started editing the article to take into account the AHA's stunning reversal on compression -only CPR (see changes in first paragraph). I thought they would have to do it with the Guidelines revision in 2010, but they surprised me. This is historic: 50 years of saying you need to do mouth-to-mouth, and now it turns out it doesn't matter. Some of the lay press articles (like the Canadian one that comes up at the top on a Google search for CPR) make it sound like this is merely a clarification of existing guidelines, but it's not. Formerly, it was do full CPR unless you're a squeamish little wimp, in which case you can just do chest compressions. Now the AHA is acknowledging that compressions-only is just as good in terms of survival--which of course means better, since bystanders will obviously do it more often and more quickly. I feel confident that further research will show CCPR is actually better for survival, but never mind for now.
I think the whole CPR article needs to be revised in light of this development. This is important because the article is used by the interested lay public. Let's make this a group effort. texasex (talk) 20:34, 12 April 2008 (UTC)
replies: text: It is important to remember that this was only the guidance of the AHA, which is only one of the organisations which make up ILCOR who set the international guidance, and as an international encyclopaedia, the article should be reflective of this.  Now, that isn't to say i'm not in favour of compression only CPR, and the ambulance service here uses protocol C, which comes from one of the academic studies which form the basis for high compression CPR, although it actually uses 200 compressions to 2 ventilations, with a high success rate.  One of the reasons that compression only CPR is as least as effective as CPR with breaths is that the survival rate is only any good when there is early EMS intervention, who will certainly use airway intervention and ventilations - by this time the oxygen saturation won't have dropped.  If the EMS is delayed, the survival rate with no ventilations will be lower if the airway is not secured, due to lack of oxygen to circulate.  Because of the mixed guidance currently in circulation, the lack of firm evidence on compression-only efficacy  in bystander pre-hospital and of course, because WP is not a how-to guide (that'll be Wikibooks) we should be careful in what is written here about it.  OwainDavies (about)(talk) edited at 21:26, 12 April 2008 (UTC)
thread_title:  Compression only CPR 

message: 40% (the rate quoted in the table for bystander CPR) sounds like a suspiciously high rate of ROSC. Is is not more likely that a large proportion of these were cases of wrongly diagnosed cardiac arrest? Also the citation does not seem to link to the original research article.  —Preceding unsigned comment added by 82.30.251.38 (talk) 19:42, 13 July 2008 (UTC)
replies: text: Exactly!  That is what pisses me off so much about these new protocols.  CPR, AR, and choking protocols are all dumbed down.  The excuse that 40% of people can't detect a pulse holds no water with me.  The protocols should assume the person using them is being TRAINED to do so- they SHOULD be training them to detect a pulse, and not certifying them until the trainees demonstrate that they can do so, consistently.  Instructing that CPR should be done WITHOUT a pulse check - how many people have died from having their heatbeat stopped with this method??  Disgusting.  AR, checking the pulse then not doing so again for TWO MINUTES!!  We were trained to check between breaths, so we could start CPR right away if necessary.  There is no point in doing AR to a body that doesn't have a pulse.  With choking, they don't teach proper placement of the hands while the patient is standing, and when they are prostrate, chest compressions instead if abdominal thrusts??? The assumption is when someone collapses in front of you with a obstruction they still have a heart beat.  Chest compressions could very well kill them, and abdominal thrust are way more effective.  These people are idiots - how can they make these techniques the standard for teaching? - at the very least these new protocols are inefficent, and in my opinion, criminal.  This is in the vein of, "The surgery was a success, but the patient died."  The organizations have a obligation to teach to the highest standard, and dumbing down to the lowest denominator is reprehensible.  I was trained to a higher standard than this (formerly called industrial.)by a excellent and decorated instructor/EMT, am taking a standard course tomorrow, and am dreading having to perform and respond to testing I know is not up to par, just to get a ticket that isn't worth the paper it is written on.  I know this is not the place to vent, this page is only about CPR, but I am so angry I could spit.  The thought of the lives that will be lost because ILCOR assumes the people being trained are so stupid they can't HANDLE PROPER TRAINING sickens me.  Shame on them.  Thanks for letting me vent here guys. 207.6.54.61 (talk) 15:39, 9 June 2010 (UTC)
thread_title:  Rate of return of spontaneous circulation 

message: What do people think about merging some of the information from History of CPR and then removing that article...that one seems redundant. Lateknightucd (talk) 17:14, 20 July 2008 (UTC)
replies: text: Oppose - The level of detail is far too high in history of CPR to be in the main article.  Normal WP policy is to have daughter articles to reduce article sizes for things like this. OwainDavies (about)(talk) edited at 17:27, 20 July 2008 (UTC)
replies: text: Understood OwainDavies.  I'm new at editing and I'm still getting the hang of things.  Would you prefer I remove the references to a merger discussion from the pages based on that level of detail? Lateknightucd (talk) 17:41, 20 July 2008 (UTC)
replies: text: Not necessarily - it's good that you're taking an active interest.  Mine is not the only opinion out there, and others may disagree with me.  The use of 'daughter' articles is useful, because it allows articles to focus on core subjects without getting sidetracked.  If you agree, you could remove the tags, but don't feel obliged to just because I object.  Regards, OwainDavies (about)(talk) edited at 17:44, 20 July 2008 (UTC)
replies: text: Actually, the use of daughter articles makes a lot of sense in keeping the core article concepts at the forefront.  Thanks for the info, I'll remove the tags shortly.  Lateknightucd (talk) 17:52, 20 July 2008 (UTC)
thread_title:  Merger Proposal