Editorial

New CPR guidelines emphasize chest compressions first

Tuesday, October 19, 2010

Nothing's more upsetting than seeing someone in a medical emergency and not knowing what to do.

Sure, we all know enough to call 9-1-1, but no matter how fast the response, minutes drag by like hours while we're waiting for help.

Thankfully, many of us have taken CPR -- cardiopulmonary resuscitation -- and many owe their lives to such training. And, automatic external defibrillators -- AEDs -- are relatively low in cost, nearly foolproof to use and becoming more and more common.

But science is advancing all the time and it turns out some of the techniques we've learned over the years aren't the best possible actions to take.

"ABC" in particular -- which stands for Airway-Breathing-Compression -- may be out of order, according to new American Heart Association Guidelines. A better acronym is "CAB" -- or "Compressions-Airway-Breathing."

The problem is, the old ABC method didn't allow oxygen-rich blood to reach the victim's brain and heart quickly enough.

"For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim's airway by tilting their head back, pinching the nose and breathing into the victim's mouth, and only then giving chest compressions," said Michael Sayre, M.D., co-author of the guidelines and chairman of the AHA's Emergency Cardiovascular Care Committee. "This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-B to C-A-B for adults and children allows all rescuers to begin chest compressions right away."

Instead of the old "look, listen and feel" for normal breathing before starting CPR, experts now recommend starting compressions immediately on anyone who is unresponsive and not breathing normally.

All victims in cardiac arrest need chest compression, according to the Heart Association. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim's brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

The change in the CPR sequence applies to adults, children and infants, but excludes newborns.

Other recommendations, based mainly on research published since the last AHA resuscitations guidelines in 2005:

* During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.

* Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.

* Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.

* Rescuers should avoid stopping chest compressions and avoid excessive ventilation.

* All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions starting when cardiac arrest is suspected.

It may take a while for the updated rules to reach local trainers, but if it's been a while since you've learned CPR, there should be a refresher course in your future.

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