New Guidelines for CPR

[Stan]

The American Heart Association has come out with new guidelines for the administration of CPR. In short, they change the sequence of ABC (airways, breath, compressions) to CAB, the priority being in keeping the blood circulating through compressions, then clearing the airways and breathing.

Here is part of a recent statement:

“DALLAS -- October 19, 2010 -- The American Heart Association is re-arranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.

Recommending that chest compressions be the first step for lay and professional rescuers to revive victims of sudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).

"For more than 40 years, CPR training has emphasised 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, MD, Department of Emergency Medicine, Ohio State University, Columbus, Ohio. "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-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away."

In previous guidelines, the association recommended looking, listening, and feeling for normal breathing before starting CPR. Now, compressions should be started immediately on anyone who is unresponsive and not breathing normally.

All victims in cardiac arrest need chest compressions. 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 resuscitation 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 started when cardiac arrest is suspected.”

Here is a link to the American Heart Association CPR page: http://www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomePage.jsp

Hikers and others with active outdoor pursuits are wise to take a first aid course, preferably wilderness first aid, whether or not they lead others or hike in groups. In itself, first aid knowledge is good preventive medicine. Not all first aid courses, however, cover CPR. That is often subject of a separate training.

 

[sardog1]

Looks like I need to make a date with Annie for some practice in the new technique. Thanks for the info!

 

[SAR-EMT40]

Keep in mind that there is a higher than normal chance the that people we may need to help (in the wilderness context) are people that have had their heart stopped not by MI but instead by respiratory arrest from lightning strike or drowning. In both of those cases you must initiate standard CPR INCLUDING breaths. Also any child found in cardiac arrest would likely have been caused by respiratory arrest. So again, use standard CPR you have been taught.

This is a little more complicated than listed in the headline. There are also differentiation between bystanders, certified laypeople and medical professionals.

Those of you that are CPR trained should continue as they had been taught until they are taught otherwise. This will not take effect until, first, the AHA re-certifies its instructor in the new techniques. Then they will start teaching the new method. This usually takes 3 months to a year.

As a legal point. Those of you that hold a AHA CPR card. You have been taught a specific method to do CPR. You are protected from lawsuits under the good Samaritan laws when you perform to the level and in the manner that you have been trained. Choosing to do something that you have not explicitly been trained to do invalidates that premise. Also, as I have already pointed out, it is more than just a headline. There are specific does and don'ts involved. You really should be trained/retrained in the new method so you know the ins and outs.

Just my thoughts,
Keith

 

[TEO]

I think the AHA is slightly confused, ABC stands for Always Be Closing.

 

[TCD]

What SAR EMT 40 said.

I've been watching this coming. I'm wondering how much of this is due to citizen reluctance to provide breaths due to lack of a mask of some sort to reduce disease transmission. My opinion is that professional rescuers with a mask and with practiced airway and breath skills should certainly still give breaths. I certainly intend to in the professional setting.

 

[griffin]

I'm wondering how much of this is due to citizen reluctance to provide breaths due to lack of a mask of some sort to reduce disease transmission.

I've seen this suggested in a number of articles, but while the new guidelines do give priority to chest compressions they don't eliminate rescue breaths so much as change the order in which they're performed. Yes? I'm not sure that does much for the "ick" factor.