Over the last 40 years, the American Heart Association (AHA) has promoted the ABCs (Airway-Breathing-Chest Compressions) of CPR. 2010 guidelines released in October, however, reordered the sequence to CAB (Chest Compressions-Airway-Breathing) for adults, children and infants (but not newborns).
The standard procedure for assisting a cardiac arrest victim has been to open a victim's airways, followed by breathing into the mouth and finally performing chest compressions. Now the AHA recommends performing chest compressions first to get blood pumping back into the heart and brain as soon as possible. Because oxygen remains in the lungs and bloodstream for a few minutes after a victim collapses, it is safe to delay the airway-breathing procedures. Rescuers who began CPR by clearing the airways took 30 seconds longer to begin chest compressions than those who started with compressions, the AHA says. In a situation where every moment counts, 30 seconds can be a lifetime.
The new guidelines also may help shave off valuable seconds lost when hesitant rescuers are unsure how to proceed or are squeamish about performing mouth-to-mouth resuscitation. Mike Guillot, director of Emergency Medical Services at East Jefferson General Hospital feels the AHA's recommendations will result in better and faster care for cardiac arrest victims.
"Clearing someone's airway or performing mouth-to-mouth can be daunting for someone who has limited experience with CPR," he says. "The new guidelines make it easier for a lay rescuer to begin reviving a victim with confidence."
Since 2008, the AHA has recommended "hands-only" CPR for all rescuers who are not certified in CPR. The hands-only procedure is to call 911 and immediately begin chest compressions, continuing quick pushes on the center of the chest until professionals arrive. This technique eliminates the breathing step completely.
"Sudden cardiac arrest claims hundreds of thousands of lives every year in the United States, and the American Heart Association's guidelines have been used to train millions of people in lifesaving techniques," AHA President Dr. Ralph Sacco said in an Oct. 18 news release. "Despite our success, the research behind the guidelines is telling us that more people need to do CPR to treat victims of sudden cardiac arrest, and that the quality of CPR matters, whether it's given by a professional or nonprofessional rescuer."
Other highlights of the new guidelines for lay rescuers include:
• Rescuers should perform at least 100 chest compressions per minute.
• Chest compressions should be about 2 inches for adults and 1.5 inches for children.
• Rescuers should allow the chest to return to its normal position completely between each compression.
• Keep interruptions in chest compressions to a minimum.
• Rescuers should avoid excessive ventilation (breathing).
• The compression-to-ventilation ratio remains the same at 30 compressions to two mouth-to-mouth procedures.
The AHA's 2010 recommendations for health care providers include:
• Training dispatchers to identify seizure-like symptoms or gasps as signs of cardiac arrest to help bystanders recognize the condition.
• Having dispatchers talk untrained rescuers through the hands-only CPR approach.
• Healthcare providers should spend a maximum of 10 seconds checking for a pulse before beginning CPR and using a defibrillator.
• Health care providers should measure carbon dioxide output after inserting a tracheal tube to confirm intubation and monitor CPR quality.
• A therapeutic cooling system should be used after a patient is resuscitated.
High-quality CPR and immediate response can be vital in an emergency situation, but cardiac arrest victims often don't receive treatment from bystanders. The AHA hopes its new guidelines will improve responses by lay rescuers and professionals.
"I can't overemphasize how important it is to start chest compressions as soon as cardiac arrest is suspected," Guillot says. "Performing CPR before [Emergency Medical Services] arrives can help to prevent permanent damage and even death. The revised format, Compression-Airway-Breathing, can add valuable seconds to that process."