First CPR Step to
Saving Sudden Cardiac Arrest Victims is Fast, Hard Chest-Compression
American Heart
Association changes ABCs of CPR to CAB (Compressions-Airway-Breathing)
(See video below story)
See Mayo
Clinic video below news story.
Oct. 18, 2010 –
Following the results of several years of studies showing compression-only
cardiopulmonary resuscitation (CPR) as the best way for untrained people
to save those suffering from sudden cardiac arrest, the American Heart
Association is now - for the record book - recommending it as the first
step. The association first made this the preferred method for lay
people in a scientific statement published online in 2008.
Reviving a pulse beat at the scene is best
chance of survival; dismal trend considering enormous spending on heart
research, new emergency care protocols, new drugs, devices such as
defibrillators
This change is
just being made official with the 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care being published today in Circulation: Journal of
the American Heart Association.
The
association's announcement says 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 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 American Heart Association’s Emergency
Cardiovascular Care (ECC) 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-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.
Steps for Adult CPR*
Based on 2010 American Heart Association
Guidelines.
Summary of
steps for adult CPR given by a nonprofessional rescuer:
1. Make sure
the scene is safe.
2. Shake the
victim’s shoulders and shout to see if they respond.
3. If the
victim does not respond, and the victim is not breathing or not
breathing normally, yell for someone to call 9-1-1 and get an
AED, if available.
• If you’re
alone, call 9-1-1 and get an AED if available. Follow the AED’s
voice prompts.
• If no AED
is available, immediately start CPR, beginning with
compressions.
COMPRESSIONS
4. Push hard
and fast on the center of the chest 30 times, at a rate of at
least 100 compressions a minute. Push down at least 2 inches
with each compression. If you haven’t been trained in CPR,
continue to give compressions until an AED arrives or trained
help takes over.
AIRWAY
5. If you have
been trained in CPR, continue CPR by opening the airway with a
head tilt–chin lift.
BREATHING
6. Pinch the
victim’s nose closed. Take a normal breath a cover the victim’s
mouth with your mouth, creating an airtight seal. Give two
breaths (one second each). Watch for chest rise as you give each
breath.
7. Keep giving
sets of 30 compressions and two breaths until the AED arrives or
trained help takes over.
* These steps are for the general public, not for
healthcare professionals
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.
“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,” said Ralph Sacco,
M.D., president of the American Heart Association.
“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
non-professional rescuer.”
Since 2008, the
American Heart Association has recommended that untrained bystanders use
Hands-Only CPR — CPR without breaths — for an adult victim who suddenly
collapses. The steps to Hands-Only CPR are simple: call 9-1-1 and push
hard and fast on the center of the chest until professional help or an
AED arrives.
Key
guidelines recommendations for healthcare professionals:
● Effective
teamwork techniques should be learned and practiced regularly.
●
Professional rescuers should use quantitative waveform capnography — the
monitoring and measuring of carbon dioxide output — to confirm
intubation and monitor CPR quality.
● Therapeutic
hypothermia, or cooling, should be part of an overall interdisciplinary
system of care after resuscitation from cardiac arrest.
● Atropine is
no longer recommended for routine use in managing and treating pulseless
electrical activity (PEA) or asystole.
Special
instructions for treating certain children
Pediatric
advanced life support (PALS) guidelines provide new information about
resuscitating infants and children with certain congenital heart
diseases and pulmonary hypertension, and emphasize organizing care
around two-minute periods of uninterrupted CPR.
The CPR and ECC
guidelines are science-based recommendations for treating cardiovascular
emergencies — particularly sudden cardiac arrest in adults, children,
infants and newborns. The American Heart Association established the
first resuscitation guidelines in 1966.
The year 2010
marks the 50th anniversary of Kouwenhoven, Jude, and Knickerbocker’s
landmark study documenting cardiac arrest survival after chest
compressions.
Video by Mayo Clinic on Hand Compression CPR
2010 American Heart
Association Guidelines for CPR & Emergency Cardiovascular Care Fact
Sheet
About
Guidelines
• The American
Heart Association’s Guidelines for CPR and ECC provide science-based
recommendations for treating cardiovascular emergencies, particularly
sudden cardiac arrest in adults, children, infants and newborns
• Every five
years, hundreds of leading resuscitation experts from around the world
review all new and existing research as part of an international
consensus process. This is the basis for any revisions to the American
Heart Association’s Guidelines for CPR and ECC
• The American
Heart Association established guidelines for resuscitation in 1966, and
since then, other major organizations around the world have continued to
use our guidelines as the basis for their own resuscitation training
History of
CPR
• In 1960,
researchers combined breaths and compressions to create CPR as we know
it today
• CPR training
has been recommended for healthcare professionals and for the general
public for more than 40 years
• 2010 marks a
change in the sequence of CPR from Airway-Breaths-Compressions (A-B-C)
to Compressions-Airway-Breaths (C-A-B) sequence
Sudden
Cardiac Arrest
• EMS treats
nearly 300,000 victims of out-of-hospital cardiac arrest each year in
the U.S
• Less than eight
percent of people who suffer cardiac arrest outside the hospital survive
to make it home from the hospital
• Sudden cardiac
arrest can happen to anyone at any time. Many victims appear healthy
with no known heart disease or other risk factors
• Sudden cardiac
arrest is not the same as a heart attack. Sudden cardiac arrest occurs
when electrical impulses in the heart become rapid or chaotic, which
causes the heart to suddenly stop beating. A heart attack occurs when
the blood supply to part of the heart muscle is blocked. A heart attack
may cause cardiac arrest
Cardiopulmonary Resuscitation (CPR)
• Less than
one-third of out-of-hospital sudden cardiac arrest victims receive
bystander CPR
• Effective
bystander CPR, provided immediately after sudden cardiac arrest, can
double or triple a victim’s chance of survival
• Last year, the
American Heart Association trained more than 13 million people in CPR
worldwide, including healthcare professionals and the general public
• Chest
compressions should be provided at a rate of at least 100 compressions
per minute – the same rhythm as the beat of the Bee Gee’s song, “Stayin’
Alive.”
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