The new guidelines put much stronger emphasis on chest compressions, and on the urgency to call emergency services. They separate the case of untrained bystanders from emergency personnel and bystanders trained in CPR. Untrained bystanders are encouraged to deliver compression-only CPR (sometimes called CCR). Trained lay-persons and emergency personnel are requested to start with chest compressions, then to clear the airway, then to alternate between 2 breaths and 30 compressions. The new acronym for trained responders is C-A-B: Compression - Airway - Breathing. The guidelines emphasize that chest compressions should be as uninterrupted as possible, and that the patient not be over-ventilated (too much breathing).
The Red Cross, the largest training organization in CPR, has not adopted the AHA recommendations yet.
The new guidelines are somewhat controversial. The past 5 years have seen many studies show the statistical superiority of CCR over traditional CPR. Some voices complain that the new AHA guidelines do not go far enough: "Why do the Guidelines state that, 'Rescuers should avoid stopping chest compressions and avoid excess ventilations' and yet not advocate chest-compression-only CPR?" asks Dr. Gordon Ewy, of Sarver Heart Center at the University of Arizona, a pioneer of CCR, "the 'Guidelines' have lost or are in danger of losing their credibility."
There is general agreement that, for cardiac arrests only, CCR is superior to CPR. For cardiac arrest following drowning, drug overdose, or for children where cardiac arrest is typically consecutive to breathing problems, the use of breaths is generally believed to be valuable or necessary. The controversy focuses on what the general recommendation for CPR should be, and what untrained bystanders should be directed to do in the general case. In general, however, less than one third of all patients undergoing cardiac arrest outside of a hospital setting get any form of CPR, so any progress on the frequency of administration of CPR or CCR would be better.
We postponed the publication of this post to be able to point at good presentations from the AHA on its new guidelines. Unfortunately, one full week after the publication of the new guidelines, the AHA pages on CPR are still a mess, and provide pitiful clarity on the new process. Surprisingly, the AHA does not make it easy to find out what good CPR is... So, not being able to point you at a very clear summary of the new guidelines from the AHA, we give you our own summary of the new process below.
For untrained bystanders, the process is:
1. Call 911, or ask someone to do it for you
2. If the victim does not respond, roll him (or her) on his back.
3. Immediately start administering chest compressions, at least 100 per minute (on the rhythm of Staying Alive, by the Bee Gees), to a depth of 2" for adults and 1.5" for children. Allow full chest recoil after each compression before the next. Keep on administering chest compressions without interruption.
For trained lay-persons, the process is:
1. Call 911, or ask someone to do it for you
2. If the victim does not respond, roll him (or her) on his back.
3. Immediately start administering 30 chest compressions, on a rhythm of at least 100 per minute (on the rhythm of Staying Alive, by the Bee Gees), to a depth of 2" for adults and 1.5" for children. Allow full chest recoil after each compression before the next.
4. Open the airway with a head tilt and chin lift
5. Quickly administer two 1-second breaths with a tight seal
6. Go back to uninterrupted cycles of 30 chest compressions followed by 2 breaths. Minimize interruptions to the chest compressions, and do not over-ventilate the patient.
Want to read more about it? Try the Washington Post, BBC,WebMD, Chicago Sun Times, CNN, Time Magazine, CBS, USA Today, Business Week HealthDay, KCRG or MedPage Today. You might also want to read our previous post on the state-of-the-art of CPR and CCR.
Circulation Abstracts - New AHA Guidelines
AHA New C-A-B Graphic (PDF)
AHA 2010 Guidelines FAQs (PDF)
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