If somebody’s heart stops while out in the street, lay rescuers should now focus on CAB (Compressions-Airway-Breathing) and not ABC (Airway-Breathing-Compressions) anymore, says the American Heart Association in its new guidelines. When a person’s heart stops there is still some oxygen in their blood, but the circulation has stopped. Chest compressions help move blood around again straight away, while focusing on airways and breathing does not – the old system causes a delay. The old system of ABC caused problems because the patient’s blood was not circulating for too long while the rescuer focused on his/her airways and mouth-to-mouth first. The new guidelines include recommendations for lay bystanders and health care professionals.
The new guidelines, called 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care have been published in the medical journal Circulation.
Co-author Michael Sayre, M.D., chairman of the American Heart Association’s Emergency Cardiovascular Care (ECC) Committee, said:
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. 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.
A rescuer should start chest compressions promtly if a person whose heart has stopped is not breathing properly or seems unresponsive, the guidelines state, rather than listening and feeling for normal breathing, as used to be the case.
According to recent studies, focusing first on the air and breathing used up precious oxygen in non-pumped blood in the patient for 30 seconds, while chest compressions first got the blood moving again around the body, which helps improve the person’s chances of survival. As mentioned above, during a cardiac arrest – when the heart stops – there is still some oxygen in the blood; getting that oxygen moving around the body is vital, that is done with chest compressions.
The American Heart Association stresses that its new guidelines do not apply to newborns, they apply to everyone else, though, including infants, children and adults.
Some more highlights of the new guidelines include:
- The rescuer should give chest compressions at a slightly faster rate than used to be recommended. Now, they should be at least 100 times per minute.
- The chest compression should push 2.5 inches into the adult chest and 1.5 inches into a baby’s chest – a deeper push than the old guidelines recommended
- Between each compression avoid doing anything that may undermine the chest’s return to its starting position. This means, for example, not leaning on the chest in between each compression (each push down)
- Avoid stopping chest compressions
- Avoid excessive ventilation
- When cardiac arrest (the heart stopped) is suspected, 911 centers should explain over the telephone what to do, making sure the rescuer starts with chest compressions
Ralph Sacco, M.D., president of the American Heart Association, said:
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. 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.
Hands-only CPR, without mouth-to-mouth, has been recommended by the American Heart Association since 2008 for lay bystanders if the victim is an adult. The recommendation has been to call emergency services (911) and push hard and fast on the center of the patient’s chest until a trained professional comes.
Below are some highlighted guidelines for health care professionals:
- Practice effective teamwork techniques frequently
- Use quantitative waveform capnography – the measurement of CO2 in expired air directly indicates changes in the elimination of C02 from the lungs – to confirm intubation, and monitor the quality of CPR
- After resuscitation from cardiac arrest, therapeutic hypothermia (cooling) should be part of an overall interdisciplinary system of care
- Atropine is not recommended any more for routine use in managing and treating pulseless electrical activity (PEA) or asystole
In a communiqué, the American Heart Association writes:
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.
In an article in last week’s The Lancet, a peer-reviewed medical journal, researchers from the USA and Austria wrote that emergency services operators should tell lay bystanders to focus just on chest compressions and ignore mouth-to-mouth completely. Their study revealed 22% better survival rates if mouth-to-mouth were omitted, and just chest compressions were used until health professionals or emergency services arrived. (Link)
John M. Field, Co-Chair; Mary Fran Hazinski, Co-Chair; Michael R. Sayre; Leon Chameides; Stephen M. Schexnayder; Robin Hemphill; Ricardo A. Samson; John Kattwinkel; Robert A. Berg; Farhan Bhanji; Diana M. Cave; Edward C. Jauch; Peter J. Kudenchuk; Robert W. Neumar; Mary Ann Peberdy; Jeffrey M. Perlman; Elizabeth Sinz; Andrew H. Travers; Marc D. Berg; John E. Billi; Brian Eigel; Robert W. Hickey; Monica E. Kleinman; Mark S. Link; Laurie J. Morrison; Robert E. O’Connor; Michael Shuster; Clifton W. Callaway; Brett Cucchiara; Jeffrey D. Ferguson; Thomas D. Rea; Terry L. Vanden Hoek
Circulation. 2010;122:S640-S656
Written by Christian Nordqvist