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Vital Signs

Winter 2011

New CPR Guidelines Can Save More Lives


VS-Witner11-CPR GuidelinesRevised CPR guidelines issued in October instruct bystanders attempting to revive someone in a state of cardiac arrest to skip mouth-to-mouth resuscitation and go straight to performing rapid chest compressions after calling 9-1-1 for help. Previously, guidelines had called for the A-B-C (airway, breathing, chest compression) approach — checking the airway and then performing the breathing technique. The revised guideline highlights C-A-B (chest compression, airway, breathing). The exceptions involve children and victims whose breathing is obstructed, whether because of choking or following a drowning rescue; in such cases, the conventional approach still applies.

In part, the change in the guidelines reflects a concern that most victims of cardiac arrest fail to receive any CPR from bystanders in the critical minutes after their heart stops. “A lot of people don’t want to do mouth-to-mouth, either because they fear catching a disease or simply because they are squeamish,” says Mark Morocco, M.D., associate residency director for Emergency Medicine at Ronald Reagan UCLA Medical Center. “Even among those who do try it, there is a tendency to become frustrated and give up. These new guidelines simplify the process and get straight to the compressions before valuable time is wasted.”

But Dr. Morocco notes that simplification isn’t the only reason for the change: Studies have shown that so-called hands-only CPR increases the likelihood of survival in comparison to the A-B-C approach.

“Compressions help to circulate warm and oxygenated blood through the body sooner, which is critically important,” says Wally Ghurabi, D.O., medical director of the Emergency Department at UCLA Medical Center, Santa Monica. Dr. Ghurabi says the chest compressions are too often not fast enough, deep enough or long enough. They should be done to a depth of at least two inches for adults, allowing the chest to recoil after each one (i.e., don’t lean on the chest), and one-and-a-half inches for infants and two inches for children; and at a rate of at least 100 per minute until the arrival of emergency personnel.

Only about 8 percent of those who suffer cardiac arrest outside a hospital survive with their brain function intact, Dr. Ghurabi notes, but when proper techniques are performed, that rate is substantially higher. “People need to understand that in these situations, the battle is won and lost in the field,” Dr. Ghurabi says. “By shifting the focus to circulating blood as long as possible in that critical time period, we can save many lives.”

For more information and a complete copy of the new American Heart Association guidelines, go to: www.heart.org/cpr

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