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CPR 2010 Guideline Changes
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CPR 2010 Guideline Changes

CPR Guideline Changes – The ABC’s of CPR Have Changed

Everyone in the medical field knows their ABC’s, but following the American Heart Association’s updated CPR guidelines for 2010, millions of health professionals and lay responders may have to relearn them. For the last several decades the acronym “ABC” has been utilized to recall the steps involved in emergency cardiopulmonary resuscitation (CPR), but, following 5 years of research, the new guidelines suggest there’s a better method to help victims suffering cardiac arrest.

CPR is the first recommended treatment for victims thought to be in cardiac arrest (whose hearts have stopped pumping blood) and involves delivering a combination of rescue breathing and chest compressions to support a small amount of blood flow to the heart and brain until normal heart function is restored.

Sudden Cardiac Arrest (SCA) is most often caused by a condition called ventricular fibrillation (VF), which is essentially an abnormal heart rhythm that causes the heart to quiver without pumping blood. Victims of VF cardiac arrest require an electric shock to the heart (defibrillation) to reset the heart and restore a normal rhythm. However, after collapsing and until a  i portable automated external defibrillator (AED) can be applied or emergency responders can make it to the scene, CPR is critical to sustain the victim and increase their chance of recovering after defibrillation.

ABC’s Change to CAB

The biggest change in the new guidelines is an amelioration of the basic life support (BLS) sequence for trained rescuers from “A-B-C” to “C-A-B”. The traditional practice used to be to follow “A-B-C”, meaning airway, breathing, and then chest compressions, which focused on opening the victims airway before trying to manually activate blood flow with chest compressions; the newly published guidelines recommend changing that well-known process to “C-A-B”, or chest compressions, airway, and then breathing.The reason for this shift in the CPR paradigm is consistent research indicating that in the majority of cardiac arrests, chest compressions and fast defibrillation are the critical elements in aiding survival.  In the CAB sequence, ventilation will only be minimally delayed and the more-important compressions will be initiated sooner.

Even after cardiac arrest, there is enough oxygen in the bloodstream to maintain the heart and brain for several minutes as long as compressions circulate that oxygen. Providing oxygen through rescue breaths is actually harmful since it requires the rescuer to not press on the chest for several seconds.

Essentially, now, compressions come first - only then do you focus on airway and breathing. These new recommendations apply to all ages – including children and infants – and only newborn babies should still receive the airway-first method according to the revised guidelines. It has also been suggested that the ABC sequence may have actually played a role in preventing assistance: because it required the most difficult part first – opening the airways – it may be one reason that fewer than 1/3 of the people in cardiac arrest receive CPR. Faster, Harder Compressions The second biggest change called for under the new 2010 guidelines is faster and more forceful compressions. For adult CPR, the previous instructions required pressing 1 ½ to 2 inches deep, but the new standard requires responders to compress the chest at least two inches on each push, at a rate of 100 compressions per minute. The AHA says that “Staying Alive” – the popular tune by the Bee Gees’ – is actually the perfect pace to follow when administering compressions.  At the recommended rate, 30 compressions should take 18 seconds – a pretty rapid pace to maintain.This fast frequency is so imperative because the number of chest compressions delivered per minute during CPR is an important determinant in victims regaining a pulse, otherwise known as return of spontaneous circulation, or ROSC, and recovering with good neurological function and no brain damage. Generally, providing more compressions during resuscitation is associated with better survival and delivery of fewer compressions is linked to lower survival.Don’t Bother to Look, Listen, or FeelAnother notable change in the new recommendations is the removal of look, listen, and feel – a protocol that (just as it sounds) wanted rescuers to observe the victims breathing ability before beginning CPR. Look, listen and feel have now been removed because they are inconsequential and delay critical care from being started. Compressions Only for the UntrainedFor untrained responders, the new 2010 AHA guidelines upholds the 2008 recommendation to call 911, and then administer chest compression only, completely omitting rescue breathing. This type of “compressions only” CPR is sometimes known as CCR, or cardiocerebral resuscitation, and is also recommended for emergency dispatchers, since it is easier to guide an untrained bystander in over the telephone.This widespread change is based on data from many recent studies on CPR. CCR was implemented in two counties in Wisconsin and survival rates of out-of-hospital cardiac arrest victims improved with the new protocol, according to an article published in April 2006 in the American Journal of Medicine.  Similarly, a study done by physicians in Tokyo and published in the The Lancet, a British medical journal, examined how CPR was being performed by the lay public and determined that CPR performed without rescue breathing was twice as successful as CPR performed with rescue breaths.

It is important to remember though that these changes apply only to adult cardiac arrest victims, for victims of near-drowning and drug overdose, the “C-A-B” style of CPR is recommended.

Never Stop Pushing

Understanding the importance of compressions, the AHA also recommends to not stop pushing. For both trained responders administering CPR and untrained responders performing CCR, it takes several chest compressions to get blood moving again, so the AHA says to continue compressions absolutely as long as possible, until an AED is in place and ready to operate.  If blood flow to the brain stops for too long it can lead to brain death. When trained responders have to do mouth to mouth, it should be as fast as possible so that compressions are quickly resumed.Making the ChangeAny change to CPR is bound to garner attention, and the change to remove rescue breathing from untrained CPR guidelines has caused quite a stir. After all, CPR is a foundation of emergency medical care that is required training for almost all emergency medical service providers in the United States, is widely taught to the lay public, and is even required by many employers and organizations.However, the AHA guidelines are a consensus document that represents the majority opinion of researchers in the field. Some advocates of compression-only CPR even criticize the new guidelines for not going far enough, citing evidence the CCR is superior to CPR, even when done by medical professionals.

Still, the 2010 guidelines are a significant change from those previously published by the AHA and, hopefully, will be effective in increasing the lives saved during sudden cardiac arrest, though the changes require widespread retraining and implementation.

Many organizations are already getting on board. As the nation's largest provider of CPR training, the American Red Cross supports the use of hands only CPR for cardiac emergencies which occur outside of a health care setting, and will soon announce the details of an initiative to train 5 million people in hands only CPR by the end of 2011.

Our goal at AED-SHOP.com is to educate the public about Sudden Cardiac Arrest and how AEDs increase the survival rate. In need of an AED for your organization, CPR training for your staff, or AED replacement accessories?  Contact us today with your questions or concerns at 877-251-7467 or customerservice@aed-shop.com. 

Posted: 4/11/2011 8:19 AM
Forum Index > CPR Training