Healthnotes Library
Happy 50th Birthday: NEW AHA GUIDELINES REGARDING CARDIOPULMONARY RESUSCITATION (CPR)
Published and reviewed August 2011
In late 2010, new guidelines were released by the American Heart Association (AHA) for CPR and emergency cardiovascular (heart) care. The new guidelines marked the 50th anniversary of the advent of modern techniques for CPR. In 2012, the 50th anniversary of the description of the technique of direct-current defibrillation for treatment of lethal heart rhythm disorders (such as ventricular fibrillation) will occur. This eventually led to the present day recommendations for the use of automatic external defibrillators (AEDs) in CPR.
Many of you may be asking: "why should I be interested in this?" In the U.S., more than 450,000 people die each year from Sudden Cardiac Arrest (SCA). SCA is the sudden, unexpected loss of heart function, breathing and consciousness; and is a bonafide medical emergency. Surprisingly, more than half of these victims exhibit no symptoms of heart disease whatsoever prior to their unexpected sudden death; and thus, there is no warning.
Oftentimes, when the subject of CPR is discussed in the general public, one hears comments such as "It's too complicated", "I don't feel comfortable with it", "I'm afraid I'll screw up". This also contributes to a general reluctance in learning and/or performing CPR. Well guess what? It just got a lot simpler!
As I mentioned above, within the past year, new guidelines were released on CPR and emergency cardiac care by the American Heart Association (AHA). The complete guidelines were published in a supplemental issue of the professional journal, Circulation (ref 2010; 122: S640-S656) and online. Although the guidelines are quite lengthy and deal with multiple issues (including special situations such as pregnancy and pediatric care), this brief summary will focus on adult patients with Sudden Cardiac Arrest.
Alphabet Soup: there is a major change in the training of Basic Life Support (BLS), with the acronym changing from "ABC" to "CAB". This is due to newer developments in the science of CPR since 2005 (the last time the guidelines were issued); and studies that have reported on the relatively poor quality of CPR being performed. In addition, it has been noted that survival rates have been very low (< 6 % of people suffering from witnessed, out-of-hospital Sudden Cardiac Arrest survive).
The sequence of steps in CPR has changed from Airway-Breathing-Chest compressions (ABC) to Chest compressions-Airway-Breathing (CAB) to reduce the time to initiation of chest compressions. This change puts stronger emphasis on compressions of the chest for several reasons. It not only simplifies CPR, but is hoped to improve survival rates, by avoiding delays in starting effective CPR. In fact, for most adults with SCA, bystander CPR that only uses chest compressions (Hands-only CPR) appears to have similar success as compared to the older, more conventional sequence of ABC. (However, it should be noted that this does not apply to children, and that the ABC sequence is still recommended for children.)
This is because, in adults, the best survival rates are seen with a witnessed SCA event in people with an abnormal heart rhythm of ventricular fibrillation or pulseless ventricular tachycardia. In this situation, prompt bystander-initiated CPR with chest compressions and early defibrillation (AED use) are the most critical elements for survival.
Unfortunately, the truth is that, in general around the US, people suffering from SCA get bystander-initiated CPR < 50% of the time. Although there may be multiple reasons for this relatively poor emergency response rate, the ABC sequence starts with things that the public find most difficult (that is, opening the mouth of the victim and delivering rescue breathing). Starting with chest compressions (CAB) reduces the delay in action during an emergency situation; and encourages bystanders to initiate potentially life-saving compressions even if they are not capable of (or unwilling to) perform rescue breathing.
So, the traditional teaching of "look, listen and feel" has been removed from the sequence of basic life support/CPR to reduce time and confusion in the effective treatment of a life-threatening condition. And the technique has evolved from ABC to CAB, with Hands-only chest compression CPR recommended for untrained bystanders. In addition, "checking the pulse" can often be misleading, and time-consuming, so it has been removed as well for bystander-initiated CPR.
If an adult suddenly collapses, is unresponsive and is not breathing, then the bystander should assume that this is SCA, with activation of an emergency response system, and immediate initiation of chest compressions.
To learn more, contact your local chapters of the AHA or American Red Cross to learn the new, simpler CPR techniques and become certified in Basic Life Support. It just might save the life of someone close to you.
Official AHA Hands-Only CPR Demo Video
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science Part 5: Adult Basic Life Support Link
About the Author
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Thomas Rocco, Jr., MD
Thomas A. Rocco, Jr., MD, F.A.C.C., F.A.H.A. is a Clinical Associate Professor of Medicine at the University of Rochester Medical Center and a Consultant in Cardiology and Cardiovascular Research at the Veterans Administration. He formerly directed the departments of Cardiology at Highland Hospital and Unity Hospital. His clinical and research interests include Preventive Cardiology, Hypertension, Congestive Heart Failure, and Geriatric Cardiology. He is the Principle Investigator on several clinical research projects, has lectured and published extensively, and has served on numerous community boards and agencies. |
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