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'Push Hard, Push Fast' Key to New CPR Guidelines

Updated CPR guidelines emphasize chest compressions over ventilation, using a 30:2 ratio

TUESDAY, Nov. 29 (HealthDay News) -- The American Heart Association issued new cardiopulmonary resuscitation (CPR) guidelines this week that emphasize the importance of chest compressions over ventilation. They now call for 30 compressions to two ventilations per cycle, according to a special supplement to Circulation: Journal of the American Heart Association.

"Simply put: rescuers should push hard, push fast, allow full chest recoil, minimize interruptions in compressions and defibrillate promptly when appropriate," write the authors of the 2005 guidelines.

Other notable changes include going straight to compressions without a pulse check after the initial two ventilations, employing the 30:2 ratio for all age groups except newborns (for whom the 3:1 ratio remains) and applying one shock by automated external defibrillator before resuming CPR. CPR should continue for at least two minutes before evaluating again for shocks. "Modern biphasic defibrillators have a high first-shock efficacy averaging more than 90%, so that ventricular fibrillation is likely to be eliminated with one shock," the consensus panel writes.

The new guidelines de-emphasize drug delivery and pulse and rhythm checks after shocks, which contribute to too-long interruptions in chest compressions. The most important part of the sequence is high-quality chest compressions with minimal interruptions.

Many of the changes were made by consensus, as level 1 evidence is still lacking, according to an editorial by Mary Fran Hazinski RN, MSN, and others. However, the most important link in the chain of survival remains "the presence of a rescuer who is trained, willing, able and equipped to act in an emergency," they write.

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