Simpler CPR Guidelines Unveiled

They emphasize chest compressions over rescue breaths

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By Amanda Gardner
HealthDay Reporter

MONDAY, Nov. 28, 2005 (HealthDay News) -- New, simplified guidelines for cardiopulmonary resuscitation (CPR) emphasize pushing on the chest over breathing into a person's mouth.

The revised guidelines are aimed at everyone -- from bystanders to police rescuers as well as doctors and nurses.

"We're starting to get more scientific evidence and this year we reached the tipping point to make changes," said Mary Fran Hazinski, senior science editor for the American Heart Association, and a clinical nurse specialist in pediatric emergency and critical care at Vanderbilt University Medical Center in Nashville, Tenn. "This year's guidelines emphasize the importance of CRP and especially high-quality CPR."

Dr. Robert O'Connor, vice chairman of the American Heart Association's emergency cardiac care committee, and director of education and research at Christiana Care Health System in Newark, Del., added, "We have tried to tighten the chain of survival."

The guidelines were released Monday by the American Heart Association and are published online in the new issue of the journal Circulation.

Both Hazinski and O'Connor spoke at a news conference Monday.

At the heart of the new effort is a desire to increase survival rates for cardiac arrest -- when the heart suddenly stops beating. "We have been concerned that the overall survival rates from cardiac arrest in the U.S. have not budged in the last several years," Hazinski said.

The chances that a victim of cardiac arrest will be successfully resuscitated and go on to live a normal life range from two percent to 70 percent in the United States and Canada, depending on location.

O'Hare and Midway airports in Chicago, however, have reported extraordinarily high rates (74 percent survival to hospital discharge), as have some casinos and some police programs, including the one in Rochester, N.Y., the researchers said.

The idea is to shift the overall figures toward that higher end.

To do that, some 380 international scientists analyzed 20,000 or more studies and came up with several recommendations.

Overall, the guidelines -- which urge laypeople to take a CPR course -- emphasize a "back-to-basics" approach.

"The most common reason people die is because no one nearby knew CPR or didn't actually do it after cardiac arrest happened," said Dr. Michael Sayre, volunteer chairman of the American Heart Association's basic life support subcommittee, and associate professor of emergency medicine at Ohio State University.

"One of the reasons for that is the skill has been very complicated," he added. "We believe that the first step towards bystanders taking action is to improve the accessibility and quality of CPR training and to simplify instructions."

The biggest change is in the ratio of chest compressions to breaths, which under the new guidelines is now 30 compressions for every two breaths, compared to 15 compressions for every two rescue breaths in the 2000 guidelines.

"The more times someone pushes on the chest, the better off the patient is, the more blood flows to the heart and brain and other vital organs," Sayre explained.

When blood flow is increased this way, there's less need for oxygen delivered through breaths. Some health experts have advocated doing away with breaths in CPR altogether, but the practice has been shown to be effective for cardiac arrest in infants and children and among some adults.

This 30-to-two ratio should be used for everyone outside of the newborn period, Sayre added.

The rate of compressions (100 per minute) has not changed. The new guidelines do, however, eliminate some steps, including checking a victim's pulse if it has already been ascertained that he or she isn't moving and breathing.

Another change is the timing of heart rhythm analysis and CPR when using automatic external defibrillators (AEDs). Before, an AED analyzed the rhythm before and after delivering a shock and the whole sequence could be repeated as many as three times before CPR was begun, thus losing precious time.

Now, the guidelines recommend one shock followed by two minutes of CPR before going back to an AED.

"It really requires choreography," O'Connor said.

Other recommendations include training 911 dispatchers to provide CPR instructions by phone.

The European Resuscitation Council also announced on Monday new guidelines for the resuscitation of adults and children. The guidelines are similar to the U.S. ones and also advocate a "back-to-basics" approach. Those guidelines appear in the journal Resuscitation.

At its most basic level, the American Heart Association guidelines urge more people to learn CPR.

"We're stressing the importance of the public taking CPR classes," O'Connor said.

More information

For more on the new CPR guidelines, visit the American Heart Association.

SOURCES: Nov. 28, 2005, news conference with Mary Fran Hazinski, R.N., senior science editor, American Heart Association, and clinical nurse specialist in pediatric emergency and critical care, Vanderbilt University Medical Center, Nashville, Tenn.; Michael Sayre, M.D., volunteer chairman, basic life support subcommittee, American Heart Association, and associate professor of emergency medicine, Ohio State University, Columbus; Robert O'Connor, M.D., M.P.H., vice chairman of emergency cardiac care committee, American Heart Association, and director of education and research, Christiana Care Health System, Newark, Del.

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