The ABCs of CPR Rearranged to “CAB”

Every shopping season we all hear a wrenching story or two of someone who dies of a heart attack at a mall with people standing around but NOT offering help. I think it’s not only because so many have not had CPR training, and don’t know what  to do, but that the definitely do NOT want to do mouth-to-mouth resuscitation on someone they do not know. Well, now even untrained observers can do CPR, except it’s now called “CAB.” Here are the details from MedScape:

Chest compressions should be the first step in addressing cardiac arrest. Therefore, the American Heart Association (AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of cardiopulmonary resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

So, if you see someone collapse and they are not breathing and do not have a pulse, (1) have someone call 9-1-1, (2) have another person locate a portable defibralator (all malls and stores have them) or call store security who will bring one, and then you begin chest compressions. No need to do mouth-to-mouth resuscitation at the beginning.

If you remember the Bee Gee’s hit song, Staying Alive, you can time your compressions to the beat as you hum it. Just push down hard (you can NOT push too hard) and fast at a point half way between the top and bottom of the sternum (chest bone). Once 9-1-1 is on the line, the dispatcher will be able to give you further instructions.

Here are the details from MedScape:

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which were published in Circulation: Journal of the American Heart Association and represent an update to previous guidelines issued in 2005.

“The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published,” note the authors in the executive summary. The new research includes information from “356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions (‘webinars’) during the 36-month period before the 2010 Consensus Conference.”

According to the AHA, chest compressions should be started immediately on anyone who is unresponsive and is not breathing normally. Oxygen will be present in the lungs and bloodstream within the first few minutes, so initiating chest compressions first will facilitate distribution of that oxygen into the brain and heart sooner. Previously, starting with “A” (airway) rather than “C” (compressions) caused significant delays of approximately 30 seconds.

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” noted Michael R. Sayre, MD, coauthor and chairman of the AHA’s Emergency Cardiovascular Care Committee, in an AHA written release. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body,” he added.

The new guidelines also recommend that during CPR, rescuers increase the speed of chest compressions to a rate of at least 100 times a minute. In addition, compressions should be made more deeply into the chest, to a depth of at least 2 inches in adults and children and 1.5 inches in infants.

Persons performing CPR should also avoid leaning on the chest so that it can return to its starting position, and compression should be continued as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers instruct untrained lay rescuers to provide Hands-Only CPR (chest compression only) for adults who are unresponsive, with no breathing or no normal breathing.

Other key recommendations for healthcare professionals performing CPR include the following:

  • Effective teamwork techniques should be learned and practiced regularly.
  • Quantitative waveform capnography, used to measure carbon dioxide output, should be used to confirm intubation and monitor CPR quality.
  • Therapeutic hypothermia should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
  • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.

Pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of continuous CPR. The new guidelines also discuss resuscitation of infants and children with various congenital heart diseases and pulmonary hypertension.

The 2010 AHA guidelines for CPR and emergency cardiovascular care are available here.

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