New Guidelines for CPR

Performing cardiopulmonary resuscitation, or CPR, doubles the chance of survival during sudden cardiac arrest, the leading cause of death in adults in the U.S. Because 75 percent of sudden cardiac arrests occur at home, knowing how to deliver CPR, which combines chest compressions with mouth-to-mouth rescue breathing, is vital.

In November 2005, the American Heart Association (AHA) announced changes in the guidelines on how to perform CPR. The changes feature new ratios for compressions and breaths and other fine-tuning designed to improve CPR's usefulness. As of October 2009, the AHA is still using the 2005 guidelines.

Guidelines Process

• The AHA developed the new guidelines at a January 2005 gathering, the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Car Science with Treatment Recommendations. The Dallas, Texas, conference featured task forces charged with evaluating research studies on CPR and using their findings to make recommendations for changes in the CPR guidelines.

History

• CPR gained acceptance in 1960 after doctors combined chest compression treatment with mouth-to-mouth resuscitation. They combined cycles of a set number of compressions and breaths for each cycle.

  According to the 2005 Dallas, Texas, conference, a review of all available research studies by conference task forces indicated that early CPR procedures over-stressed breathing. According to what the researchers had discovered, the lungs require less oxygen when they are receiving less blood flow. Therefore, doctors suggested changes in CPR to place more stress on compressions and less on breathing.

  In 2000, the AHA set new guidelines for CPR that reflected this shift in thinking. In November 2005, the AHA again altered CPR guidelines to reflect an even greater emphasis on chest compressions and their affect on blood pressure.

Significance of the Changes

• The new CPR guidelines, the AHA says, should improve the rate of survival among those who suffer sudden cardiac arrest because they emphasize the effectiveness of chest compressions. The guidelines provide specific information about chest compression technique, directing rescuers to "push hard and push fast" when doing compressions. They suggest doing 100 compressions per minute for all victims other than newborns, and stress the need to allow the chest to return to its normal position and limiting interruptions during the compressions. Previous to 2005, the AHA's guidelines provided little specificity regarding chest compression technique.

Changes

• The 2000 CPR guidelines recommended 15 chest compressions with two breaths per cycle for adults and a 5-to-1 ratio for children. In 2005, as a result of the Dallas, Texas, conference, the AHA changed this to 30 compressions with two breaths for all adults and all children except for newborns. By taking fewer breaks between compressions, rescuers can keep blood pressure higher, which helps to pump blood to the brain and other vital organs. The new guidelines result in giving about 12 to 20 breaths per minute for children and infants and about 10 to 12 breaths per minute for adults.

Considerations

• The 2005 guidelines also changed the rules regarding the use of defibrillators, a shocking device that can restart the heart. The 2000 recommendation called for the use of as many as three defibrillation shocks before the start of CPR. The 2005 recommendation suggests only one shock before starting CPR.

  The new guidelines also provide specific instruction regarding how rescuers check for breathing. Under the 2000 guidelines, rescuers checked for the absence of breathing for all victims. Under the 2005 guidelines, rescuers only check for breathing in unresponsive individuals. The new guidelines suggest taking only 5 to 10 seconds to check for breathing in unresponsive victims.

  The new guidelines also change how rescuers open the airway in an unresponsive victim. Lay rescuers should use a head-tilt chin maneuver instead of the jaw-thrust technique outlined in the 2000 guidelines.

Types of Rescuers

• The 2005 CPR guidelines also specify different procedures according to the type of person who is doing the CPR. The guidelines say that "lay rescuers" should begin cycles of chest compressions and breaths immediately after giving two rescue breaths for an unresponsive victim. Lay rescuers are not allowed to administer rescue breathing without chest compressions. The guidelines also no longer teach/require lay rescuers to assess pulse or circulation. Health care providers should do so of course, and the guidelines suggest health care providers spend as long as 10 seconds to determine whether the person has a pulse.