It has been 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR). The technique is simple and it has saved many lives of victims of cardiac arrest.
As we know, CPR is an emergency procedure involving chest compressions (pressing down on the chest) and artificial respiration (rescue breathing). It has the power to restore blood flow to someone suffering cardiac arrest, keeping them alive until an ambulance arrives.
The guidelines are reviewed every five years and updated only when evidence is clear that changes will improve survival rates. Over the years it has become clear that high quality chest compressions is vital to proper resuscitation technique.
It is also evident that many people are reluctant to provide mouth-to-mouth resuscitation due to hygienic reasons. The Heart and Stroke Foundation of Canada survey finds that only 40 per cent of Canadians trained in CPR would try to revive someone who has had a cardiac arrest.
So, it was time for change. The Heart and Stroke Foundation of Canada is co-author of the 2010 Guidelines for CPR and Emergency Cardiovascular Care (ECC) in North America. The Foundation is actively involved in resuscitation science, education and training (http://www.heartandstroke.com).
Experts looked at all the evidence to see if the technique can be simplified so we can save more lives. The 2010 guidelines are based on input from 356 resuscitation experts from 29 countries.
As indicated earlier, most victims of out-of-hospital cardiac arrest do not receive any bystander CPR. Why? There are probably many reasons for this, but one impediment may be the A-B-C (Airway, Breathing, Chest compressions) sequence, which starts with the procedures that rescuers find most difficult, namely, opening the airway and delivering breaths. Starting with chest compressions might encourage more rescuers to begin CPR.
So, the new guideline has changed the sequence from A-B-C to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants (excluding the newly born). Here are some important points from the new guidelines (2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science):
-A chest compression rate of at least 100/min (a change from “approximately” 100/min)
-A chest compression depth of at least 2 inches (5 cm) in adults and a compression depth of at least one third of the anterior-posterior diameter of the chest in infants and children.
-Allow for complete chest recoil after each chest compression
-Minimize interruptions in chest compressions
-Avoid excessive ventilation. There is no change in the recommendation for a compression-to-ventilation ratio of 30:2 for single rescuers of adults, children, and infants
If you are the only person to witness a cardiac arrest, at home or on a street, then start with chest compressions and call for help. If there are two or more rescuers around then one rescuer immediately initiates chest compressions while another rescuer gets an automated external defibrillator (AED), if available, and calls for help. A third rescuer opens the airway and provides ventilations.
Once the heart stops pumping, seconds count. For every minute that passes without help, a person’s chance of surviving drops by about 10 per cent. But if you know how to respond to a cardiac arrest, a person’s odds of survival and recovery may increase by 30 per cent or more.
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