New CPR Rules: Pump First, and Save the Breaths for Later

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If you saw someone in cardiac arrest, would you know what to do? If you had ever been trained in CPR, you might remember your ABCs — airway, breathing, chest compressions. First you open the airway and try to resuscitate the victim by giving quick breaths through the mouth. Then you move on to pumping the chest to get the heart beating again. But now the American Heart Association (AHA) is officially changing the order of CPR, and urging rescuers to start with chest compressions first.

It’s the first major change in the procedure since CPR, or cardiopulmonary resuscitation, was introduced in 1960. In recent years, the results of study after study have supported the fact that victims who receive chest compressions alone from untrained bystanders survive as well as those who received traditional CPR, which starts with two quick breaths and then 30 chest compressions. (More on The Case Against Mouth-to-Mouth Resuscitation).

“We want to emphasize chest compression as the most important part of CPR by starting with those first,” says Dr. Michael Sayre, a professor of emergency medicine at Ohio State University and co-author of the new guidelines, published in the journal Circulation.

The AHA’s committee reviewed several studies that indicated that outcomes for victims treated with hands-only CPR did as well as those who received both compressions and mouth-to-mouth resuscitation.

The reasons, says Sayre, are both social and biologic. Only about one third of those who suffer cardiac arrest (which is a stopping of the heart, as opposed to a heart attack, in which blockages may impede blood flow to the heart but the patient is often still conscious and in pain) get any form of CPR, and much of that has to do with the reluctance of bystanders to jump in and start the procedure. “CPR is perceived to be too complex,” he says. “There are two social barriers and those are the panic effect, that rescuers just don’t know what to do, and the confidence factor, that even if they do know CPR they don’t feel they are able do it well enough.” (More on Want Good Health? There Are 10 Apps for That).

By focusing on the chest compressions only, he says, more bystanders, even untrained in CPR, might feel more comfortable starting CPR to help save a victim. A recent study also showed that when lay people calling into 911 were talked through traditional CPR or hands-only compressions, those performing the compressions alone were more likely to follow the instructions and that the final outcomes for the patients in terms of survival were similar.

The medical reason for that is that heart needs to beat continuously, and the quicker rescuers can restore the pumping, the better for the victim. “We know that the number of chest compressions given in the first few minutes after cardiac arrest really makes a difference,” says Sayre. “The heart doesn’t take breaks. So somebody needs to be pushing on the chest as close to continuously as possible in order to really try to get the maximum amount of oxygen to the heart and brain.”

By reversing the order of chest compressions and breaths, he says, rescuers are delaying any additional intake of oxygen by only about 20 seconds, and the body has enough oxygen from its last breath before the attack to maintain itself. (More on 5 Keys to Health Reform’s Success or Failure).

The guidelines apply to children and adults alike, since AHA officials did not want separate and potentially confusing advice for different groups of people. The change in CPR is part of a larger revision of its emergency heart care recommendations, and do not apply, for instance, to drowning victims who are also unresponsive — for them, the first priority is to resuscitate them with oxygen.

The new CPR advice also applies to EMTs, doctors, nurses, lifeguards and other professional emergency personnel as well, to reinforce the AHA’s belief in the importance of chest compressions. But the advice should be particularly reassuring and empowering for lay people who may feel more confident in helping those who need it. “For most victims of cardiac arrest, chest compressions are as good as if not slightly better than conventional CPR. So people should feel really good that they are helping out,” says Sayre.

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