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2010 American Heart Association Guideline for CPR and Emergency Cardiovascular Care

For more than 40 years, CPR training has emphasized the ABC's of CPR which instructed to open a victim's airway by tilting their head back, pinching nose and breathing into the victim's mouth, and only then giving chest compressions. "This approach was causing significant delays in starting chest compression, which are essential for keeping oxygen rich blood circulating through the body," Sayre stated.

Thus, in its 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care, published in Circulation:Journal of the American Heart Association recommends that CHEST COMPRESSIONS be the FIRST STEP for lay and professional rescuers to revive the victims of sudden cardiac arrest. Further, the association said that A-B-C's of CPR must now be
CHANGED to C-A-B's (Compression-Airway-Breathing). This sequence will allow all rescuers to begin chest compressions right away for adults, children and infants but excludes newborns.

In the previous guidelines it can be noted that looking, listening and feeling for normal breathing is done before starting CPR. In the first few minutes of cardiac arrest, victims will have oxygen remaining in the lungs and bloodstream, so starting CPR with chest compression can pump blood to the victim's brain and heart sooner. Moreover, research shows that rescuers who started CPR with opening airway took 30 critical seconds longer to begin chest compressions than rescuers who begin CPR with chest compressions. Now, it is highly recommended that for anyone who is unresponsive and not breathing normally, chest compressions should be started immediately.

Further, since 2008, AHA has recommended that untrained lay people are urged to administer HANDS-only CPR (chest compressions only) for adult victim who suddenly collapses. Steps such as Calling 911 and push hard and fast on the center of the chest until professional help or an AED arrives must be done.

Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005 are as follows:

* During CPR, rescuer should give chest compression a little faster, at a rate of at least 100 times in a minute.
* Rescuers should push deeper to the chest, compressing at least 2 inches in adults and children and 1.5 inches in infants.
* Between each, compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
Rescuers should avoid stopping compressions and avoid excessive ventilation
* All should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.

Key guidelines recommendations for health care professionals:

* Effective teamwork techniques should be learned and practiced regularly
* Professional rescuers should use quantitative waveform capnography - the monitoring and measuring of carbon dioxide output - to confirm intubation and monitor CPR quality
* Therapeutic hypothermia, or cooling should be a 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 (PEA)

Moreover, Pediatric Advanced Life Support (PALS) guidelines provide new information about resuscitating infants and children with certain congenital heart diseases and pulmonary hypertension, and emphasize organizing care around two-minute periods of uninterrupted CPR.

Visit for electronic press kit that includes a stats/fact sheet, chart of key changes, steps of CPR, CPR graphic and survivor stories

Source: BON advisory dated October 19, 2010.

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