New guidelines for CPR have been issued by the American Heart
Association. These are based on international review and consensus, and
will ultimately result in changes to all CPR taught in the USA. However,
lifeguards should follow the training under which they are most
currently certified, until they have received updated training and
certification.
The primary changes DO NOT APPLY TO DROWNING. Why? Because in sudden
cardiac arrest, the body is oxygenated when the heart suddenly stops. In
drowning, the heart stops due in large part to suffocation, causing a
severe lack of oxygen.
Note in the article below, the new guidelines, "… do not apply, for
instance, to drowning victims who are also unresponsive — for them, the
first priority is to resuscitate them with oxygen.”
A brief video from the AHA detailing some changes is here:
Time Magazine
New CPR Rules: Pump First, and Save the Breaths for Later
By Alice Park Monday, October 18, 2010
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 Time.com: 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 Time.com: 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 Time.com: 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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