CPR changes

More focus on chest compressions

More focus on chest compressions

February 20, 2006|by JULIE E. GREENE

Helping someone who appears to have stopped breathing, whose heart isn't beating and is unresponsive can be a traumatic enough experience.

To improve the chances of helping someone and make the experience easier for potential rescuers, especially nonprofessionals, the American Heart Association has made some changes to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines.

AHA officials decided to put more emphasis on chest compressions than mouth-to-mouth resuscitation.

Compressing the chest circulates oxygenated blood to the brain, says Joanne Hirsch. Hirsch, of Silver Spring, Md., is a long-time AHA volunteer who teaches CPR to CPR instructors and community members.


"The change has shown that the superior delivery of oxygenated blood to the brain is accomplished through more compressions and less focus on ventilation," Hirsch says. With chest compressions, the brain gets 25 percent to 30 percent of the oxygenated blood it would normally get, Hirsch says.

"We don't even like one minute to go by" without oxygenated blood getting to the brain, Hirsch says. After four minutes without oxygenated blood, brain cells begin to die.

A rescuer doing chest compressions is acting like the heart, says Cindy Earle, coordinator of community health education at Washington County Hospital and a registered nurse who teaches CPR.

AHA studies have shown that limiting interruptions to chest compressions can improve the chances for survival, Earle says.

To dramatically increase the survival rate for adults from 2 percent to 40 percent, CPR and an AED should be used, Earle says. Some basic CPR training involves defibrillator use.

Earle encourages people to get CPR training to give victims a better chance of survival.

The previous recommendation for a lone rescuer to provide CPR outside a health-care facility was to do 15 chest compressions to two breaths.

The new recommendations, issued in December, call for a lone rescuer to provide 30 chest compressions to two breaths for adults, children and infants, according to Hirsch and Currents, an AHA publication.

The new recommendations for basic life support classes are to begin being taught as of July 1, Hirsch says.


Also, nonprofessional rescuers will no longer be taught to look for a pulse or signs of circulation before beginning CPR.

Not checking for a pulse was a change made in 2000. Looking for a pulse can waste time and can result in errors, Hirsch says.

Instead nonprofessionals were told to look for signs of circulation, including normal breathing, coughing or movement, Earle says.

Now AHA officials don't want laypeople to even look for signs of circulation, instead beginning immediately with two breaths and starting the 30 chest compressions, Earle says.

"Minimal harm can be done by providing chest compressions when they are not needed," Earle says.

To start CPR, it's still important to think of ABC - airway, breathing, circulation, Hirsch says.

Clear the airway, including making sure the tongue isn't blocking air.

Then tilt the head back, lift the chin and provide two breaths.

To give a chest compression, place the heal of your hand in the center of the person's chest between the nipples. Place your other hand on top of your first hand, keeping your fingers off the chest. The elbows should be locked as you press as deeply as you can comfortably press. Hirsch says 1.5 to 2 inches on an adult is a good target, but you don't have a ruler so just press as hard as you can. Relax just long enough after each compression to allow the chest to recoil or come back to its original position.

Chest compressions should be given quickly, at a rate of 100 per minute, Hirsch says.

Before you begin CPR, call 911.

Often a 911 dispatcher will tell a layperson what to do in an emergency, perhaps just chest compressions, Hirsch says.

In Washington County, 911 dispatchers will give people instructions for a variety of emergencies before emergency personnel arrive, says Chief Bardona Woods, chief of communications for Washington County Fire & Rescue Communications.

"We assume they don't know how to do (CPR). We tell them how to do it," Woods said. If someone says they know how to do CPR, the dispatcher will stay on the line in case they need assistance before the ambulance arrives.

To learn more

To register for a CPR course through Washington County Hospital or request a CPR instructor to come to your place of work to provide training, call 301-790-8907.

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