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CPR Update: It's C-A-B, not A-B-C

Published December 6, 2010 9:41 AM by Bridgette Williams
She was at the right place at the right time. A registered nurse not far from the Albany, NY, area was planning to assist a family member who stopped breathing. On the way to the hospital, she came across a stranger who was unconscious. She could not feel a pulse and the man was not breathing. She immediately started CPR. The stranger was saved and her family member recovered from respiratory distress. This nurse was formally recognized by the local safety commissioner for her heroic actions.

Last November, I renewed my CPR certification. I did this to maintain requirements for my job. My next renewal date is not until November 2011. But, after learning of the actions of a local RN, I started to think, if placed in the similar circumstances, what would I do?

More than likely, if I saw that stranger in acute distress, I would have taken action. Namely, dialing 9-1-1 and starting CPR. After I looked, listened and felt to confirm no breathing and no pulse. I would have opened the airway to give two breaths then started the compressions. The A-B-Cs: Airway, Breathing, Compression/Circulation. This was what I learned in my current American Heart Association, AHA, CPR renewal course. I would guess the local nurse did this, too, to save the stranger. But, after re-checking the AHA website, I learned the accepted rules have changed. Once regarded as CPR principle, A-B-C is now C-A-B: Compression, Airway, and Breathing.

In October 2010, the AHA released new guidelines for CPR. And, emphasis is now stressed on compressions first. The change from A-B-C to C-A-B is based on data of survival rates for out-of-hospital cardiac arrests correlating to CPR. The AHA learned victims of cardiac arrest showed greater chance for survival with improved return to baseline health when compression were started before ventilation (breathing).

Large numbers of survivors of cardiac arrest were reported with more overall chest compressions. The link to the survival rates was associated with initiation and number of chest compressions.

During cardiac arrest, the heart is essentially not beating; blood is not circulating to vital organs, namely the brain. In the research data retrieved from the AHA, the longer organs such as the heart and brain are without circulated blood, the more likely the cells die and full-recovery from cardiac arrest is lengthened.

Manual chest compressions essentially push blood from the heart to organs: maintaining circulation of blood in the body. In the new guidelines, the compression-to-ventilation ratio is the same: 30 compressions to two breaths. But, the rate has to be a minimum of 100 per minute. The depth has to be 2 inches (5 centimeters) down in the chest. And, the well-known step, "look, listen and feel" was removed from the algorithm. The reason was to streamline the CPR process to emphasize compression first, then ventilation.

Assessment of the cardiac arrest victim takes time: looking for chest rising and falling, listening for breaths and feeling for a pulse takes up time. Also time consuming is properly adjusting the head (i.e. head-tilt, chin-lift) to open the airway to give ventilation. The steps of assessment and adjustment for airway take valuable time away from immediate compression of the heart to maintain blood circulation to vital organs.

Effective, high-quality chest compressions requires full chest recoil from each compression. In other words, after pushing down 2 inches on the chest, the rescuer has to allow the chest to rise back to the original position before compressing down on the chest again.

Another change to the AHA CPR guidelines is emphasis of the team-rescue approach. Often, the out-of-hospital cardiac arrest victim receives CPR from one person. But the AHA learned when more than one person is performing CPR, effective chest compression can be maintained and the interruption of them is reduced. A second rescuer could assist with decreased loss of time by obtaining and preparing the AED device and taking turns to perform chest compressions on the victim. Ventilation is needed but should not be excessive: one ventilation (breath) for every 6 to 8 seconds is adequate.

Other changes in CPR and rmergency care were updated. If the out-of-hospital victim experienced a sudden cardiac arrest, untrained bystanders can use compression-only CPR for the victim. Most interesting to me has been the inclusion of care for snakebites and jellyfish stings. The official and complete updated 2010 AHA CPR and emergency care guidelines will be available in print in November 2010. Summary of the guidelines can be seen here.
posted by Bridgette Williams


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