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New CPR Guidelines: Chest Compressions First

American Heart Association Says 'C-A-B' Is the Way to Go: Compressions, Airway, and Breathing
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WebMD Health News
Reviewed by Laura J. Martin, MD

man performing compression cpr on dummy

C-A-B graphic from American Heart AssociationOct. 18, 2010 -- New guidelines released today by the American Heart Association recommend that the three steps of cardiopulmonary resuscitation (CPR) be rearranged.

The new first step is doing chest compressions instead of first establishing the airway and then doing mouth to mouth. The new guidelines apply to adults, children, and infants but exclude newborns.

The old way was A-B-C -- for airway, breathing and compressions.

The new way is C-A-B -- for compressions, airway, and breathing.

"By starting with chest compressions, that's easy to remember, and for many victims that alone will be lifesaving," says Michael R. Sayre, MD, chair of the emergency cardiovascular care committee for the American Heart Association and co-author of the executive summary of the 2010 AHA guidelines for CPR and emergency cardiovascular care.

The old approach, he says, was causing delays in chest compressions, which are crucial for keeping the blood circulating.

The new guidelines may inspire more people to perform CPR, says Sayre, an associate professor of emergency medicine at Ohio State University, Columbus. "Mouth to mouth is hard if you're not trained," he tells WebMD. ''Anybody can do chest compressions, whether they have had a class or not. Good chest compressions really help save lives. In many cases, there is a reserve of oxygen left in the patient's blood and lungs, from the last breath, and we can take advantage of that oxygen reserve and just do chest compressions."

How to Do the New CPR

Here is a step-by-step guide for the new CPR:

1. Call 911 or ask someone else to do so.

2. Try to get the person to respond; if he doesn't, roll the person on his or her back.

3. Start chest compressions. Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.

4. Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. ''One hundred times a minute or even a little faster is optimal," Sayre says. (That's about the same rhythm as the beat of the Bee Gee's song "Stayin' Alive.")

5.  If you're been trained in CPR, you can now open the airway with a head tilt and chin lift.

6. Pinch closed the nose of the victim. Take a normal breath, cover the victim's mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.

7. Continue compressions and breaths -- 30 compressions, two breaths -- until help arrives.

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