Heart Association Breathes New Life Into CPR Guidelines
Aug. 15, 2000 (Washington) -- The American Heart Association (AHA) is updating its recommendations on the best way to do cardiopulmonary resuscitation (CPR). The bottom line, AHA officials say, is that some newly developed techniques -- and the increasingly available automated external defibrillators -- could make it easier to save lives that would otherwise be lost to heart attacks or strokes.
"What greater gift, what greater contribution could you make to your family, to your friends, and to your community?" asked AHA President Rose Marie Robertson, MD, at a news conference held here Tuesday to unveil the new approach.
The most obvious change from the old guidelines, which were last revised in 1992, is that non-medically trained rescuers are no longer told to try to find the victim's pulse before starting CPR. Previously, if no pulse was found, it was thought there was no need to try CPR. The current thinking is to look for signs of life like breathing, moving, or coughing, and then proceed. Those who decide whether to do CPR based on whether they think the patient has a pulse are wrong about 35% of the time.
"Now, you might say that's not a big problem, but what it does is ... deny the opportunity for resuscitation to victims of cardiac arrest," says Mary Fran Hazinski, RN, MSN, of the Vanderbilt University Medical Center.
Another big change is that the new guidelines offer just one set of instructions for doing chest compressions, in which the rescuer pushes down on the victim's chest. The old way had two different sets of instructions, depending on whether one or two people were performing the resuscitation. Now, the advice is for the rescuer or rescuers to do 15 chest compressions, then administer two rescue breaths, at a rate of about 100 chest compressions per minute.
One of the old recommendations was to try to help an unconscious choking victim by performing the Heimlich maneuver before starting CPR. But the AHA thinks it's best now to simply begin CPR. The new guidelines state that before the rescuers give the two rescue breaths, they should search the victim's mouth for any foreign item, and remove it if seen.
The new guidelines, published in Circulation: Journal of the American Heart Association, are the culmination of an 18-month effort to study the best research available.
"Really, what these new international guidelines do is provide the ... basis to ask the questions, 'Are we doing the right thing, and are we doing the things right?'" said Vinay Nadkarni, MD, of the Alfred I. DuPont Hospital for Children in Wilmington, Del.
The AHA also hopes that infants will benefit from the CPR reappraisal. Based on three new studies, it appears that using both thumbs to do compressions on the lower part of a baby's chest may be the best way to deal with a breathing emergency. The old method called for doing the compressions with two fingers from the same hand.