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Heart Association Breathes New Life Into CPR Guidelines

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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.

The need for change is urgent, since the AHA says that only 5% of those who suffer a cardiac arrest are saved. If that percentage could be increased to 20%, it's estimated another 50,000 people might survive each year.

What the AHA hopes to accomplish with these guidelines is to strengthen the "chain of survival" in the event of a heart attack. That means rescuers should immediately call "911" for emergency assistance, then begin CPR so that oxygenated blood will continue flowing through the heart and to the brain.

Next, if it is available, use the automated external defibrillator (AED). This laptop computer-sized device can be operated safely by a non-medically trained person to administer a shock that can restart a heart and return it to its normal rhythm. For each minute defibrillation is delayed, the patient's chances of survival drop by 7 to 10%.

In a demonstration showing what would happen in the best-case scenario, Hazinski showed that it's possible to determine whether someone is conscious, get a call to 911, and administer a jolt from the AED in just two minutes. That's a lot quicker than the best average emergency response time in the District of Columbia, which is six and a half minutes.

The AED actually has a computerized voice that tells the user what to do, and the AHA would like to see these devices in places where people congregate. For instance, in Chicago's O'Hare Airport, you can't walk for one minute without being in range of an AED.

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