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.
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.
Now that the new CPR approach is out, the AHA hopes to get as many people as possible trained in courses offered around the country. In fact, the voluntary organization is hoping to launch classes in every middle and high school in the coming year.
It only takes three or four hours to become proficient in CPR and the use of an AED, but what happens if you see someone in cardiac distress and don't know what to do?
"It's always better to do something than nothing. So any attempt to do CPR, even if you don't think you're doing it well, has to be better than no attempt at all," Edward Stapleton, MD, of the State University of New York at Stony Brook, tells WebMD.