Question of the Week

February 20, 2006


Most people have heard of CPR.

"Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of mouth-to-mouth rescue breathing and chest compression that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

"When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing."

While most people are familiar with the concept of CPR, even those who have taken CPR classes in the past may not be familiar with the "New CPR" that was introduced in November of 2005.

"High-quality CPR with fewer interruptions is the goal of this update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care. Focusing on the value of quality CPR in saving lives when hearts are stopped, a consortium of experts recommended simplifying and streamlining the guidelines for CPR. The biggest change is increasing to 30 the number of chest compressions given for every two rescue breaths for cardiac arrest victims."

For those who thought that the "old way" had too many details for the non-medical professional to remember, the process has been simplified. With the hope of getting the important steps done (and done correctly), some of the other details have been eliminated completely.

"Streamlining CPR for the lay person who witnesses someone suffering a cardiac arrest promises to save lives. 'We eliminated some steps,' said Dr Sayre. 'One is that if someone encounters a person who cannot be awakened and is not breathing, he or she should assume that the person is in cardiac arrest. They should give two breaths and move right into giving chest compressions without wasting any more time evaluating the victim. ...' The other major change for bystanders is to increase to 30 the number of chest compressions given before pausing to give two rescue breaths. This change applies to victims of all ages (except newborn infants) and is even recommended for healthcare professionals who might be working on their own before additional help arrives."

Knowing the "old way" will probably make it easier to transition to the new, but for those unfamiliar with either, just knowing the changes will not be very helpful. As of November 2005, the new guidelines for CPR for infants, children, and adults include:

"For the Infant
Recommendations for lay rescuer and healthcare provider chest compressions for infants (up to 1 year of age) include the following:
* Lay rescuers and healthcare providers should compress the infant chest just below the nipple line (on lower half of sternum).
* Lay rescuers will use 2 fingers to compress the infant chest with a compression-ventilation ratio of 30:2.
* The lone healthcare provider should use 2 fingers to compress the infant chest.
* When 2 healthcare providers are performing CPR, the compression-ventilation ratio should be 15:2 until an advanced airway is in place. The healthcare provider who is compressing the chest should, when feasible, use the 2-thumb´┐Żencircling hands technique.

"For the Child
Recommendations for lay rescuer and healthcare provider compressions for child victims (about 1 to 8 years of age) include the following:
* Lay rescuers should use a 30:2 compression-ventilation ratio for CPR for all victims.
* Rescuers should compress over the lower half of the sternum, at the nipple line (as for adults).
* Lay rescuers should use 1 or 2 hands, as needed, to compress the child‚s chest to one third to one half the depth of the chest.
* Lay rescuers and lone healthcare providers should use a compression-ventilation ratio of 30:2.
* Healthcare providers (and all rescuers who complete the healthcare provider course, such as lifeguards) performing 2-rescuer CPR should use a 15:2 compression-ventilation ratio until an advanced airway is in place.

"For the Adult
Recommendations for lay rescuer and healthcare provider chest compressions for adult victims (about 8 years of age and older) include the following:
* The rescuer should compress in the center of the chest at the nipple line.
* The rescuer should compress the chest approximately 1 to 2 inches, using the heel of both hands."

For those who have been trained to use an Automated External Defibrillator (AED), the new CPR guidelines will affect their use, as well.

"The emphasis on providing high quality CPR with fewer interruptions is also reflected in the changes to the new guidelines for using a defibrillator.  For example, rescuers are advised to use only one shock before resuming CPR, rather than three, as previously recommended."

For those with no training, or those considering getting retrained with the new guidelines:

"American Red Cross first aid, CPR and AED programs are designed to give you the confidence to respond in an emergency situation with skills that can save a life. Additional training in bloodborne pathogens, oxygen administration and injury prevention can be added to CPR and first aid training to prepare you to prevent and respond to life-threatening emergencies. Red Cross Preparedness programs in first aid, CPR and AED are available for any age and can be tailored to the needs of specific groups and individuals. Whether you work with children, want training for employees, are a professional rescuer, or simply want to know how to help someone in an emergency, the American Red Cross has a program for you. Find out more about the American Red Cross Advantage."

For those wondering whether it is still important to get the training when reading over the guidelines seems to give all the information:

"Cardiopulmonary resuscitation should be performed only by persons trained in the technique because specific CPR recommendations vary depending on the patient's age and the cause of arrest. If performed incorrectly, CPR may be ineffective or harmful. Because most cardiac arrests occur outside the hospital, it is important for laypersons to be trained in CPR."

Questions of the Week:
In what situations might you need to know CPR? If you have previously learned the "old version" of CPR, how do you think that the changes will affect the use of CPR by those who are not in the medical profession? If you have not previous learned the CPR, do you think the changes make it easier for people to learn and use CPR? Who should know basic CPR? If you have friends or family members that you think should learn CPR, what reasons would you give to encourage them to do so? How would these reasons differ for different people?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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