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Compression, Airway, then Breathe new Order for Cardiac Arrest

Kathleen Blanchard's picture

The American Heart Association has issued new guidelines for professionals and laypersons that can save lives in the event of cardiac arrest. The new order for CPR focuses on chest compressions, followed by attention to the airway and then breathing. In the past, ABC was the order of events - airway, breathing and circulation (chest compression).

The changes are recommended after 40 years of focus on breathing for cardiac arrest victims as the first step. Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart Association's Emergency Cardiovascular Care (ECC) Committee says tilting the head back and providing a breath to unconscious victims "was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for all victims of cardiac arrest allows all rescuers to begin chest compressions right away."

The new CPR changes apply to infants, children and adults but not newborns.

Another change in the way CPR is delivered includes starting chest compressions for anyone not breathing normally. In the past, the recommendation was to take time to "look, listen and feel" for signs of breathing. Starting chest compressions immediately saves approximately 30 seconds that in the past was spent opening the airway of an unconscious victim that can be critical for survival.

Rate, Depth of Chest Compression and Drug Change for CPR

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Another change is the rate of chest compression delivered per minute; now recommended at 100 per minute. In the past, the depth of chest compression was 1.5 inches for adults and is now recommended at 2 inches for adults and 1.5 inches for infants. Between compressions rescuers are advised to completely allow the chest to return to normal by avoiding leaning on the chest.

Atropine, a drug given to stimulate the heart during asystole (lack of heart beat) is no longer recommended for routine use as part of the algorithm for professional healthcare providers.

Professionals delivering CPR are urged to practice the new guidelines. Capnography, already used following insertion of a tube into the trachea (endotracheal tube) is the standard for measuring carbon dioxide and ensuring proper tube placement and for monitoring the quality of chest compressions and circulation.

Following resuscitation cooling the body to induce hypothermia is also included in the new CPR guidelines. The new guidelines for cardiac arrest resuscitation are based on multiple studies showing chest compression started early leads to better survival for cardiac arrest victims.

For laypersons, savings lives is easier - call 911 and start pushing hard and fast on the center of the chest (100 times a minute) until help arrives. Beginning chest compressions immediately ensures oxygen reaches the brain and other vital organs. To avoid confusion, the American Heart Association offers online classes that can teach the new C-A-B guidelines for CPR in the event of cardiac arrest. According to the AHA, now "it's much easier for anyone to save a life using CPR".

This page is updated on May 24, 2013.