Technique In CPR Saves More Lives
In what may
prove to be the biggest shift in emergency care of cardiac
arrest in 40 years, cities across the country are leading
a move away from the familiar practice of using mouth-to-mouth
resuscitation. In its place, the cities are recommending simple
chest compressions — pushing down repeatedly on the
victim's chest — to mimic a steady heartbeat. The emergency
medical directors who are behind the shift say research in
various cities suggests it will save many more lives.
as New York, Los Angeles and Chicago, have decided to make
the switch. They join at least seven other cities that already
are advising 911 callers to do chest compressions without
mouth-to-mouth "rescue breathing."
forgoing the rescue-breathing instructions that have long
been given by 911 dispatchers in order to eliminate delays
that can be caused by bystanders reluctant to perform mouth-to-mouth
resuscitation or unable to understand the technique.
goal is to get chest compressions started immediately after
a cardiac-arrest victim collapses and to keep the compressions
going until trained rescuers arrive. It is a lot easier to
tell a panicked person to just compress the chest until rescuers
arrive. They can start this critical life saving technique
as soon as they leave the phone.
deep compressions — pushing the breastbone down about
2 inches (one third to one half the depth of the chest for
children) and then releasing it — untrained people have
saved lives. Research continues to favor chest compressions
over rescue breathing in those first critical minutes. During
that time, the blood in the brain and other vital organs still
has oxygen that was picked up when it last passed through
the lungs before the heart stopped. The body needs chest compressions
to keep this blood moving.
For now, the
shift applies primarily to untrained bystanders, the group
most likely to reach victims in the first critical minutes.
In such emergencies, lives generally are saved or lost within
six minutes. The emergency directors agreed that trying to
talk 911 callers through mouth-to-mouth procedures was doing
more harm than good because it wasted time. Now, rescuers
are arriving on the scene to find 10 times more victims (60%
vs. 6%) getting lifesaving compressions when not distracted
by advice on breathing techniques.
Heart Association also changed its guidelines in 2005 to emphasize
compression over mouth-to-mouth.
new guidelines call for a lone rescuer to provide 30 chest
compressions for every two rescue breaths. That advice applies
to victims of all ages, except for newborn infants.
previous guidelines, issued in 2000, called for 15 chest compressions
for every two rescue breaths. If two rescuers are performing
CPR, then they are to follow the previous ratio of 15 chest
compressions to two rescue breaths.
lay rescuer will be taught to begin chest compressions immediately
after delivering two rescue breaths to the unresponsive victim
who is not breathing," state the guidelines.
breath should be delivered in 1 second and should produce
visible chest rise.
lay rescuers and healthcare providers should deliver chest
compressions that "push hard, push fast" (rate of
100 compressions per minute) in the center of the chest at
the nipple line, allow complete chest recoil between compressions,
and minimize interruptions in compressions for all victims."
While the heart
association would prefer that all adults be trained in CPR
so that they can practice their skills before they are faced
with a crisis, officials with the association agree that immediately
beginning compressions alone is better than waiting even a
minute or two to begin CPR.