June 2006

New 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.

Cities such 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."

Doctors are 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.

Instead, the 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.

By performing 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.

The American Heart Association also changed its guidelines in 2005 to emphasize compression over mouth-to-mouth.

The 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.

The 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.

"The 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.

Each rescue breath should be delivered in 1 second and should produce visible chest rise.

"Both 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.