The Family Health Guide

Streamlined CPR guidelines

Without warning, a family member or friend collapses, gasps a few times, then lies still. What do you do?

After calling 911 - the right first move - most people do nothing during the wait for an ambulance to arrive. Starting cardiopulmonary resuscitation, even if you have never taken a CPR class, can make the difference between life and death.

Here's all you need to know: Put your hands on the middle of the person's chest, push hard, and relax. Repeat the push-relax cycle twice a second. Don't stop. And don't worry about doing it wrong - poor CPR is better than no CPR.

The guidelines, announced in November 2005, represent a back-to-basics approach aimed at making CPR less intimidating and more effective. Previous guidelines were so detailed that performing CPR not only seemed like a daunting task but was tough to do properly. The updated guidelines underscore the importance of maintaining a steady flow of blood through the heart, brain, and other vital organs by emphasizing chest compressions over everything else. They call for two breaths every 30 compressions and, in some cases, no breaths at all.

The only way to stop a cardiac arrest (when the heart's powerful lower chambers, the ventricles, veer away from a normal, steady rhythm and start beating fast) is with a well-placed shock from a defibrillator. That's why people who have survived cardiac arrest or who are at high risk for one often have a small defibrillator implanted in the chest. Because external defibrillators are rarely at hand, CPR is needed to buy precious time until one arrives. There's no question that the body needs a constant supply of oxygen. That's why earlier CPR guidelines called for two breaths for every 15 chest compressions. It turns out, though, that this can be counterproductive, especially for people with sudden cardiac arrest.

Most victims of a sudden cardiac arrest already have a fair amount of oxygen in their lungs and bloodstreams. If you are doing CPR alone, stopping chest compressions to give breaths takes precious time away from compressions. Too many breaths also increase the pressure inside the chest. This makes it harder for chest compressions to circulate blood through the arteries that feed the heart muscle.

A revolutionary approach called compression-only CPR seems to work as well as standard CPR for people with sudden cardiac arrest. In fact, this is what emergency dispatchers have been coaching people to do by telephone, an approach sanctioned by the new AHA guidelines. Surviving a cardiac arrest depends on what's been called the chain of survival.

Call 911. This essential first step summons experienced health care professionals and their equipment. The dispatcher on the other end of the line can help you do what needs to be done until they arrive.

Start CPR. For a sudden cardiac arrest, the most important part of CPR is pressing on the chest; breathing is secondary. Start by pinching the victim's nose and blowing twice into his or her mouth. Press down hard enough to make the chest move 1½-2 inches, repeating almost twice a second, if you can. If you start immediately after someone collapses, you can give up to 50 or 100 compressions between breaths. Stop every 30 to 60 seconds and give the person two quick breaths. Get back to doing compressions as fast as you can.

Restart the heart. CPR by itself won't transform a lethal heart rhythm into a regular healthy heart. That takes a shock from a defibrillator. The new guidelines say to give just one shock. Although some people have an automated defibrillator device in the home, most often defibrillation is administered by medical professionals.

Advanced life support. The fourth link in the chain of survival involves medications and other techniques such as cooling the body and brain that can improve survival from a sudden cardiac arrest. This is not something that you can do.

A cardiac arrest is a chaotic, confusing event. It's even worse if you know the person who seems to be slipping toward death. If you can keep your wits about you, call 911, and start CPR, then his or her life is literally in good hands.

March 2006 update