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
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
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