Statistics show that only one-third of bystanders to cardiac arrest will do anything to help. But cardiac professionals are hoping that the new compression-only CPR guidelines will up that percentage. Under the new guidelines, in a witnessed collapse, the bystander calls 911 and starts rapid deep chest compressions until paramedics or an automated external defibrillator (AED) arrive.
“People are often not likely to do CPR, particularly on a stranger, because of the distaste for the mouth-to-mouth part. Compressions-only is much more acceptable,” says Dr. James Wessely, the emergency room co-director at St. Luke’s Hospital. “Still, others might have taken a CPR class and performed perfectly during class, but six months later were too afraid of doing it wrong.”
Wessely says that the two most important things to remember are to do something and to have an AED nearby. The great saves are the ones in which response times were short, CPR was performed, and an AED was used quickly. “Time is the whole thing,” he stresses. “Most emergency room issues are not that time-critical. But with cardiac arrest, seconds count. If we make it easier to respond, there is a difference in outcomes.”
Greg Light, a paramedic on the national faculty for basic life support with the American Heart Association (AHA), says research shows that bystanders are more likely to do compression. “You can blow all you want to give oxygen, but unless it’s being pumped around, it doesn’t help that person; and using AEDs in conjunction with compressions greatly increases chance of survival.”
Light explains that it takes 13 or 14 compressions to get the blood all the way through the body. If compressions are interrupted for more than 10 seconds, it severely affects circulation. With the new guidelines, the AHA is recommending compressions be done at a rate of 100 or more per minute at a depth of at least two inches. That’s strenuous, says Light, but compressions should be continued until someone else relieves you or until an AED arrives. The AHA has changed the way it teaches CPR from the ABCs (airway-breathing-compression) to CAB (compressions-airway-breathing). In the ABC sequence, chest compressions tended to be delayed while the person opened the airway, retrieved mouth barrier devices, and gave breaths.
The American Red Cross has a similar approach to training, because recent research shows that if more people learned compression-only CPR, it could increase the likelihood of surviving cardiac emergencies outside the hospital. The organization has launched an initiative to educate five million people in “Citizen CPR” (compression-only) by the end of 2011.
The Red Cross also would like to see the benefits of having compression-only training offered to high school students before graduation and to at least 25 percent of employees in businesses. Maxine Hepper, chief preparedness officer for health and safety services, is excited about the change and says more information will be coming out from the Red Cross soon. “The plan changes already announced have divided our target audiences for emergency training into citizen/bystander, workplace responder, and professional rescuer/health care provider,” she says. “The citizen/bystanders protocol calls for the use of compression-only CPR for witnessed sudden collapse of any person.”
Hepper says the combination of AEDs and chest compressions is key. Rescue breathing continues to be needed for infants and children, drowning and electrocution. When EMS responds quickly, compression-only CPR can bridge the gap, but at some point, everyone needs oxygen. LN