New CPR guidelines Rose Marie Robertson, MD President, American Heart Association Professor of Medicine Vanderbilt University Medical Center Nashville, Tenn.

The new CPR guidelines reflect current, international standards in resuscitation science. One dramatic and often quoted difference is that now the lay-rescuer should not stop to check for a pulse. This change is based on good data showing that up to 35% of lay-rescuers were wrong when checking for a pulse (ie, not finding a pulse when it was present, or finding one when it was absent). Reflecting medical science New CPR guidelines

Cardiopulmonary status can easily be assessed by performing simple measures such as looking for movement, breathing, coughing, or response to stimulation. The patient who responds to rescue breathing does not require CPR, and this is a more effective measure than checking for a pulse. For medically trained personnel, checking for a pulse is still part of the recommendations. In lieu of a pulse New CPR guidelines

Lay rescuers performing adult CPR now will provide 15 chest compressions for every 2 breaths, regardless of whether one and two rescuers are present. Chest compressions should be administered to an adult at 100 per minute. To treat an unconscious adult choking victim, lay rescuers will now begin standard CPR including chest compressions and will not conduct abdominal thrusts or blind finger sweeps of the mouth. Additional changes New CPR guidelines

By July 2001, all training courses will incorporate these guidelines. The new guidelines will improve and facilitate training. They are easier to remember. Currently certified individuals need not retrain, although it will be easier to eventually recertify using the new guidelines. Retraining? New CPR guidelines

In the Heartsaver AED course, participants can be trained in CPR and the use of automated external defibrillators (AED’s) within hours. Although CPR is important in “buying time”, getting a defibrillator to the patient, and defibrillating quickly are the most important lifesaving measures. Of those victims ultimately salvageable, 7-10% are lost every minute that defibrillation is delayed. Automated external defibrillators New CPR guidelines

Currently, of the people who suffer cardiac arrest every year in the US, 4-5% are saved. By defibrillating more quickly, and increasing survival to 20-25%, to additional lives would be saved per year. Both CPR and early use of AED’s are links in the “chain of survival”. Additional links include early access to emergency care (911 capability) and early advanced care with appropriate site allocation. Potential impact of AED’s New CPR guidelines

Actual success of CPR depends on the cause. Events not requiring defibrillation include near- drowning with laryngospasm, or the presence of a blocked airway in a conscious choking victim. Trainees must learn that they will improve a patient's chances of being saved by learning how to do CPR appropriately and correctly, but there are patients whose lives cannot be saved even with timely and appropriate administration of CPR. Success of CPR New CPR guidelines

Family members of patients at risk for future adverse ischemic events are greatly reassured when they learn CPR. The trainee should realize that he is not just learning what to do for people at large, but that there are circumstances where he might need to use CPR in his own home with his own family. CPR doubles the survival rate, roughly increasing a 2-2.5% survival rate to 5%, and rates are much higher by adding defibrillators. A source of comfort New CPR guidelines

In Chicago O’Hare airport, a defibrillator is never more than 1 minute away, and 75% of all cardiac arrest victims have been saved. Defibrillators should be found in airplanes, airports, shopping malls, and sporting venues and personnel, such as security guards, should be trained to administer CPR. The new guidelines recommend that AED’s be placed where there is a reasonable probability of one sudden cardiac arrest occurring every 5 years. Public access to CPR and defibrillation New CPR guidelines

Emergency Cardiovascular Care (ECC) Guidelines 2000 are published in: Circulation Volume 102, Supp 1; August 22, 2000 Resources for CPR training New CPR guidelines CPR training is offered at hospitals and public agencies. For the nearest access to CPR training, call: AHA-4CPR