CPR Guidelines

Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

The new CPR guidelines (2010) are meant to encourage untrained bystanders to help a person who collapses, and to avoid being paralyzed into not assisting by the fear of doing something wrong.

Ideally, the sequence is pretty easy. The victim collapses from a heart attack or other heart problem and is unresponsive and isn't breathing. Trying to feel a pulse fails, and the good Samaritan turns to other bystanders and tells them to go get help, and an AED (automatic external defibrillator) if available. Next comes CPR: start pushing on the chest hard and fast. In reality, a rescuer can't do much harm. Death is a reasonable definition when a patient's heart stops beating and they stop breathing. You can't get any worse.

Adding rules about technique make it too easy to have the rescuer fear, that once again, they might do something wrong.

Those rules:

Put one hand in the middle of the chest and begin pushing. Not too many worries with this one. Your hands have to go somewhere, and the target zone is pretty wide. Ideally, it's in the middle of the breast bone.

Compress the chest to a depth of two inches and allow it to spring back before pressing again. This is a bit problematic since it's hard to measure how far down you can press the chest. Too deep and ribs can be broken, too shallow and the heart isn't being squeezed enough to circulate blood. As it turns out, even the most practiced paramedic or nurse will break a rib or two performing CPR on a patient.

Push on the chest at a rate of 100 beats a minute. The teaching video recommends using the beat of the Bee Gee's disco hit of "Staying Alive." Once upon a time, CPR classes would demand that students perform chest compressions on a dummy that would spit out a recording of how well they did. Only a perfect score would allow a person to pass the course and become certified. The physiology was sound. Push too slowly and not enough blood gets circulated to the brain and other vital organs. Push too fast and the heart doesn't have a chance to refill for the next beat. Lost in the process was the concept that people were trying to learn a general technique that they would likely never use. They were good Samaritans trying to be better Samaritans. No matter how well you remember disco, whatever rate you can manage is better than no rate at all.

Most victims will die. The few that live survive because they have developed ventricular fibrillation or ventricular tachycardia, heart electrical rhythms that do not allow the heart muscle to beat in a coordinated fashion. It just sits there and jiggles like a bowl of Jello. The treatment that makes a difference is electricity that is delivered by a defibrillator to shock the heart back into a normal rhythm that can generate its own heartbeat. CPR is the bridge that can help those few survive until an AED or a paramedic with a defibrillator can get to the patient's side.

Starting chest compression kindles a glimmer of hope where none existed before. Bystander CPR should be easy and the rules even easier:

  1. Push hard and fast.
  2. Don't worry about "just right."
  3. Like the Nike ad says, Just do it!

This American Heart Association video demonstrates the steps to provide CPR to cardiac arrest victim.

NOTE: This reference is only intended to serve as a guideline for learning about CPR. It is not intended to be a replacement for a formal CPR course. If you are interested in taking a CPR course contact the American Heart Association at (800) AHA-USA1 (800) AHA-USA1, or the American Red Cross by phoning your local chapter. Never practice CPR on another person, because bodily damage can occur.

REFERENCES:

American Heart Association. 2010 CPR Guideline Changes.


Last Editorial Review: 9/14/2011