From Our 2007 Archives

Chest Compressions Key to Revised CPR Guidelines

By Serena Gordon
HealthDay Reporter

SUNDAY, Oct. 14 (HealthDay News) -- Maintaining blood flow to the brain and other vital organs is the key to simplified cardiopulmonary resuscitation (CPR) guidelines that emphasize chest compressions over rescue breathing, particularly for heart attack victims.

In fact, the revised recommended ratio is just two breaths per every 30 chest compressions. That's twice as many compressions as was recommended in the past.

"Just doing chest compressions can make a difference," explained Dr. Shukri David, chief of cardiology at Providence Hospital of St. John's Health System, in Southfield, Mich. "When you compress the chest deep enough, you create a vacuum that pulls in air as you release."

However, David and other experts caution that in the case of drowning victims or people who were deprived of oxygen, rescue breaths are still necessary. Because health experts wanted to make the revised CPR guidelines as simple as possible, and they felt it might be difficult for lay people to differentiate who needed rescue breaths and who didn't, the guidelines include rescue breaths, as well as the rescue breaths-to-chest-compression ratio.

The need for simplified CPR was clear. Little progress had been made in the CPR survival rate over the past decade, according to the American Heart Association. And, it wasn't for lack of CPR opportunities. Four out of five heart attacks occur in the home, according to the American Heart Association, and many are witnessed by family members.

The biggest problem was that standard CPR allowed for too much time without chest compressions. Even health-care professionals, such as nurses or emergency workers, trained to do CPR often weren't providing an adequate number of chest compressions per minute, according to past studies. And, getting enough chest compressions can make the difference in survival. In animal studies, researchers have found that when animals in cardiac arrest receive 80 compressions per minute that 100 percent survive. When that number dropped below 80 compressions per minute, just 10 percent survived, according to a recent editorial in the Journal of the American Medical Association.

In a study of CPR given to people in cardiac arrest, the editorial reported that those who received "good" CPR from bystanders had about a 23 percent survival rate compared to less than 6 percent for poor or no CPR.

"The most common reason that many people die is because none of the people nearby knew CPR, and if they knew it, they didn't do it. One of the reasons is that the skill has been too complicated. [The revised] guidelines simplify the instructions and make them easier to remember," Dr. Michael Sayre, an associate professor of emergency medicine at Ohio State University School of Medicine, said in a prepared statement.

The revised guidelines, introduced in late 2005, emphasize chest compressions to restore blood flow. Rescuers should push hard and push fast and try to maintain a rate of 100 chest compressions per minute, according to the guidelines. The chest must be allowed to return to its normal position completely after each compression to allow the heart to fill with blood. And, the guidelines remind rescuers that every interruption in compressions stops the blood flow.

The updated guidelines also establish a universal compression-to-breath ratio of 30 compressions to two breaths, and that each breath should last just one second.

These changes are already starting to pay off. "In various studies, a clear improvement in outcomes in the community is becoming apparent," said Dr. Paul Pepe, chief of emergency medicine at the University of Texas Southwestern Medical Center at Dallas.

And, Pepe added, he expects CPR to improve even more with the introduction of faster, easier training of CPR, with more feedback. The American Heart Association has recently introduced its CPR Anytime Personal Training programs that teach CPR at home in less than a half-hour. "This will be a breakthrough in CPR. We will see a lot more lives saved," he said.

Other training programs are also available through the American Red Cross and local community groups.

"If you perform CPR, you can save someone's life. It's simple and easy to do. All you really need to do is put your hands in the middle of the breast bone and push down two inches," David said. "If you do CPR immediately on someone with cardiac arrest, the survival rate goes from 6 percent to 50 percent. This will really make a difference if the population pulls together."

SOURCES: Shukri David, M.D., chief of cardiology, Providence Hospital, St. John's Health System, Southfield, Mich.; Paul Pepe, M.D., chief of emergency medicine, University of Texas Southwestern Medical Center at Dallas; Jan. 19, 2005, Journal of the American Medical Association; Nov. 28, 2005, American Heart Association Guidelines for CPR

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