Cardiac Experts Explain New AHA Cardiac Emergency Guidelines

Published on in CHOP News

November 16, 2010 — In cardiac emergencies, rescuers performing CPR should do chest compressions first. That’s the most important change in new guidelines for cardiopulmonary resuscitation, recently announced by the American Heart Association (AHA). Experts from The Children’s Hospital of Philadelphia who helped develop the new recommendations discussed the changes in the life-saving emergency technique at the AHA Scientific Sessions in Chicago on Monday evening, Nov. 15.

Difference between old and new CPR recommendations

“The AHA has changed the order of CPR from A-B-C, or Airway-Breathing-Compressions, to C-A-B, which is Compressions-Airway-Breathing,” said Robert Berg, MD, chief of the critical care department at Children’s Hospital and chair of the AHA’s Basic Life Support committee. “Both professional and lay rescuers should begin chest compressions immediately for anyone— adult or child — who is unresponsive and not breathing normally. Chest compressions are absolutely essential for keeping oxygen-rich blood circulating through the body.”

Berg participated on the AHA committee that reviewed the CPR guidelines, which are revised every five years to incorporate the most current research. Another co-author of those guidelines is Berg’s colleague at The Children’s Hospital of Philadelphia, Vinay Nadkarni, MD, the medical director of the hospital’s Center for Simulation, Advanced Education and Innovation.

The full document, 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, was recently published in Circulation: Journal of the American Heart Association. Those guidelines form the foundation for CPR training by organizations worldwide.

Formerly, CPR training stressed checking a victim’s airway first, then breathing into the victim’s mouth, followed by chest compressions. Research showed that this sequence delayed cardiac compression by 30 critical seconds compared to performing chest compressions first. Because oxygen remains in a victim’s lungs and bloodstream in the first few minutes of a cardiac arrest, starting CPR with chest compressions pushes that blood to the brain and heart sooner.

How untrained bystanders should perform CPR

The new C-A-B sequence applies to adults, children and infants, excluding only newborns. The new guidelines follow a 2008 recommendation that untrained bystanders should use “Hands-Only CPR,” or CPR without breaths, for an adult victim who suddenly collapses. Hands-Only CPR involves first calling 911, then pushing hard and fast on the center of the victim’s chest until professional help arrives.

“Research tells us that effective bystander CPR, if provided immediately after sudden cardiac arrest, can double or triple a victim’s chance of survival,” said Berg. “We hope this new C-A-B approach will increase the chances that bystanders will perform CPR on victims of all ages.”