A-B-C of CPR Changes to C-A-B (2010 AHA Guidelines)

Most of us have heard of cardio - pulmonary resuscitations (CPR) although many among us remain unsure as to how to go about it. It appears now that the order of the steps involved in CPR needs to be re-arranged.

CPR –The old way

For more than four decades, CPR involved-

• first opening the airway by backwardly tilting the victim’s head (Airway)

• pinching the nose of the person and breathing into the mouth (Breathing)

• giving pressure on the chest (Compressions)

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This gave the ABC tag to the sequence of events.

AHA Amendments According to the recentAmerican Heart Association (AHA) guidelines the procedure needs to be sorted out. Chest compressions should be the first step while administering CPR to a person suspected of cardiac arrest.

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It appears that the A-B-Cs (Airway-Breathing-Compressions) of cardiorespiratory resuscitation (CPR) needs to be changed to C-A-B (Compressions-Airway-Breathing).

The AHA has recently documented these changes under the banner ‘American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care’.

The change was brought about after gathering information from "356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions ('webinars') during the 36-month period before the 2010 Consensus Conference."

According to the authors of the article "The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published."

C-B-A Method

According to the new changes brought about by the AHA, CPR carried out on anyone who is unresponsive and not breathing normally must always begin with immediate chest compressions.

This is to ensure that on initiating chest compressions, the oxygen that is present in the lungs and in the bloodstream is distributed quickly to the brain and the heart, gaining 30 seconds of critical time in favor of the patient.

The new guidelines recommends around 2-minute periods of continuous CPR as part of advanced pediatric life -support.

It further discusses the methods involving resuscitation of infants and children with congenital heart conditions and pulmonary hypertension.

AHA Recommendations

According to the new guidelines, some of the IMPORTANT recommendations include –

• Those carrying out CPR need to increase the speed at which they administer of chest compressions to a minimum rate 100 times a minute.

• The depth of these compressions must be increased to at least 2 inches in adults and children and to 1.5 inches in infants.

• The rescuers are advised to avoid leaning on the patient’s chest and to continue compression without too much ventilation.

• Teamwork techniques should be learned and put to effective practice on a regular basis.

• Quantitative waveform capnography, (which is used to measure carbon dioxide output) must be used to confirm CPR quality.

• Therapeutic hypothermia (decreased body temperature) should be considered after resuscitation, as a part of an overall inter-disciplinary system of after-care 

• Atropine is no longer recommended for the management and treatment of pulse less electrical activity (asystole), on a regular basis.

The new guidelines also strongly advise that the untrained rescuers confine themselves to providing Hands-Only CPR ;in other words they provide just the chest compression for unresponsive, non-breathing adults.

Reference:Circulation 2010;122[suppl 3]:S640-S656.

Source-Medindia