Hoping to save more lives by making CPR performance as straightforward as possible, the American Heart Association today announced it has revised its guidelines for cardiopulmonary resuscitation and the treatment of cardiovascular emergencies.
One of the most significant alterations to the policy, which hasn’t been changed in eight years, is that untrained bystanders and CPR-certified lay people will no longer have to check an unconscious person’s pulse before administering chest compressions. Instead the person can “check for lifelessness” using breath, movement and response to stimulation as indicators, says Dr. Roger D. White, professor of anesthesiology at Mayo Medical School in Rochester, Minn.
Research indicates that at least 35 percent of trained and untrained rescuers are wrong about whether or not a victim has a pulse, Dr. Vinay Nadkarni, chairman-elect of the heart association’s Emergency Cardiovascular Care committee says. According to Nadkarni, the United Kingdom and European Resuscitation Councils have already successfully deleted pulse checks by lay people from CPR training.
Pulse Check Not Effective
“Pulse check is not effective. Even health care workers have difficulties. And when bystanders look for a pulse, it’s even less effective. Almost 99 percent of them can’t do it in the first 10-15 seconds,” explains Dr. Paul Pepe, AHA spokesperson and professor and chair of Emergency Medicine at the University of Texas. Southwestern Medical Center in Dallas, Texas Healthcare providers will, however, still be expected to check a victim’s pulse before doing chest compressions, he said.
The guideline changes mean that people who have previously been trained in CPR will need to be re-trained when their current certification expires, and new CPR training materials used in CPR classes will be available for widespread use by next summer, the AHA said. U.S. guidelines for emergency CPR were last revised in 1992.
The heart association also released new, simplified guidelines for managing an unconscious choking victim, saying there is evidence that chest compression in CPR creates enough pressure in an unconscious patient to eject a foreign body from an airway without also using mouth-to-mouth resuscitation or abdominal thrusts.
Rescue breathing instructions can be too complicated for untrained people to follow, explains White, adding that there is also “a definite aesthetic concern for some people doing mouth-to-mouth.”
A Seattle study, published in the New England Journal of Medicine in May, found that bystanders at the scene of a collapse advised by emergency services over the telephone to perform chest compressions alone were more effective than those instructed to do chest compressions combined with mouth-to-mouth resuscitation.
Trend for the Future
Mouth-to-mouth resuscitation guidelines will change in Britain as well, the Independent reported yesterday. “I think this may well be the trend for the future,” Dr Lotte Newman, medical adviser to St. John Ambulance, Britain’s leading first aid organization, told the British newspaper.
Other changes recommended by the AHA include using two thumbs rather than two fingers to perform CPR on infants and the standardization of the ratios of chest compressions to rescue breaths that had been recommended in adults.
AHA president Dr. Rose Marie Robertson says the association is also pressing a campaign to get automatic heart defibrillators installed in places like sports stadiums, airports and other public buildings. Defibrillators can automatically assess whether a cardiac arrest victim’s heart is fibrillating, or beating randomly, and provides an electric shock to regulate the heartbeat.
Automated external defibrillators are now considered “standard CPR,” says the AHA, and their availability significantly decreases the number of needless deaths each year. Today, 80 percent to 90 percent of patients collapsing at O’Hare Airport are resuscitated by bystanders using defibrillators, with most of these patients awake and talking by the time professional rescuers arrive, according to the association.
Heart attack survival chances fall by 7 percent to 10 percent for every minute between collapse and defibrillation, Mary Fran Hazinski of Vanderbilt University Medical Center says. Currently in the U.S. only 5 percent of the victims of sudden cardiac arrest survive, but rates vary widely from place to place, according to Hazinski.
Edward Stapleton of the State University of New York at Stony Brook said the new guidelines will cut the time needed for CPR refresher courses from 3 1/2 to 4 hours down to 2 hours.
The new guidelines will be published in the association’s Aug. 22 issue of Circulation magazine. CPR instructors will be trained in the new policy next month and in January are expected to be teaching it. People who currently are CPR-certified will be re-trained in the new methods when they get recertified.
ABCNEWS’ Maria A. Flores, ABCNEWS.com’s Ephrat Livni and the Associated Press contributed to this report.