TORONTO – Anyone who has taken a first-aid course will have to rethink their alphabet mantra because the ABCs of CPR are changing.
The letters are being scrambled so that C – chest compressions – will now come first if there’s a lone rescuer, before A for checking the victim’s airway and B for breathing, according to updated guidelines released Monday by the Heart and Stroke Foundation of Canada.
And for those who have never taken a course in cardiopulmonary resuscitation and who come across someone who appears to have suffered cardiac arrest, the guidelines say that calling 911 and quickly providing compressions only can mean the difference between life and death. Just act – don’t waste time by looking or feeling for breathing or a pulse, the foundation urged.
“That lay person who’s a spouse of an individual who’s got bad heart disease, who hasn’t done a CPR course, can take solace in the fact the recommendations say, ‘You know what, if your spouse collapses, they are unresponsive and not breathing, call 911, call for help and push hard and fast in the middle of the chest,’ and that’s going to be the perfect thing to do to build the chain of survival for this patient,” said Dr. Andrew Travers, a Halifax emergency doctor and spokesperson for the foundation.
“Everyone’s worried that they may hurt a patient, but you can’t hurt someone if they don’t live to see another day.”
It’s the first update to the guidelines in five years, and takes into account research on the benefits of chest compressions and the reluctance of some bystanders to do mouth-to-mouth resuscitation. There was input from 356 experts in 29 countries. Just last week, a meta-analysis published online by The Lancet pooled data from three randomized trials involving more than 3,000 patients outside the hospital setting. When dispatchers were giving instructions, chest compression-only CPR was associated with an improved chance of survival compared with standard CPR (14 per cent vs. 12 per cent).
A national survey conducted Sept. 2-10 by Environics for the Heart and Stroke Foundation found that 62 per cent of respondents had taken a CPR course, but it was more than a year ago for three-quarters of them.
Only 40 per cent of those who had taken a CPR class said that nothing would prevent them from trying to revive a person. Reasons for inaction varied, with 15 per cent citing a lack of confidence in their skills and training, eight per cent saying they’d prefer to wait for qualified help to arrive and seven per cent mentioning a fear of catching a disease. The sample size for the survey was 2,003 people, and results are considered accurate to within plus or minus 2.19 percentage points, 19 times out of 20.
The 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care map out how to provide care based on the skills of the rescuer, the situation and the setting. It’s no longer a one-approach-fits-all guideline.
“If you think of it like a pyramid, chest compressions are at the very bottom, the widest part of the pyramid, and that’s the most important thing you can do. If you can do chest compressions, and you’re able to provide ventilations, then you can add that on top of it,” explained Travers.
“Then at the very top of that triangle is essentially those people that can provide CPR as a highly proficient team where people can actually work together. That’s an example of people that are formally trained in CPR. And I think these guidelines kind of separates the two, saying if you do not know, or haven’t been trained in CPR, or if you’re not proficient in being able to provide ventilations in an effective way, then compression-only CPR is the way to go. And it’s a good thing compared to doing nothing.”
For those who are trained, the new guidelines ratio calls for 30 compressions, then opening the victim’s airway and delivering two breaths. There should be complete recoil (lifting the hands off the chest) between compressions.
Chest compressions should be performed at a rate of at least 100 per minute – around the same pace as the Bee Gees’ song “Stayin’ Alive” – and the adult sternum should be depressed at least five centimetres. For infants, it should be about four centimetres.
Shannon Bannen, 34, of Mississauga, Ont., is a strong advocate for CPR courses. In April 2007, she was feeding her then-seven-week-old son Keegan when he started coughing and choking.
“So I sat him up, thinking he just swallowed wrong, and I patted him on the back, and it still continued. And then I realized, ‘He’s not breathing correctly.’ So I told my husband to call 911, and as soon as I told him to call 911, because I was holding him (Keegan), I actually felt his heart stop.”
She took her baby to the front hallway to wait for the paramedics, and immediately began CPR. The police arrived and took over, then Keegan was transported to a local hospital, and later moved to the Hospital for Sick Children in Toronto. His body temperature was cooled for 48 hours, and brain scans later showed no damage.
Bannen gives credit for the outcome to the fact that Keegan didn’t go without oxygen because of the continuous CPR.
“I have three kids. I work with adults who are developmentally handicapped, and I just think you never know when you’re going to need it. And it’s better to have it and never use it, or have knowledge of it and never use it, than when something happens, you’re struck in a panic and can’t function at all.”
Travers said the overall survival rate from cardiac arrest in Canada is just five per cent, but if all systems work well together – CPR, defibrillation by paramedics, cooling of the patient in hospital and opening blocked coronary arteries – then survival rates could approach 40 to 50 per cent.
“That’s based on basically systems working together. So we can clearly improve survivability of these events if people work together and connect the chain of survival for these patients.”