CPR guidelines updated to hands-only

Posted: October 19, 2010

A lifesaving technique is in your hands - literally - when someone's heart stops.

The American Heart Association on Monday released updated cardiopulmonary resuscitation guidelines that call for pressing on the victim's chest and skipping or delaying mouth-to-mouth breaths.

The recommendations reflect research showing that "hands-only" CPR is at least as effective in the first few crucial minutes after cardiac arrest as conventional CPR - and unquestionably better than doing nothing.

"The science strongly shows that hands-only CPR is the best way to keep someone alive until help arrives," said Benjamin Abella, a University of Pennsylvania resuscitation researcher and one of 356 experts, including some at Children's Hospital of Philadelphia, who vetted the new guidance.

As many as 310,000 Americans suffer cardiac arrest outside hospitals each year. Only about 6 percent of those survive.

Studies show people are reluctant to give CPR because they don't know how, they're afraid they'll make things worse, or they're squeamish about mouth-to-mouth resuscitation.

"Hands-only CPR is easier to perform by those with no training and can be more readily guided by dispatchers over the phone," the guidelines say.

Calling a 911 emergency dispatcher is still the first thing to do to help a heart attack victim.

The guidelines say emergency responders should continue to give rescue breaths about every 18 seconds, but even they should begin CPR with compressions - 100 per minute - to keep blood pumping to vital organs. This is a departure from the approach that emergency personnel should first check the victim's airway and give a breath before starting compressions.

By changing the order of the initial steps, "chest compressions will be initiated sooner and ventilation only minimally delayed," concluded the article in Circulation, the journal of the heart association.

Pumping the chest before giving breaths is also recommended for newborns and children, though most pediatric cardiac arrests are caused by a sudden lack of oxygen due to choking or drowning, not heart disease.

Over the last five years, the heart association has been putting growing emphasis on hands-only CPR as studies have validated it. Most adults who collapse after cardiac arrest have normal levels of oxygen in their blood, so keeping that blood circulating can protect their organs for several minutes even without breathing oxygen into their lungs.

The American Red Cross will continue training people in CPR using the old approach for the time being, said Kathleen Cassidy, director of health and safety for the Southeastern Pennsylvania chapter. Each year, the chapter teaches lifesaving techniques to about 52,000 people in the five-county area.

"Right now, it is status quo" until the national Red Cross has reviewed the heart association's recommendations, Cassidy said.

Cassidy added that the national organization, which annually trains about five million people in CPR, "does support the use of hands-only CPR for emergencies, but will be reviewing these new guidelines and giving us guidance."

In addition to the CPR guidance, the heart association on Monday joined the Red Cross in issuing updated recommendations for first aid, including how bystanders should treat snake bites, jellyfish stings, and allergic shock.

The two groups now recommend putting a pressure bandage on any venomous snake bite rather than using suction, which may worsen the wound and is unlikely to remove much venom.

Applying vinegar, followed by hot water, can help with jellyfish stings by neutralizing the venom and reducing pain, the guidelines say.

And for allergic shock, called anaphylaxis, the first aid provider should give an epinephrine injection from a prescribed auto-injector. If help is delayed and the victim doesn't respond "after a few minutes," a second injection can be given.

Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.

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