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From Newsweek

The Shifting Science of CPR

New guidelines stress chest compressions, not mouth-to-mouth resuscitation.

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A man practices chest compressions in San Francisco this summer on the 50th anniversary of CPR. (Justin Sullivan/Getty Images)

The American Heart Association today issued new guidelines on how to perform CPR. The recommendations say rescuers should focus first and foremost on chest compressions, not breathing into the victim’s mouth—what most call mouth-to-mouth resuscitation—and they come after the efficacy of the previous standard was called into question.

A training aide used under previous guidelines was “ABC,” or “airway, breathing, chest compression": check the airway for lodged objects, perform mouth-to-mouth, then start on chest compressions. The new 2010 directions are “CAB,” or “chest compressions, airway, breathing”—and the AHA notes that the mouth-to-mouth can be skipped by those leery of "breathing for a stranger" or without formal training.

“We certainly recognize the challenge of getting bystanders to act,” says Michael Sayre, coauthor of the new AHA guidelines and associate professor of emergency medicine at Ohio State University. Making CPR easier for nonprofessionals to practice has been a leading goal of the AHA, he says, noting that chest compressions need to be administered even before 911 is called. (Though the AHA recommends that all 911 call centers provide over-the-phone, compression-only CPR instructions, many don’t, Sayre says, and even when they do, instructions may take too long and come too late.)

The previous set of guidelines from the AHA did not include separate instructions for trained versus untrained rescuers, and Sayre says there is a perception among untrained individuals that they might hurt someone and shouldn’t try to help. In addition to these new recommendations, he cites an AHA public-awareness campaign called Hands-Only CPR, which has an instructional Web site encouraging people not to be afraid to help. “The message definitely is that, even if you’ve never been trained, you can help save a life by calling 911 and initiating hands-only CPR,” he said, instead of traditional chest compressions and assisted breathing.

This change in guidelines supports the findings of two studies published this summer in The New England Journal of Medicine, which focused on this new technique of compression-only CPR. Traditional CPR—or cardiopulmonary resuscitation—has the performer alternate between chest compressions and breathing into the mouth of the victim.

One study, out of Sweden, focused on whether the use of compression-only CPR, compared with chest compressions and assisted breathing, would have an impact on the number of patients who survived at least 30 days after their medical incident. The results showed that there was no significant difference in the survival rate between techniques.

Meanwhile, the second study, out of the University of Washington, suggested, as the new AHA guidelines do, that when CPR is being administered by a “layperson”—not a doctor—911 operators should emphasize compression-only CPR.

Additionally, the AP reports that people are more likely to attempt lifesaving measures if an emergency operator is giving them explicit and firm directions, and that 80 percent of people will attempt lifesaving actions when instructed to use compression-only CPR, compared with 70 percent who would willingly begin both compressions and assisted breathing for the victim.

The new guidelines also emphasize that rescuers need to focus on delivering at least 100 chest compressions per minute, and should press down the victim’s chest by at least two inches.

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