CPR Guidelines
Document Number: 314
History
Sudden cardiac arrest (SCA) is still the leading cause of death in the United States and Canada. Approximately 330,000 people die in the United States each year from coronary heart disease. When the heart stops beating during cardiac arrest, the brain starts to die within 5 minutes and is certain to be completely dead in 10 minutes. Some victims can last longer due to hypothermia from a cold water drowning or when a bystander is doing CPR (Cardio-Pulmonary Resuscitation). CPR keeps oxygenated blood flowing to the brain and heart and can keep the victims brain alive longer than 10 minutes. CPR is a combination of chest compressions and mouth-to-mouth ventilations performed by a bystander until medical help arrives. The proper rate and ratio has been studied by the American Heart Association (AHA) for years. Recently, the AHA made some changes to the procedures that are already increasing survival rates.
Chain of Survival
Performing CPR alone is not usually what saves most victims, it takes a chain of events to help improve survival. The first link of the chain is early access to call 911 or the Emergency Medical Services in your area. The second link is to start early CPR without interruption. Third is early defibrillation from Public AEDs (Automated External Defibrillators). The fourth link is Early Advanced Life Support by EMTs or Paramedics who can provide specific medications to help revive a victim.
Good Samaritan Laws
Getting someone to perform CPR is another challenge because people are afraid of diseases and law suits if they do something wrong. Most states have enacted Good Samaritan Laws to encourage people to help others in emergency situations. These laws give legal protection to people who provide emergency care to ill or injured persons. They require that the Good Samaritan use common sense and a reasonable level of skill not to exceed the scope of the individuals training in emergency situations.
2005 CPR Guidelines
These guidelines require faster, harder and more chest compressions with less interruption for ventilations. Basically, the more someone pushes on the chest, the better off the patient is, said Dr. Michael Sayre of Ohio State University Emergency Medicine who helped develop the new guidelines for the American Heart Association. The streamline guidelines should make it easier for people to learn CPR. The ratio is 30 compressions to 2 breaths for all victims young or old at a rate of 100 compressions per minute until help arrives with a defibrillator or the victim starts breathing.
4 Simple Steps to CPR
After finding an adult victim unresponsive, first call 911, then follow these four steps.
- Carefully position the person flat on his or her back; tilt the head back and lift the chin; then look and listen for chest movement and breathing.
- If the person is not breathing, pinch the nose and give the person two breaths over 1 to 2 seconds in duration to produce a visible chest rise.
- Place your hands in the center of the persons chest between the nipples; place one hand on top of the other and with elbows locked press the heel of your hand into the chest until resistance and then let the chest fully rise back up.
- Give 30 of these chest compressions for every two breaths; repeat this until medical help with a defibrillator arrives or the person starts breathing.
For children (ages 1 to 8), compress the heel of one hand in the same location as the adult. For infants (age under 1), compress two fingers of one hand in the same location as the adult.
There is no need to check for a pulse or circulation if a person is not breathing or moving, just start these steps to CPR.
Changes for Automated External Defibrillators (AEDs)
AEDs can double the chance of survival if theyre used within the first 5 minutes. CPR should be performed for 2 minutes or 200 compressions before an AED is used. CPR should be immediately restarted for 2 more minutes after each shock or analysis of the hearts rhythm from the defibrillator. AEDs can also be used on children between the ages of 1 and 8 if the appropriate pediatric pads are used. AED users are also covered under the Good Samaritan Law.
| Previous CPR Guidelines |
2005 CPR Guidelines |
15 chest compressions / 2 breaths
4 sets of 15:2 |
30 chest compressions / 2 breaths
5 sets of 30:2 |
| 1 minutes or 100 compressions and then reassess |
2 minutes or 200 compressions and then reassess |
| AED performed 3 shocks back to back and then start CPR for 1 minute |
AED performs 1 shock and then start CPR for 2 minutes |
| Hand placement was just above the xyphoid process. |
Hand placement is between the nipples. |
| ** Rescue breathing and chocking obstruction is the same for both CPR Guidelines. |
Diseases
Many people fear CPR because of the risk of contracting a virus or disease when performing mouth-to-mouth. Even though the risk is minimal, there are special plastic barrier devices available to prevent contact with the victims mouth. If the bystander doesnt have a barrier available at the time and doesnt want to perform mouth-to-mouth, then it is recommended to at least perform continuous chest compressions with the airway open for passive ventilation. Remember, that any CPR is better than doing nothing.
Another option to CPR that is gaining popularity due to its ease and success rate is continuous chest compression CPR (CCC CPR). CCC CPR uses chest compression at 100 compressions per minute with no mouth to mouth contact. This technique keeps the blood flowing uninterrupted, unlike the 2 ventilations required in standard CPR. It also removes the fear of contracting a virus or disease while performing CPR, the reason most onlookers hesitate to perform CPR. Although it is becoming more common in use, CCC CPR has not been endorsed by the AHA at this time.
Sources For More Information
For other documents related to this topic please see EZ facts document numbers 116 and 105.
Regulations: 29 CFR 1910.151(b) and The American Heart Association site.
CPR Masks , disposable gloves, and AEDs.
Commonly Asked Questions
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Can I contract a disease by performing mouth to mouth? |
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Yes, you could contract a disease from doing mouth to mouth; however, the risk is very minimal. The chances are only about .4% because you would have to have some direct contact of the victims blood or certain body fluids into you bloodstream from an open cut or mucous membranes. There are special mouth to mask barriers (available through Lab Safety Supply) to eliminate direct contact of the victims mouth. Also, if you did not have a mask with you, the American Heart Association advises doing compression only CPR which is better than doing nothing at all. |
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Could I be sued if I do something wrong while performing CPR? |
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No, you cannot be sued for acting as a reasonable and prudent person would under an emergency situation because you are protected under the Good Samaritan Law. |
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| Q. |
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If I'm alone with someone who collapses, when do I call 911? |
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If the adult victim just collapsed, 911 should be called as soon as possible. If the victim was an unwitnessed collapse or is less than 8 years old, you should do 2 minutes of CPR and then call 911. |
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If I'm certified in CPR, do I have to do it when I come across a victim? |
| A. |
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No, you do not have to do CPR once you are certified if you feel there is a safety issue with blood or other infectious fluids. However, if you are a health care professional that is on duty, then you would have to perform CPR because you have a Duty to Act. Also, remember that if you don't do CPR, the victim will be completely brain dead in 10 minutes; therefore, any CPR is better than no CPR. |