New CPR Guidelines to save lives

The American Heart Association (AHA) today issued new guidelines for cardiopulmonary resuscitation, better known as CPR, making rapid chest compressions the mainstay of basic life support for bystanders trying to revive people whose hearts have stopped.

Doctors say the AHA's change marks the end of the organization's advocacy of a practice believed for at least half a century to be essential for saving victims of cardiac arrest or heart attacks. 

"Compression is the only way to go," says AHA's Michael Sayre, an emergency physician at Ohio State University. He added that rescue breathing is still recommended for children and anyone whose cardiac arrest is likely due to oxygen deprivation.

The AHA decision was driven by a growing body of research showing that bystanders are more likely to perform compression-only CPR on strangers and that it works better than conventional CPR.

"It's a big deal," says Corey Slovis, chairman of emergency medicine at Vanderbilt University in Nashville and an early advocate of the change. "People are standing around while others are dying, when all they have to do is pump on their chests."

About 300,000 people suffer out-of-hospital cardiac arrest in the USA each year, either because they've had a heart attack or suffered a rhythm disturbance; fewer than 8% survive. An analysis of 3,700 cardiac arrests published Friday in the journal Lancet found that hands-only CPR saved 22% more lives than the conventional method. 

All told, the switch could save up to 3,000 additional lives a year in the USA and 5,000 to 10,000 in North America and Europe, says lead author Peter Nagele of Washington University in St. Louis.

A landmark study published Oct. 6 in The Journal of the American Medical Association found that bystanders who applied hands-only CPR were able to boost survival to 34% from 18% for those who got conventional CPR or none at all. In addition, the percentage of people willing to provide CPR rose from 28% in 2005 to 40% in 2009.

The new guidelines dictate that a bystander should compress the victim's chest 100 times a minute to a depth of about 2 inches. That keeps blood and oxygen flowing to the brain, sustaining it until help arrives. Stopping for rescue breaths can interrupt blood flow, AHA's Sayre says.

Studies also show that bystanders reluctant to perform mouth-to-mouth breathing often give up, thinking there's nothing they can do. "Bystanders aren't doing anything in two-thirds of cases," Sayre says. "This is not hard; it's really easy."

Slovis says it's natural to balk. "Doing artificial ventilation, risking getting infectious disease, is something that most of us are afraid of," he says.