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New CPR Guidelines A Change From A-B-C to C-A-B

-----compiled by Ivan Berkowitz, Winnipeg, Canada

Some 35 years ago, as one of my initiatives as Chairman of the Manitoba Heart Foundation’s first public fund raising campaign, we organized the first public training in the new technique for Cardio Pulmonary Resuscitation. About 400 of us spent the day working on “Resusci-Annie”.

A Change From A-B-C to C-A-B The 2010 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants (excluding the newly born). This fundamental change in CPR sequence will require reeducation of everyone who has ever learned CPR, but the consensus of the authors and experts involved in the creation of the 2010 AHA Guidelines for CPR and ECC is that the benefit will justify the effort.

Why: The vast majority of cardiac arrests occur in adults, and the highest survival rates from cardiac arrest are reported among patients of all ages who have a witnessed arrest and an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). In these patients, the critical initial elements of BLS are chest compressions and early defibrillation. In the A-B-C sequence, chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths, retrieves a barrier device, or gathers and assembles ventilation equipment. By changing the sequence to C-A-B, chest compressions will be initiated sooner and the delay in ventilation should be minimal (ie, only the time required to deliver the first cycle of 30 chest compressions, or approximately 18 seconds; when 2 rescuers are present for resuscitation of the infant or child, the delay will be even shorter). Most victims of out-of-hospital cardiac arrest do not receive any bystander CPR. There are probably many reasons for this, but one impediment may be the A-B-C sequence, which starts with the procedures that rescuers find most difficult, namely, opening the airway and delivering breaths. Starting with chest compressions might encourage more rescuers to begin CPR. Basic life support is usually described as a sequence of actions, and this continues to be true for the lone rescuer. Most healthcare providers, however, work in teams, and team members typically perform BLS actions simultaneously. For example, one rescuer immediately initiates chest compressions while another rescuer gets an automated external defibrillator (AED) and calls for help, and a third rescuer opens the airway and provides ventilations. the AHA Guidelines for CPR and ECC.

According to the Heart and Stroke Foundation of Canada (HSFC), chest compressions alone, or Hands-Only Cardiopulmonary Resuscitation (CPR), can save lives and can be used to help an adult who suddenly collapses. The HSFC supported a new American Heart Association scientific statement published in Circulation: Journal of the American Heart Association. Hands-Only CPR is a potentially lifesaving option that can be used by people not trained in conventional CPR, or those who are unsure of their ability to give the combination of chest compressions and mouth-to-mouth breathing required. There are some caveats, however, about when and where to use this new technique, according to the Foundation. “The new recommendations apply only to bystanders who witness an adult cardiac arrest outside a hospital setting,” notes Dr. Allan de Caen, chair of the HSFC Policy Advisory Committee on Resuscitation. “Conventional CPR is still an important skill to learn, and medical personnel should still perform conventional CPR in the course of their professional duties.” Hands-Only CPR should also not be used for infants or children, for adults whose cardiac arrest is from respiratory causes (like drug overdose or near-drowning), or for an unwitnessed cardiac arrest. In those cases, the victim would benefit most from the combination of both chest compressions and breaths in conventional CPR. “Clearly the best option is for all Canadians to be trained in all the steps of CPR, so they are prepared for any emergency,” says Dr. de Caen. “But the science is pointing to good results with this simplified technique, and if it helps us improve the rates of bystander CPR, and therefore the chances of survival after cardiac arrest, that would be a tremendous advance.”

The Heart and Stroke Foundation of New Brunswick (HSFNB) announced on July 19, 2010 a $100,000 contribution to the Heart & Stroke Restart a Heart – Restart a Life campaign from the Government of New Brunswick and the Department of Health. This commitment will purchase a minimum of 25 automated external defibrillators (AEDs) and cover the cost of related training for New Brunswick public facilities and high schools over the next year. “Our government is committed to supporting projects that will improve the quality and accessibility of health care, and help save lives in New Brunswick,” Health Minister Mary Schryer said. “We are pleased to support a campaign that distributes life-saving technology and training throughout the province.” The objective of the Restart a Heart – Restart a Life campaign is to secure funding that will enable the partners to distribute AEDs throughout New Brunswick through an application and selection process, i.e., community centres, hockey arenas and other public gathering places. The HSFNB has been soliciting donations from the public and the corporate sector to achieve this goal.

For untrained people, the A H A web site http://handsonlycpr.org suggests: CPR. A lifesaving action. When an adult has a sudden cardiac arrest, his or her survival depends greatly on immediately getting CPR from someone nearby. Unfortunately, less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location get that help. Most bystanders are worried that they might do something wrong or make things worse. That’s why the AHA has simplified things. Don’t be afraid. Your actions can only help. It’s not normal to see an adult suddenly collapse, but if you do, call 911 and push hard and fast in the center of the chest. Don’t be afraid. Your actions can only help. Take a minute and look around http://handsonlycpr.org and invite your friends! Increasing the number of people who know about “Hands-Only CPR” will increase the chance that someone can help when an adult suddenly collapses, and more lives can be saved.

World-renowned Research Centre renamed

St-Boniface Hospital honoured Winnipeg visionary and philanthropist Paul Albrechtsen by renaming its Research Centre the St-Boniface Hospital Albrechtsen Research Centre. The Centre is the global headquarters of the International Academy of Cardiovascular Sciences where our Dr. Naranjan Dhalla was the founder of the Institute of Cardiovascular Sciences.

He was interviewed recently by the American Physiological Society's for their "Living History Program.

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