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CPR Guidelines

Quick Tips #314

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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 Cardio-Pulmonary Resuscitation (CPR). 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 helping increase 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 Service in your area. The second link is to start early CPR without interruption. Third is early defibrillation from Public Automated External Defibrillators (AEDs). 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 a 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 individual's training in emergency situations.

2010 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, according to Dr. Michael Sayre of Ohio State University Emergency Medicine who helped develop these guidelines for the American Heart Association. The streamlined guidelines should make it easier for people to learn CPR. The ratio is 30 compressions to 2 breaths for all victims, regardless of age, 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.

  1. 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.
  2. 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.
  3. Place your hands in the center of the person's 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.
  4. 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 CPR.

Changes for Automated External Defibrillators (AEDs)

AEDs can double the chance of survival if they're 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 heart's 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 2010 CPR Guidelines
15 chest compressions / 2 breaths
4 sets of 15:2
30 chest compressions / 2 breaths
5 sets of 30:2
1 minute 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 choking 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, special plastic barrier devices can help prevent contact with the victims mouth. If the bystander doesn't have a barrier available at the time and doesn't 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.

Commonly Asked Questions
Q.   Can I contract a disease by performing mouth to mouth?
A.   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 have to come in direct contact of the victim's blood or introduce certain bodily fluids into your bloodstream from an open cut or mucous membranes. There are special mouth-to-mask barriers (available through Grainger) to help eliminate direct contact of the victim's mouth. Also, if you don't have a mask with you, the American Heart Association advises doing compression-only CPR, which is better than doing nothing at all.
 
Q.   Can I be sued if I do something wrong while performing CPR?
A.   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.
 
Q.   If I'm alone with someone who collapses, when do I call 911?
A.   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.
 
Q.   If I'm certified in CPR, do I have to do it when I come across a victim?
A.   No, you do not have to do CPR, even if 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.
 
Sources

Quick Tips #105: OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

Regulations: 29 CFR 1910.151(b) and The American Heart Association site.

CPR Masks , disposable gloves, and AEDs

(Rev. 1/2012)

 

Find even more information you can use to help make informed decisions about the regulatory issues you face in your workplace every day. View all Quick Tips Technical Resources at www.grainger.com/quicktips.

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