Rose Marie Robertson, MD

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New CPR guidelines

• Rose Marie Robertson, MD
• President, American Heart Association
• Professor of Medicine
• Vanderbilt University Medical Center Nashville,
  Tenn.

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New CPR guidelines
Reflecting medical science

• The new CPR guidelines reflect current,
  international standards in resuscitation science.
• One dramatic and often quoted difference is that
  now the lay-rescuer should not stop to check for
  a pulse.
• This change is based on good data showing that up
  to 35 of lay-rescuers were wrong when checking
  for a pulse (ie, not finding a pulse when it was
  present, or finding one when it was absent).

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New CPR guidelines
In lieu of a pulse

• Cardiopulmonary status can easily be assessed by
  performing simple measures such as looking for
  movement, breathing, coughing, or response to
  stimulation.
• The patient who responds to rescue breathing does
  not require CPR, and this is a more effective
  measure than checking for a pulse.
• For medically trained personnel, checking for a
  pulse is still part of the recommendations.

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New CPR guidelines
Additional changes

• Lay rescuers performing adult CPR now will
  provide 15 chest compressions for every 2
  breaths, regardless of whether one and two
  rescuers are present.
• Chest compressions should be administered to an
  adult at 100 per minute.
• To treat an unconscious adult choking victim, lay
  rescuers will now begin standard CPR including
  chest compressions and will not conduct abdominal
  thrusts or blind finger sweeps of the mouth.

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New CPR guidelines
Retraining?

• By July 2001, all training courses will
  incorporate these guidelines.
• The new guidelines will improve and facilitate
  training. They are easier to remember.
• Currently certified individuals need not retrain,
  although it will be easier to eventually
  recertify using the new guidelines.

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New CPR guidelines
Automated external defibrillators

• In the Heartsaver AED course, participants can be
  trained in CPR and the use of automated external
  defibrillators (AEDs) within 3.5-4 hours.
• Although CPR is important in buying time,
  getting a defibrillator to the patient, and
  defibrillating quickly are the most important
  lifesaving measures.
• Of those victims ultimately salvageable, 7-10
  are lost every minute that defibrillation is
  delayed.

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New CPR guidelines
Potential impact of AEDs

• Currently, of the 225 000 people who suffer
  cardiac arrest every year in the US, 4-5 are
  saved.
• By defibrillating more quickly, and increasing
  survival to 20-25, 45 000 to 50 000 additional
  lives would be saved per year.
• Both CPR and early use of AEDs are links in the
  chain of survival. Additional links include
  early access to emergency care (911 capability)
  and early advanced care with appropriate site
  allocation.

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New CPR guidelines
Success of CPR

• Actual success of CPR depends on the cause.
• Events not requiring defibrillation include
  near-drowning with laryngospasm, or the presence
  of a blocked airway in a conscious choking
  victim.
• Trainees must learn that they will improve a
  patient's chances of being saved by learning how
  to do CPR appropriately and correctly, but there
  are patients whose lives cannot be saved even
  with timely and appropriate administration of CPR.

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New CPR guidelines
A source of comfort

• Family members of patients at risk for future
  adverse ischemic events are greatly reassured
  when they learn CPR.
• The trainee should realize that he is not just
  learning what to do for people at large, but that
  there are circumstances where he might need to
  use CPR in his own home with his own family.
• CPR doubles the survival rate, roughly increasing
  a 2-2.5 survival rate to 5, and rates are much
  higher by adding defibrillators.

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New CPR guidelines
Public access to CPR and defibrillation

• In Chicago OHare airport, a defibrillator is
  never more than 1 minute away, and 75 of all
  cardiac arrest victims have been saved.
• Defibrillators should be found in airplanes,
  airports, shopping malls, and sporting venues and
  personnel, such as security guards, should be
  trained to administer CPR.
• The new guidelines recommend that AEDs be placed
  where there is a reasonable probability of one
  sudden cardiac arrest occurring every 5 years.

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New CPR guidelines
Resources for CPR training

• Emergency Cardiovascular Care (ECC) Guidelines
  2000 are published in
• Circulation
• Volume 102, Supp 1 August 22, 2000   

CPR training is offered at hospitals and public
agencies. For the nearest access to CPR training,
call 1-877-AHA-4CPR