The new guidelines on Cardiopulmonary resuscitation (CPR) have been released by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR). The Philippine Heart Association Council on CPR calls on all CPR providers and educators to take note of the revisions, adopt the changes in practice, and promote them in the coming CPR courses. Among the major highlighted changes is the rearrangement in the sequence of steps in CPR.

Change from A-B-C to C-A-B
Instead of the old sequence of action which was A-B-C: airway, breathing and compressions, the new sequence is C-A-B : for compressions, airway, and breathing. This is the new first step - doing chest compressions instead of first establishing the airway and then doing mouth to mouth. This applies to adults, children, and infants but exclude newborns.
AHA says starting with the C of chest compressions will help oxygen-rich blood circulate throughout the body sooner. This is important for victims of cardiac arrest due to a heart attack. In many cases, there is a reserve of oxygen left in the patient's blood and lungs, from the last breath, and we can take advantage of that oxygen reserve and just do chest compressions. With this shift, lay and paramedical personnel are now encouraged to follow the C-A-B process—begin with Chest compression to assist Circulation, then move on to address the Airway and Breathing.
 
According to the AHA, the old approach was causing delays in chest compressions, which are crucial for keeping the blood circulating. Scientific evidence has shown that delays in chest compression decreases survival.
 
No more “Look, Listen and Feel”
In the new guidelines, the Basic Life Support algorithm has been simplified, and “Look, Listen and Feel” has been removed from the algorithm. The new guidelines now stress immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing.
 
At least 2 inchest deep at a rate of at least 100/min
The recommended depth of compression for adult victims has increased from a depth of 11⁄2 to 2 inches to a depth of at least 2 inches (5 cm). With an increased focus on ensuring high-quality CPR, the guidelines recommend that compressions should be provided at the appropriate depth and rate, allowing complete recoil of the chest after each compression with continued emphasis on minimizing interruption in compressions and avoiding excessive ventilation.
This new guideline will make performance of CPR easier, and may inspire more people, especially lay persons without any standard training, to perform CPR if needed. The Council maintains that anybody can do chest compressions, whether they attended a class or not. One does not need to be a doctor or nurse to do CPR.




THE NEW STEP BY STEP GUIDE IN CPR FOR LAY / UNTRAINED RESCUERS:
IF A PATIENT/VICTIM SUDDENLY DROPS UNCONSCIOUS OR IS SEEN UNCONSCIOUS:
1. Survey the scene to see if it’s safe to do CPR.
2. Check victim’s unresponsiveness. If unresponsive, roll victim on his/her back.
3. Call for help; activate the emergency medical services; call for an ambulance/doctor.
4. Start chest compressions. Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.
5. Press down and compress the chest at least 2 inches in adults. Allow complete recoil after each compression. Compress continuously with both hands at a rate of 100/minute or more (Compress to the tune of Bee Gee's song "Stayin' Alive.")
6. For lay or untrained rescuers, continue this Hands Only CPR - do continuous chest compressions until help arrives, an automated external defibrillator (AED) is available or the emergency personnel arrives, or the victim is revived back to life.
THE NEW STEP BY STEP GUIDE IN CPR FOR TRAINED RESCUERS:
IF A PATIENT/VICTIM SUDDENLY DROPS UNCONSCIOUS OR IS SEEN UNCONSCIOUS:
1. Survey the scene to see if it’s safe to do CPR.
2. Check victim’s unresponsiveness. If unresponsive, roll victim on his/her back.
3. Call for help; activate the emergency medical services; call for an ambulance/doctor.
4. Start chest compressions. Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.
5. Press down and compress the chest at least 2 inches in adults. Allow complete recoil after each compression. Compress 30 times with both hands at a rate of 100/minute or more (Compress to the tune of Bee Gee's song "Stayin' Alive.").
6. After 30 compressions, you can now open the airway with a head tilt and chin lift.
7. Pinch to close the nose of the victim. Take a normal breath, cover the victim's mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch the chest rise.
8. Continue cycles of compressions and breaths -- 30 compressions, two breaths - until help arrives, until an automated external defibrillator (AED) is available, until the victim is revived back to life, or until the emergency medical personnel takes over.


If the rescuer is unsure or not confident or hesitant about doing mouth to mouth breathing, or does not have a barrier device for mouth to mouth, he may just do compression only, or Hands Only CPR: press hard and fast in the center of the chest by pressing down with two hands compressing the chest 2 inches at a rate of at least 100 per minute.

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