Dramatic changes in new CPR guidelines will simplify lifesaving measures

New emergency care guidelines include dramatic changes to CPR and emphasis on chest compressions, according to the Heart and Stroke Foundation of Canada, co-author of the 2005 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

The most significant change to CPR is to the ratio of chest compressions to rescue breaths – from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The change resulted from studies that showed that blood circulation decreased when compressions were interrupted, and time was being wasted after every interruption because it takes several compressions to build up enough pressure to begin circulating blood again. This is the most significant change since CPR’s inception in the early 1960s.

The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of cardiac arrest victims. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body, buying a few critical minutes until defibrillation can be attempted. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that rescuers “push hard and push fast” when giving chest compressions.

“The 2005 guidelines take a ‘back to basics’ approach to resuscitation,” said Dr. Michael Shuster, one of the expert authors of the guidelines and Chair of the Heart and Stroke Foundation of Canada’s Policy Advisory Committee on Resuscitation. “Since the 2000 guidelines, new research and information has strengthened the emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and easy to do, and the Foundation believes the 2005 guidelines will help increase the number of people able to perform effective CPR.”

Every year about 1,000,000 Canadians are trained in CPR, with materials based on the Heart and Stroke Foundation’s guidelines. According to a national survey recently conducted by the Heart and Stroke Foundation, 63% of Canadians said that they have received CPR training. Of those who have not been trained, nearly one quarter said that “not enough time/no opportunity” were their main reasons for not taking CPR training.

“The Heart and Stroke Foundation is always looking for ways to deliver better, more effective CPR training and encourage the public to get training,” says Dr. Anthony Graham, a Heart and Stroke Foundation spokesperson and long time advocate for CPR. “Some new training options will be introduced early in 2006 that will take as little as 30 minutes, and can be done in the person’s own home. There’s no excuse for not learning this lifesaving skill, particularly if you are living with or caring for someone with known heart disease or who is at risk for its development,” says the cardiologist.

The new recommendations reflect the Heart and Stroke Foundation’s policy to continue to encourage greater access to AEDs in public locations like airports, casinos, and sports facilities. The 2005 guidelines reflect results of the Public Access Defibrillation trial, which reinforced the importance of planned and practiced response to cardiac emergencies by lay rescuers.

Another guidelines change emphasizing the importance of CPR is the sequence of rhythm analysis and CPR when using defibrillators. Previously three shocks could be delivered before CPR was recommended, resulting in delays of 37 seconds or more. Now, after one shock, the new guidelines recommend that rescuers provide about two minutes of CPR, beginning with chest compressions, before activating the defibrillators to re-analyze the heart rhythm and attempt another shock.

The guidelines also recommend that healthcare providers minimize interruptions to chest compressions by doing heart rhythm checks, inserting airway devices, and administering drugs without delaying CPR. “These guidelines are all about minimizing distraction and disruptions in CPR,” says Dr. Shuster. “It certainly underlines the critical importance of CPR, even in a professional setting, for saving lives.”

The guidelines are based on the Consensus on Science and Treatment Recommendations (CoSTR), a document developed by the International Liaison Committee on Resuscitation. The Heart and Stroke Foundation of Canada is the Canadian member of this expert group, which also includes the American Heart Association and resuscitation councils of other countries.

The Heart and Stroke Foundation of Canada will continue its leadership in the development of the science behind CPR by hosting a national research workshop in Vancouver on February 2 and 3, 2006. The workshop will bring together top emergency care experts to identify the gaps in our knowledge around CPR and emergency care, and the Foundation will identify research that can fill those critical gaps.