New emergency care guidelines simplify CPR

HEART AND STROKE FOUNDATION OF CANADAOct 18 2010

HSF survey finds that only 40 per cent of Canadians trained in CPR would try to revive someone who has had a cardiac arrest

New emergency care guidelines simplify performing cardiopulmonary resuscitation (CPR) and highlight the need for high quality CPR by addressing some of the barriers to performing CPR. The Heart and Stroke Foundation of Canada, co-author of the 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), released the guidelines today.

The updated resuscitation guidelines have effectively mapped out a process of care based on the skill set of the rescuer, the situation and the resources available to respond. "In the past we limited ourselves by making the approach to resuscitation the same across all types of patients, all types of settings, and all types of rescuers," says Dr. Andrew Travers, chair of the Heart and Stroke Foundation of Canada's policy advisory committee on resuscitation and one of the expert co-authors of the 2010 guidelines "We recognize that one size no longer fits all when it comes to CPR."

The new guidelines stress early recognition, urging people to call 9-1-1 or their local emergency number if they ever find someone collapsed and unresponsive, and not to delay by 'looking, listening and feeling' for breathing or pulse. They also recommend that instead of trying to remember how many compressions and how many breaths, bystanders doing CPR are urged simply to "push fast and push hard."

"Many people hold back from doing CPR because they are afraid they may do it wrong or that they may hurt the person," says Dr. Andrew Travers. "We want to make it clear that technique is less important than doing chest compressions quickly and firmly.

"Think of the '70s Bee Gees song Stayin' Alive and that will give you an idea of how fast compressions should be done."

The 2010 guidelines also note that to effectively move blood in the victim, compressions need to be fairly forceful. "Think about moving the heel of your hands up and down about two inches into the chest - or the height of your pinky finger," says Dr. Travers. "We want people to know that they can make a difference, even just by taking these simple actions. But doing something - including making that 9-1-1 call immediately - is crucially important."

The guidelines are reviewed every five years, and updated only when evidence is clear that changes will improve survival rates. The 2010 guidelines are based on input from 356 resuscitation experts from 29 countries, Heart and Stroke Foundation of Canada International Liaison Committee on Resuscitation (ILCOR) representatives and representatives of the American Heart Association and resuscitation councils of other countries. Hundreds of scientific evidence reviews were rigorously examined and resulted in the guidelines being updated in key areas.

The biggest update for healthcare providers and emergency medical services personnel involves changes to the order in which CPR skills are used: the first step should be chest compressions, followed by airway check then rescue breathing. This is a major change from previous guidelines which recommended compression as the third step, after an airway check and rescue breathing had been performed. This shortens the time to the first compression, a significant factor in reducing brain and heart damage following cardiac arrest.

"We recognize that compressions are fundamental key building blocks - other things are important, but not as important as compression, and that is why we changed the order," says Travers.

"These changes will help break down some of the barriers that keep people from doing CPR if they are faced with a cardiac emergency," says Linda Piazza, director of health policy and research with the Heart and Stroke Foundation of Canada.

"Many Canadians want to help if they are ever faced with this type of situation, especially given the fact that four out of five cardiac arrests occur at home or in public places," she notes. "The changes announced today make CPR easier to learn, easier to do and we believe will make Canadians more likely to step in and respond to a cardiac emergency."

Only 40 per cent of Canadians would try to revive victim of Cardiac arrest

Currently, most victims of out-of-hospital sudden cardiac arrest do not receive any bystander CPR. To learn what barriers keep people from providing CPR, the Heart and Stroke Foundation recently surveyed Canadians on their willingness to act. The national survey found that while 62 per cent of Canadians said they had taken a CPR class, almost three-quarters reported that it was more than a year ago. And when asked what they would do if they saw someone having a cardiac arrest, just 40 per cent said they would try to revive the person.

What's stopping you?

Barriers that influence using CPR training to revive or resuscitate a person in cardiac arrest:

Nothing would prevent me from attempting to revive the person 40%

Lack of confidence in my skills & training 15%

Would prefer to wait for qualified help to arrive 8%

Unsafe/dangerous environment/personal safety 7%

Fear of catching a disease/something from the person 7%

Someone else might be already doing CPR 6%

Fear of legal liability/being sued 5%

Fear of failure/being unable to save the person 3%

Hazard/injury of person/victim 3%

Note: this is a subsample of respondents who have taken any training on how to perform CPR Source: Environics National Omnibus Poll, September 2-10, 2010 re: HSFC Cardiopulmonary Resuscitation (CPR)

Overall, the odds of surviving a cardiac arrest are almost four times greater if someone performs CPR right away. When CPR is combined with an Automated External Defibrillator (AED), survival rates soar to 50 per cent and even greater, according to the Heart and Stroke Foundation. Without CPR and defibrillation, fewer than 5 per cent of people who have a cardiac arrest outside of a hospital survive.

"Although barriers cited include lack of confidence, fear of failure and potentially injuring the victim, the reality is, that you can't help if you don't try - you can't hurt the cardiac arrest victim, if they don't live to see another day - and without CPR, that is the likely outcome," says Travers.

The Foundation recommends that all Canadians learn the life-saving skills of CPR and review this knowledge often. Learning and reviewing CPR skills has been made much easier with an at-home video kit, the Heart and Stroke CPR Anytime(TM) for Family and Friends(TM). The kit teaches the basic skills of CPR in as little as 22 minutes. People can review it at their leisure and share it with their families so that the skills can stay top-of-mind in case they are ever needed.

The 2010 resuscitation guidelines are available at www.heartandstroke.ca/CPRguidelines. Resuscitation and health care providers will be trained with the new guidelines in a series of sessions in the coming months.