Since its introduction half a century ago, cardiopulmonary resuscitation (CPR) has saved countless lives. In the unfortunate event of witnessing a cardiac arrest, the immediate performance of CPR is often the difference between life and death. From CPR’s inception, guidelines have focused on performing the ABCs – airway, breathing and circulation – by making sure the patient’s airway is open and first providing rescue breathing and then chest compressions. This method is still championed by most health organisations worldwide, however the American Heart Association (AHA) announced this October a revision to their CPR recommendations in a bid to simplify the procedure and enable more people to help save lives.

What makes AHA’s news confusing is other major health organisations, including the Resuscitation Council UK and the American Red Cross, have not changed their CPR guidelines in-line with the new regulations. In an effort to better understand this issue, TALK spoke with Mary Drobnak, a registered nurse with experience teaching first aid and basic life support in Shanghai.

“The standards for CPR delivery have always emphasised airway, breathing and circulation when performing the initial assessment in an emergency situation,” she says. “The AHA believes the most likely reason an adult will require CPR is because their heart has stopped, and the heart should be the initial focus of attention. Beginning with chest compressions has been determined to be more effective during a cardiac arrest and an important way to pump the heart and blood through the body. Hence, the AHA has simply altered the way they teach CPR from ABC to CAB.”

The AHA also believes by moving the focus to chest compressions, CPR becomes more practical for untrained bystanders during an emergency. “Lay people will be the 'first one at the scene' during an unpredictable medical emergency such as a heart attack,” Mary points out. “The thought is, if giving chest compressions is the only action an untrained person may be inclined to do, it is better than doing nothing at all. It has proven effective enough for use in the absence of artificial respiration (breathing) if rescue is not too prolonged before a trained professional arrives.” Thus, by de-emphasising mouth-to-mouth, the AHA suspects more lives may be saved.

However, there are several critical caveats to these new guidelines. “There will come a point during a rescue scenario when the blood will no longer carry oxygen,” Mary stresses, “and rescue breathing is essential in order to keep the brain oxygenated – therefore, a step that should not be skipped.” Additionally, there are circumstances where compression-only CPR is not appropriate, for example in cardiac arrest due to non-cardiac causes or on children when causes are more likely due to asphyxia like drowning or choking.

“We are a reactive society and often think we will never be in situations we hear about or see on TV. By changing our culture to think proactively means we are 'prepared' and know what to do – it's about having a plan. I would recommend untrained people familiarise themselves by going to AHA’s website and reviewing compression-only techniques,” Mary advises.

Better yet, CPR and first aid classes are available in Shanghai including Parkway Health’s program, taught in both Chinese and English. “Investing only a few hours in learning CPR and basic life support, and gaining the basic steps to saving a life, can make a huge difference in how one handles emergency situations,” Mary says. “Many of the skills learned during a CPR/BLS class are ways to avoid harming yourself and others and what you take from it builds confidence and actually alleviates panic that can so easily set in during emergency situations.”

American Heart Association: www.heart.org; Resuscitation Council UK: www.resus.org.uk; American Red Cross: www.redcross.org; Parkway Health: www.parkwayhealth.cn