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CPR, or cardiopulmonary resuscitation, made headlines this year when emergency medicine experts announced bold new recommendations regarding the fifty-year-old technique.
Rather "hands-only" than "hands off"
In March the American Heart Association (AHA) launched their campaign to champion “hands-only” CPR – CPR using chest compressions alone without pausing to breathe into the patient’s mouth.
Research showed that many people are so anxious to cause harm to someone who collapses that they rather do nothing at all than perform CPR incorrectly, says the AHA. Also, many people baulk at giving mouth-to-mouth resuscitation to a stranger.
But imperfect CPR at least gives the patient a chance, whereas a hands-off attitude from bystanders usually means zero chance. Studies indicate that hands-only CPR may be as effective as CPR with ventilation. In fact, some resuscitation scientists think it may be more effective.
The new recommendation for lay-person rescuers (non-medic bystanders) is very simple:
1. Call emergency services
2. Push hard and fast in the centre of the chest.
If you’ve done a first aid course and you know the compression-to-breath ratio: great. But don’t waste time fretting if you can’t remember it exactly – get on with those compressions.
The compression-to-breath ratio has also been changed, and is much simpler than before: the latest AHA recommendation is 30:2 (30 compressions followed by two breaths) for patients of all ages.
Bee Gees to the rescue
Most people, says the AHA, don’t push down on the chest hard or fast enough. The aim is for 100 compressions per minute. And if you aren’t sure how fast that is, doctors at the University of Illinois College of Medicine have come up with a catchy way to remember: the Bee Gees.
It turns out the aptly titled 70s classic “Stayin’ Alive” struts along at a similar pace – 103 beats per minute, to be precise – and the Illinois study found that if medics hummed the song internally and matched their chest compression rate to it, they performed CPR much more effectively.
Emergency medicine experts strongly encourage everyone to do a first aid course and keep their skills up-to-date. But that said, even if you are you are inexperienced you can still administer this simple technique and possibly save a life.
So this “silly season”, when alcohol, swimming, road accidents and general hi-jinks increase the likelihood of someone needing CPR help, don’t just throw up your hands if a medical emergency occurs. If there’s no-one more qualified present, it’s up to you to do what you can.
CPR blow-by-blow
Here are the detailed steps to follow when performing CPR as a lay rescuer (provided by Dr Cleeve Robertson, Head of Metro Emergency Medical Services Western Cape):
Action plan
In an emergency situation it is difficult to remember what to do and so we learn the simple routine of H H H ABC:
H: Hazards
H: Hello
H: Help
A: Airway
B: Breathing
C: Circulation
Follow these steps:
H is for Hazards
Ask yourself: Are there any life-threatening hazards or dangers to you or the patient? If so, you need to manage them, or move yourself and the patient out of harm’s way.
There is significant risk of infection with mouth-to-mouth contact and so unless the victim is a family member it is best to use a pocket mask during resuscitation. (This simple mask, which covers the patient’s mouth and nose, prevents any contact with body fluids).
If a pocket mask is not available it is acceptable to do compression-only CPR if there are no signs of circulation.
H is for Hello
Is the patient awake or unconscious? Ask loudly: Are you OK? If there is no response, tap the shoulder. In the case of a baby, tap the feet.
If there is no response it means the patient is not getting enough blood and oxygen to the brain and needs help.
H is for Help
Call for others around you to come and help – there may be a doctor or paramedic within shouting distance!
Phone for emergency medical help on one of the following numbers:
- 112 on a cellular phone
- 10177 National medical emergency number for ambulance services
- 082 911 Netcare
- 084 124 ER24
A is for AIRWAY
Open the airway.
The patient will normally be lying on his or her back. Place two fingers on the forehead and two fingers under the bony part of the chin and gently tilt the head backwards – the so-called “head- tilt chin-lift” method of opening the airway.
B is for BREATHING
Listen, look and feel for breathing. Kneel next to the patient with your head close to his or her head. Look to see if the chest/abdomen rises and falls. Listen for any sound of breathing. Feel for any air moving in or out the mouth or nose: hold your cheek near the patient’s nose and mouth to feel for exhaled air. Do this for up to 10 seconds.
If there is breathing (about 12 breaths or more per minute), place the person in the recovery position.
If there is no breathing (or if you are unsure), log-roll the patient i.e. roll their body as a unit (the vertebral column must be kept in a straight line from head to buttocks) onto his or her back.
If the patient is not breathing you need to breathe for them:
Again, ensure the airway is open by tilting the head back - keep one hand on the victim’s forehead and two fingers of the other hand under the chin to lift the jaw. Place the pocket mask over the patient’s mouth and nose.
- Blow gently and slowly while you watch to see if the chest rises.
- Each breath should take 2 seconds (one in one out). Between breaths, lift your head and see if the chest moves. If the chest rises and falls, it is effective breathing. If it does not, adjust the head and try again. Make up to 5 attempts if necessary.
C is for CIRCULATION
In addition to breathing for the patient, you need to perform chest compressions to keep blood circulating to the tissues.
It is difficult for the lay rescuer to effectively determine whether the patient has a pulse or not. Therefore, the appropriate action is to start immediately with chest compressions once you have given 2 effective breaths.
Chest compressions:
Kneel beside the patient. Place the heel of one hand in the centre of the chest on the nipple line (imaginary line joining the two nipples) on the breastbone. Place the heel of your other hand on top of the first hand. Lean over the victim with your arms straight and elbows locked, and your shoulders directly above your hands. Press down vertically on the victim’s breastbone 4-5 cm to a count of “one-and-two-and-three-and-four…”, giving one push each time you say a number. When saying “and”, release the pressure but do not move your hands from their location on the chest. Give 30 pumps at a rate of 100 per minute. Push hard and push fast.
Then give 2 slow breaths.
Repeat the cycle of 30 pumps and 2 breaths until help arrives or the patient starts to recover. If you are not sure that the patient is breathing unaided, continue with CPR. Is it not always obvious when someone has started to breathe unaided; they may be breathing but not well enough.
Even if the patient appears to have fully recovered, stay with them and monitor them closely until medical help arrives.
The American Heart Association (AHA) recommends a compression-to-ventilation ratio of 30:2 for all lone (single) rescuers to use for all patients from infants (excluding newborns) to adults. This recommendation applies to all lay rescuers and to all healthcare providers who perform 1-rescuer CPR.
For lay rescuers who have not been trained in CPR, or who have recieved training but feel uncertain about or unwilling to perform ventilation, the AHA recommends performing compression-only, or "hands-only" CPR i.e. pumping the chest at a rate of 100 compressions per minute until emergency help arrives.
(Olivia Rose-Innes, Health24, November 2008)
Information sources
American Heart Association: Hands-Only CPR Scientific Statement, Circulation, April 2008
Reuters Health, October 2008:Bee Gees song could save your life
