Ask Dr. Hallberg: New CPR guidelinesby Tom Crann, Minnesota Public Radio
St. Paul, Minn. — Anyone who's qualified to give CPR is getting accustomed to yet another new set of guidelines. Experts from the American Heart Association now say chest compressions, which they call the simplest step, should be given first.
MPR News medical analyst Dr. Jon Hallberg joined All Things Considered's Tom Crann on Thursday to discuss the new guidelines. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic in Minneapolis.
Tom Crann: First tell us what the new guidelines are.
Dr. Jon Hallberg: Well, these were just released within the last month. And they came on the heels of a massive study done in the state of Arizona for about five years, which found that rather than what we've been thinking all these years - A, B, C, airway, breathing, circulation - that the circulation or compressions should now come first, that we're more concerned about circulating blood than we are about breathing in someone who has cardiac arrest, someone who has basically died, (where) there is no pulse to speak of.
Crann: You mentioned the study done in Arizona. What were the findings? Is that why they actually changed the guidelines?
Hallberg: Yes. The study was done in Arizona. It was a statewide campaign to get bystanders, to get regular people on the street comfortable enough to start CPR. And they dropped the breathing part entirely (and) called it 'compression-only CPR.' The idea being that people are pretty reluctant anyway to jump in and help, probably more so by the thought of doing mouth-to-mouth resuscitation to somebody who's a stranger who may have vomited or may have blood around their mouth.
So by just educating the people to do this, could they take a pretty abysmal amount of participation and make it better, and in so doing, see better outcomes? And in fact, that was the case.
Crann: Give us an idea of what difference, if someone's in cardiac arrest, what difference chest compressions can make.
Hallberg: If you do nothing, the chance of that person surviving is maybe five percent by the time help arrives. If you do traditional CPR, the way we've been taught over the years, it might be like seven percent or so. If they do this compression-only version, it rises up to like 13 to 14 percent, so a substantial increase.
Now the big difference is if you have an automatic external defibrillator, an AED, the thing that people are sort of familiar with. You see them when you go to the Guthrie (Theater), for example, or you go to a sporting arena. They're on the walls. If you can get that on in time, your survival rate increases easily to about 30 percent.
Crann: Can someone just pick one up? I'd be a little worried if someone didn't know what they were doing.
Hallberg: Well that's sort of the thing. It's fine to have people who are certified to use them, but then you find that person, a minute or two or three have gone by by the time they arrive.
These things are absolutely fool-proof, and it's a case of where something that's well-designed can be used by anybody. And when I used it, never seen this unit, it talks you through it. It's speaking to you, and it tells you, 'Put this pad here, this one here. Step back. Push this button.' It analyzes for a rhythm. If there isn't one, it will shock.
It will ask you to push a button to shock, and if it's fine, then you're very relieved that there's a pulse, there's a heartbeat.
Crann: Let's say I haven't been trained in CPR or haven't been in years, and I'm a bystander and witness someone going into cardiac arrest or someone you're with. What's the first and most effective thing you can do?
Hallberg: Get help. I think it's often forgotten that the most important thing is to call 911, get people, get paramedics on the site as fast as possible, and then we still want to assess if someone's got a pulse or not. Many times when I've seen people fall or drop to the ground, it's a simple faint. I mean they simply need to have their feet elevated (and) within a few seconds they're coming to again.
And that's an important thing. I don't want to be doing CPR on someone who's just fainted, but if you know they don't have a heart rate, you start doing compressions, and you put your hands on the chest, you push down over the sternum, and you do it at a rate of about a hundred compressions per minute, which is pretty fast.
Crann: That is pretty fast. And this may sound totally silly, but it may come in handy for people. The guideline is 100 beats a minute. You're supposed to remember the old Bee Gees' song Stayin' Alive.
Hallberg: Yes, you know the name says it all, and it's a catchy tune. And many people have it--. You can just sort of say it to yourself as you're going along and doing those compressions at that rate, and you basically do it until you can't do it anymore, you're too tired. Someone can replace you. Or hopefully by the time you need help, someone's arrived.
(Interview edited and transcribed by MPR News reporter Madeleine Baran.)
- All Things Considered, 11/04/2010, 4:54 p.m.