October 24, 2010

ABCs of CPR Rearranged to "CAB" - 2010 AHA guidelines

Chest compressions should be the first step in addressing cardiac arrest. This is why the American Heart Association now recommends that the A-B-C (Airway-Breathing-Compressions) of cardiorespiratory resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in the November 2 supplemental issue of Circulation: Journal of the American Heart Association, and represent an update to previous guidelines issued in 2005.

In the executive summary of the publication, the authors are quoted as saying: "The 2010 AHA Guidelines for CPR and ECC (Emergency Cardiovascular Care) are based on the most current and comprehensive review of resuscitation literature ever published."

The new research includes information from "356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions ('webinars') during the 36-month period before the 2010 Consensus Conference."

According to the AHA, chest compressions should be started immediately on anyone who is unresponsive and is not breathing normally. Oxygen will be present in the lungs and bloodstream within the first few minutes, so initiating chest compressions first will facilitate distribution of that oxygen into the brain and heart sooner; starting with "A" rather than "C" adds another 30 critical seconds.

Michael R. Sayre, MD, coauthor and chairman of the AHA's Emergency Cardiovascular Care Committee, in an AHA written release notes: "For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim's airway by tilting their head back, pinching the nose and breathing into the victim's mouth, and only then giving chest compressions."

"This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body," he added.

The new guidelines also recommend that during CPR, rescuers increase the speed of chest compressions to a rate of at least 100 times a minute. In addition, compressions should be made more deeply into the chest, to a depth of at least 2 inches in adults and children and 1.5 inches in infants.

Persons performing CPR should also avoid leaning on the chest so that it can return to its starting position, and compression should be continued as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers instruct untrained lay rescuers to provide Hands-Only CPR (chest compression only) for adults who are unresponsive, with no breathing or no normal breathing.

Other Key Recommendations

Other key recommendations for healthcare professionals performing CPR include the following:
  • Effective teamwork techniques should be learned and practiced regularly.
  • Quantitative waveform capnography, used to measure carbon dioxide output, should be used to confirm intubation and monitor CPR quality.
  • Therapeutic hypothermia should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
  • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.
Pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of continuous CPR. The new guidelines also discuss resuscitation of infants and children with various congenital heart diseases and pulmonary hypertension.

My Thoughts?

It's too early to make any conclusions. On the face of it, I do think it sounds good because the cardiac compression is what truly matters in a CPR. As this recommendation gets adopted, I am keen to see if it will improve the outcome of CPRs.

The above article is reproduced from material entitled '2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science ' as provided by the medical journal, Circulation. See Circulation. 2010;122[suppl 3]:S640-S656. Note: Materials may be edited for content and length.


  1. I just took an Online ACLS class. The instructor went over the new 2010 AHA guidelines. They really seems to make more since. If more people feel inclined to act with compressions before ventilations, then I think it's for the best!

  2. @ACLS, my thoughts are on the same line with yours


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