New CPR guide stresses hard, fast pushes

Canadians who see an adult in cardiac arrest should "push fast and push hard" on the chest, according to new CPR guidelines.

Cardiopulmonary resuscitation is a first-aid procedure for an unconscious person whose breathing or pulse has stopped.

CPR is traditionally defined as a combination of chest compressions and ventilation, also known as mouth-to-mouth resuscitation, with the aim of protecting the heart and brain until the heart resumes pumping in a normal rhythm.

But research suggests "hands-only" chest compression by amateur bystanders is enough to save a life. Based on a review of the latest evidence, the American Heart Association released new CPR guidelines Monday that will require everyone who's learned the ABCs of the lifesaving procedure to use a new formula.

Rather than the ABCs of Airway, Breathing and Compressions, the new guidelines for experts such as health-care providers and emergency medical services stress starting compressions first. For highly specialized teams working in the emergency department, there is no sequence, since team members may do all the steps at the same time. 

The guidelines, which also apply to amateur rescuers in Canada, now stress:

• Early recognition of cardiac arrest, urging people to call 911 or their local emergency if they find someone collapsed and unresponsive and not to delay by looking, listening and feeling for breathing or pulse.
• "Push fast and push hard" on the chest to perform compressions rather than trying to remember the recommended ration of 30 compressions to two breaths of traditional mouth-to-mouth.
• Give compressions to a depth of at least five centimetres in adults, about five centimetres in children, and about four centimetres in infants. 

"If you're not formally trained in CPR then the new guidelines tell us they should call for help, ask for a defibrillator and to push hard and fast in the very centre of a patient's chest," said guideline co-author Dr. Andrew Travers of the Queen Elizabeth II Health Sciences Centre in Halifax.

Quick response vital

Travers suggested people think of the 1970s song Stayin' Alive by the Bee Gees to remember how fast the compressions should be done.

The guidelines, which are reviewed every five years, now aim to move blood in the victim more effectively with more forceful compressions, according to the Heart and Stroke Foundation of Canada.

The group hopes the clear, simple message for bystanders will encourage more people to take action if they see someone in distress.

First-aid instructor Mahfuz Chisti of the Canadian Red Cross in Toronto said the most important lesson he wants his students to learn is simple: respond.

"CPR saves lives," Chisti said. "Every one-minute delay in using CPR reduces the chance of survival by 10 per cent."

Christi's class was a reminder for Amir Backbit of Toronto, who has been taking CPR courses routinely as part of his work with youth since 2004.

'It could be your own child'

"Take a look at the patient, take a look at what's going on," Backbit said. "If no one's responding, try and help."

Shannon Bannen, 34, of Mississauga, Ont., was feeding her then seven-week-old son Keegan in April 2007 when he started coughing and choking. Bannen immediately performed CPR on Keegan.

The CPR kept his heart pumping oxygenated blood after a virus shut down his lungs and stopped his heart. Tests show no brain or heart damage for Keegan, who is now three.

"Take a course," Bannen suggested to people uncertain about learning CPR. "You're never going to know who you're going to need it for. It could be your own child, it could be your mom, your husband, your wife, or it could just be somebody you come across that needs help."

St. John Ambulance, which offers CPR classes, said it supports the new guidelines. The Canadian Red Cross said it will take the new guidelines into consideration when revising its training programs.

In a national survey by Environics, conducted from Sept. 2 to Sept. 10 for the Heart and Stroke Foundation, 62 per cent of respondents had taken a CPR class, but only 40 per cent of these people said they would try to revive someone.

The sample size for the survey was 2,003 people, and results are considered accurate to within plus or minus 2.19 percentage points, 19 times out of 20.