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You've dialed 911. While you are waiting for the ambulance, you hastily recall the steps of CPR (cardiopulmonary resuscitation) you were taught in a first-aid class you once took. What do you do first? Check for a pulse? Perform mouth-to-mouth resuscitation?
The American Heart Association (AHA) updated its guidelines on CPR. The association says you don't have to check for a pulse before starting CPR to keep a cardiac arrest victim alive. There also is some debate in the medical community on whether the standard techniques of CPR - pressing down on the victim's chest repeatedly with your hands, combined with mouth-to-mouth resuscitation - should still be done together or whether chest compressions alone are good enough to keep a person alive until more help arrives.
If you have sudden cardiac arrest outside of a hospital -- as 225,000 Americans do every year -- you have only a 2 percent to 5 percent chance of being successfully revived, the AHA says. Your chance of survival improves if someone gives you CPR four to six minutes after you collapse and you receive advanced cardiac life support, such as an electric shock to the heart provided by an automated external defibrillator (AED), within 10 to 12 minutes, according to the AHA.
During American Heart Month, the AHA encourages you to be prepared for cardiac emergencies in the following ways:
- Learn the warning signs of cardiac arrest - loss of consciousness (not responding to voice or touch) and not breathing. Sudden cardiac arrest can be caused by a heart attack, electrocution, drowning or accident, or can have no known cause.
- Call immediately for emergency help when you recognize that someone is in cardiac arrest. This is one of the most important things you can do!!! In most areas of the United States, you only have to dial 911.
- Start CPR to keep the victim alive until trained medical personnel arrive.
CPR without pulse detection
Instead of checking a person's pulse, bystanders should note a cardiac victim's breathing, movement and response to stimulation when deciding to begin chest compressions, according to CPR guidelines. However, trained medical professionals should still check for a pulse before starting CPR.
In deciding to change the rules, the AHA said research found that at least 35 percent of lay persons trained in CPR are wrong about whether a cardiac victim has a pulse, says Vinay Nadkarni, M.D., chairman of the heart association's Emergency Cardiovascular Care Committee.
"We recognize that it is very difficult for a layperson to assess whether a patient has a pulse within the first few seconds of a cardiovascular emergency," says Nadkarni, who is director of pediatric intensive care at A.I. duPont Hospital for Children in Wilmington, Del.
Is mouth-to-mouth CPR valuable?
If you're hesitant to perform mouth-to-mouth resuscitation, you're not alone. Studies show CPR is not performed on the majority of people who need lifesaving intervention and that bystanders are leery about attempting mouth-to-mouth ventilation for fear of contracting an illness or disease from the victim. The chance of contracting an infection from secretions during emergency mouth-to-mouth contact is extremely remote, Nadkarni says.
But can chest compressions without mouth-to-mouth ventilation of a victim's respiratory system, be just as effective in saving lives? Researchers at the University of Seattle Department of Medicine found that chest compressions alone lead to slightly better survival rates compared with using chest compressions in combination with mouth-to-mouth resuscitation, according to a study of 500 emergency rescues published in the New England Journal of Medicine.
Nadkarni says there is not enough evidence for the heart association to recommend that bystanders only perform chest compressions without mouth-to-mouth. Trained medical professionals may be able to respond more quickly to emergencies in urban areas such as Seattle than rural parts of the United States, which can make a difference in how bystanders should try to save a cardiac victim's life, he says.
Chest compressions may be more important in the first few minutes of a cardiac emergency, the AHA says, but mouth-to-mouth resuscitation may be important for lengthy episodes of cardiac arrest. If you're hesitant about mouth-to-mouth contact, you should at least do chest compressions instead of not attempting resuscitation at all, the heart association says.
If you want emergency training, the AHA recommends its four-hour course, Heartsaver AED, which provides training and education in CPR and the use of an automated external defibrillator. Studies have found that public access to these simple-to-use machines in casinos, airports and airplanes is highly effective in increasing the survival rate for victims of sudden cardiac arrest, AHA President Rose Marie Robertson, M.D., said in the New England Journal of Medicine.
"If you walk through O'Hare Airport in Chicago, you're never more than a minute away from a defibrillator, and they are saving lives," Robertson says.
To sign up for CPR training, call the AHA toll-free at 1-877-AHA-4CPR.
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Related Articles
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External Sources
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American Heart Association, 2001
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Cardiopulmonary Resuscitation by Chest Compression Alone or With Mouth-to-Mouth Ventilation, New England Journal of Medicine, May 25, 2000.
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Sudden Death from Cardiac Arrest - Improving the Odds, New England Journal of Medicine, Oct. 26, 2000.
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This article was reviewed and updated June 2007.
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