New CPR Guidelines Stress More Reps The American Heart Association issues new CPR guidelines for the first time in five years. The new recommendations stress more chest pumping, less mouth-to-mouth resuscitation, and generally making it easier for bystanders to help in an emergency.
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With more than a quarter million Americans dying from cardiac arrest every year, the American Heart Association has released new guidelines for cardiopulmonary resuscitation, CPR. The new guidelines are an effort to make it easier to perform resuscitation. If you've ever received CPR or had to administer it or have questions about these new guidelines, give us a call: (800) 989-8255 or send an e-mail to us: Mary Fran Hazinski is an emergency and critical care nurse, editor of the new guidelines for the American Heart Association. She joins us from her home office in Nashville, Tennessee.

Good of you to join us today.

Ms. MARY FRAN HAZINSKI (Medical Editor): Thank you, Neal. I'm glad to be here.

CONAN: What are the changes and how are they different from the old guidelines?

Ms. HAZINSKI: Well, the biggest change is that there's much more emphasis on basic CPR, getting back to the basics. We've streamlined the guidelines and we've put much more emphasis so that rescuers will know to compress harder, compress with fewer interruptions, allow the chest to recoil completely. So it really is a back-to-the-basics approach with the guidelines.

CONAN: And when you say compress harder and compress more, am I wrong? I mean, the old guidelines used to be 15 compressions, a breath, a mouth-to-mouth.

Ms. HAZINSKI: Right. You're right, and for children it was a 5:1 ratio, five compressions to one breath, and now for all single rescuers, we're recommending 30 compressions to two-breath ratio. And so that will give a longer series of uninterrupted compressions, and with compressions, of course, you generate blood flow and so that's critical.

CONAN: And that's the reason why the change has been recommended.

Ms. HAZINSKI: It's been recommended for two reasons: one, by giving a single compression ventilation ratio for all single rescuers for all victims--that's for infants and children and adults--it'll make CPR easier to learn, remember and perform. And then the other thing is we do have some data from studies done of actual resuscitations that rescuers were interrupting compressions too often to do legitimate medical things, but they were interrupting too often. So we think that these longer series of compressions will lead to better survival.

CONAN: We're talking about the new recommendations from the American Heart Association on CPR.

You're listening to TALK OF THE NATION from NPR News.

And in terms of--I mean, obviously if a quarter of a million people are going to die from cardiac arrest every year, this is an enormous issue. How many people are you training now in CPR, and are these people getting the chance to apply that knowledge?

Ms. HAZINSKI: Well, we train about--our goal is to train 20 million people a year in CPR. We're not quite halfway there, but we're working very, very hard to do it. The American Heart Association has recently launched a CPR Anytime program that allows people to learn CPR in 30 minutes or less, so you can learn CPR in less time than it takes you to get the oil changed in your car. So we are making headway in teaching people, but we need to do a better job.

CONAN: You also mentioned harder compressions. A lot of people are worried about obviously hurting somebody.

Ms. HAZINSKI: Right, but you have to remember if someone's unresponsive and you think they're in cardiac arrest, they will be dead if you do not do something to save their life. And the risk of a rib fracture or a bruise seems very, very small when you compare it to the possibility of saving a life. So people need to push hard. They need to compress the chest deeply enough. In an adult it would be one and a half to two inches, and in a child it would be one-third to one-half the depth of the chest and push it at a rate of about a hundred times a minute.

CONAN: Let's get a caller in. This is Steve. Steve, calling us from Fayetteville.

STEVE (Caller): Yes. My wife has a pace maker. How do you go about giving CPR to someone with a pace maker?

Ms. HAZINSKI: That's an excellent question. A pace maker does not interfere with giving CPR because the pace maker does have some--there are some wires that are attached to the heart but they should not interfere with CPR in a normal fashion.

CONAN: So no problem.

Ms. HAZINSKI: No problem.


Ms. HAZINSKI: And I would encourage you to learn CPR because two-thirds of people who arrest arrest in their homes, and so if you learn CPR you will be most likely to use the skills for someone you love.

STEVE: Thank you very much.

Ms. HAZINSKI: You're welcome.

CONAN: Thanks for the call, Steve. Let's hear from Stephanie. Stephanie, calling from Granville, Ohio.

STEPHANIE (Caller): Hello. I have a question for the guest. When she began explaining the changes in the rules, and pardon the baby--he's trying to talk, too.

CONAN: Oh, the baby's all right.

STEPHANIE: She said that it is not 15:1 but 30 compressions to two breaths for adults. I was wondering if the rules have changed in any way applying to infants and children.

Ms. HAZINSKI: Yes, they have, and that's a very, very good question. We recommend that for a single rescuer and for all lay rescuers that you use the same compression ventilation ratio for adults and infants and children, and that's a 30:2 compression ventilation ratio. We do know that infants and children need breath because they most often have a respiratory arrest first or what we call a hypoxic arrest more commonly than adults do. So we know that the breaths are very, very important for infants and children. So we think when you give a 30:2 compression ventilation ratio you will be giving just enough breaths for infants and children and also enough breaths for adults.

STEPHANIE: OK. May I ask another question.

CONAN: Sure. Go ahead.

STEPHANIE: You also said that the recommendations are to push harder and compress the chest deeper, and I just took my CPR class two weeks ago, so I'm wondering--as did my teen-age son and I'm wondering how much of a new lesson I need to give him or if we should just take a new class.

Ms. HAZINSKI: Well, actually the depth of compression that we're recommending is the same depth as we recommended it that you learned about in your course that we recommended in 2000. What we found, however, is we observe actual CPR that people don't compress as deeply as we recommend they compress, so it's a matter of practicing CPR and pressing as hard as we recommend. So the compressions that you learned, that compression depth in the course that you learned is appropriate. You--it would be a good idea to take another CPR course sometime in the near future because we know that the more you practice CPR the better you'll get. And you might consider getting one of these CPR Anytime systems that have the inflatable manikin and the CD-ROM and they will be able to teach you the new ratios.

STEPHANIE: That is a very good idea. Where could I find information about that?

Ms. HAZINSKI: You can get on the American Heart Association Web site.

STEPHANIE: Excellent. Thank you very much.

Ms. HAZINSKI: Thank you.

CONAN: Thanks for the call, Stephanie. We just have a very few seconds left with you, Mary Fran, but our emergency teams--are they going to be retrained?

Ms. HAZINSKI: Everybody's going to be retrained. The American Heart Association will have information for instructors after the first of the year, and in fact, there's information on the American Heart Association Web site today that's available to give more details, and we'd encourage everybody to take a CPR course.

CONAN: Mary Fran Hazinski, thanks very much for being with us.

Ms. HAZINSKI: Thank you, Neal.

CONAN: Mary Fran is an emergency and critical care nurse, editor of the new guidelines for the American Heart Association and she joined us from her home office in Nashville, Tennessee.

This is TALK OF THE NATION from NPR News. I'm Neal Conan.

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