'Push fast, push hard,' heart association says in simpler CPR guidelines

"Push hard, push fast" next time you give CPR to someone having cardiac arrest, say new, simpler guidelines in a radical departure from past advice.

Putting the emphasis on chest compressions instead of mouth-to-mouth resuscitation, the American Heart Association now urges people to give 30 compressions -- instead of 15 -- for every two rescue breaths.

"Basically, the more times someone pushes on the chest, the better off the patient is," said Dr. Michael Sayre, an Ohio State University emergency medicine professor who helped develop the guidelines announced Monday.

"We have made things simpler," he said. "Push hard on the person's chest and push fast."

Cape Girardeau CPR instructors say the streamlined guidelines should make it easier for people to learn CPR.

"People are always nervous about learning this stuff, but I think the changes will be fine," said Scott Givens, a CPR instructor with Southeast Missouri Hospital. "For the general public, this is making it as simple as possible."

Earlier rules were different for adults and for children and called on untrained rescuers to stop pushing the chest periodically to check for signs of circulation.

Now, the advice is the same for all ages -- 30 compressions -- and you don't have to stop to check for improvement. What's important is to keep the blood flowing.

Leah Gordillo, a CPR instructor at Saint Francis Medical Center, said she was impressed by the extensive research that went in to changing the guidelines.

"They've found out it takes more compressions to circulate blood to get oxygen to organs," said Gordillo.

Studies have shown that blood circulation increases with each chest compression and it must be built back up after an interruption.

Sudden cardiac arrest -- when the heart suddenly stops beating -- can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.

More than 300,000 Americans die from it each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.

More than nine out of 10 cardiac arrest victims die before they get to the hospital, the heart association estimates.

"The bottom line is we think more people need to learn CPR," said Mary Fran Hazinski, a clinical nurse specialist at Vanderbilt University Medical Center who also worked on the guidelines. "We have more and more evidence that good CPR works. We're doing our best to increase the number of bystanders that learn CPR."

Currently, about 9 million Americans a year are trained in CPR, the heart association says, but it has a goal of more than doubling that number in the next five years to 20 million.

The new guidelines call for 911 operators to be trained to provide easy-to-follow CPR instructions by phone.

The heart association also offers new guidance to professionals, calling for cooling down cardiac arrest patients to about 90 degrees Fahrenheit for 12 to 24 hours. Two significant studies have shown that practice can improve survival and brain function for those who are comatose after initial resuscitation.

There are a variety of methods -- both internal and external -- for cooling a person down, but the guidelines don't recommend a specific approach.

The new guidelines also advise just one shock from a defibrillator before beginning chest compressions instead of giving up to three shocks first. Studies show that the first shock works more than 85 percent of the time.

Defibrillators have been popping up in public places like airports and businesses, but the heart association says that more public places need to install the devices. Survival rates have been as high as 49 percent to 74 percent for lay rescuer programs when defibrillators are placed in casinos, airports or used by police.

The new guidelines provide an opportunity for those who have taken CPR in the past to take a refresher course, said Dr. Ahamed Idris, professor of surgery and medicine at the University of Texas Southwestern Medical Center.

"I think it's a good idea for people to take CPR lessons at least every couple of years," said Idris, also involved in creating the guidelines.

He led a study presented at the American Heart Association meeting earlier this month that showed CPR can be effectively taught in little more than 20 minutes. The study found that just five minutes of training on defibrillator use and 20 minutes of instruction in CPR was as effective as the standard four-hour course.

Staff writer Callie Clark Miller contributed to this report.

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How to administer cardiopulmonary resuscitation

1. Call 911 immediately. CPR, while able to keep a person alive, cannot replace the ambulatory care provided by trained medical professionals.

2. Tilt the victim's head back and left the chin until the teeth almost touch. Look and listen for breathing.

3. If the person is not breathing, pinch the nose closed and cover the person's mouth with yours. Administer two full breaths.

4. Put your hands in the center of the victim's chest, approximately one fist's width from the bottom of the breastbone. Place one hand on top of the other. Provide 30 compressions by pushing down firmly on the chest.

5. Continue with two breaths, followed by 30 compressions until medical help arrives, or the person resumes breathing.

~ Source: McKesson Health Solutions