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Doctors: Haste in CPR is life
By WES ALLISON © St. Petersburg Times, published August 16, 2000 If someone collapses of an apparent heart attack, forget about fumbling for a pulse before you start CPR: There's a good chance you'll mess it up anyway. Instead, just start pumping. The American Heart Association on Tuesday announced it has streamlined its venerable CPR guidelines -- for the first time in eight years -- in hopes of making them easier to follow and more likely to be used. Millions of Americans learn cardiopulmonary resuscitation each year, but a bystander starts CPR in just 2 percent of all cases of cardiac arrest, the association says. "By making it simpler, we think there will be more chance that people will, No. 1, do it, and No. 2, do it right," said Dr. Charles Sand, a Tampa emergency physician who helped craft the new guidelines. In the most significant change, lay rescuers are now advised against trying to find a pulse before beginning CPR. Instead, they should look for other signs of life, such as breathing, movement or response to stimulation. Absent any, start CPR. That change was based on research that found 35 percent of lay rescuers are wrong or unsure about whether a victim has a pulse, and that the resulting indecision costs life-saving minutes. If the person does have a pulse and you begin CPR anyway, the chances are slim that you'll do any damage, provided you have been properly trained, said Sand, a physician at St. Joseph's Hospital and chairman of Emergency Cardiovascular Care for the heart association's Florida-Puerto Rico affiliate. "The risk of not doing CPR when someone needs it is much higher, because they're not going to have a chance if something's not done," he said. The new guidelines also advise against using the Heimlich maneuver on unconscious choking victims. Instead, if the person isn't breathing, you should begin CPR, including the rescue breaths and chest compressions. The pressure on the chest should dislodge an obstruction, Sand said. The American Heart Association is considered the definitive source for facts and training for CPR, and its guidelines are used by doctors, nurses, paramedics and lay people faced with the task of trying to save a life. They also are incorporated in the popular CPR courses offered by the American Red Cross, which trains 15,000 people in the Tampa Bay area each year and 2-million nationally. About 250,000 Americans die annually from sudden cardiac arrest. The American Heart Association estimates 50,000 of them could be saved by initiating the so-called chain of survival: starting CPR to keep oxygen flowing and the heart pumping, calling 911, and using an automated external defibrillator, or AED, which is a portable shocking device. In accordance with continual efforts by the heart association, the Red Cross and other organizations, the new guidelines strongly call for placing more AEDs in public places, including offices, malls, sporting arenas and airports. They cost about $3,000 apiece, and anyone can use them to bring the heart back to its proper rhythm. When two electrodes are placed on the chest, the defibrillator can automatically tell whether the heart needs a shock. The new guidelines have been under review for more than a year and a half. Some 500 national and international experts, including Sand, convened in Dallas in February to hash out particulars. George Castrataro, health and safety services director for the Tampa Bay chapter of the Red Cross, said it likely will be June 2001 before the new recommendations are used in every training class. But they have the support of the international scientific community and are in keeping with the ongoing trend toward making CPR easier to handle in a tough situation. The Red Cross supports that trend. "What (researchers) found was they did well in the class, they can complete these skills very well," Castrataro said. "But when you look at those same participants in real-life situations, they don't process the multiple steps very well, and they sometimes skip them or make errors." For more informationAmerican Heart Association On the Web: www.cpr-ecc.americanheart.org Florida-Puerto Rico affiliate, (800) 275-0448 American Red Cross On the Web: http://www.redcross.org Tampa Bay chapter, (877) 741-1444
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