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Compress first, ask questions later, new CPR guidelines say

Students at Senator O'Connor College School in Toronto practise CPR.


"Push fast and push hard" – that is the key to saving the life of someone who has suffered cardiac arrest and the central message in the revamped rules for performing cardiopulmonary resuscitation.

"There is a real big emphasis now on chest compressions," Andrew Travers, a spokesman for the Heart and Stroke Foundation of Canada, said in an interview. "Anyone can do that, even if they have no training."

The new CPR guidelines, published in Monday's edition of the medical journal Circulation, recommend compressing the chest at a rate of 100 times per minute. "That's about the tempo of the song Stayin' Alive by the Bee Gees," said Dr. Travers, a Halifax ER doctor who is one of the co-authors of the international guidelines.

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If someone has collapsed and is not breathing – a sign their heart has stopped – bystanders should call 911 and then begin compressions immediately. No need to "look, listen, feel" first, or to count breaths. If a portable defibrillator is available it should be used to shock the heart.

While the compressions are taking place, a second person should check that the victim's airways are clear then assist with their breathing with mouth-to-mouth.

That order, C-A-B, is a marked change from previous guidelines: Until now, CPR students were taught the A-B-C approach, meaning clear airways, pinch the nose and breath into the victim's mouth and then start chest compressions.

"This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away," said Michael Sayre, chairman of the American Heart Association's emergency cardiovascular care committee and another co-author. (With newborns, mouth-to-mouth remains essential.)

The guidelines process is led by a committee of the American Heart Association – and has been since 1966 – but the rules are generally adopted internationally and promoted by domestic heart associations. The focus of the new guidelines is on simplifying CPR for bystanders; there is a separate, more technical document with recommendations for health professionals.

Sandra Clarke, executive director of the ACT Foundation, which promotes and supports CPR training in high schools, said the "new guidelines will make our job easier because they make CPR easier."

She said CPR is an important life skill and she would like to see training made mandatory for all high school students – as it now is in Ontario, Manitoba and Alberta.

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André Corriveau can attest to the importance of CPR training. Just over year ago, during a recreational hockey game, he suffered arrhythmia and his heart stopped.

One of his teammates immediately began chest compressions, while a second called 911. An alert arena employee ran for a portable defibrillator and shocked him back to life.

"If those guys didn't know CPR, I would be six feet under," Mr. Corriveau said. He underwent a triple bypass and, a year later, is back playing hockey.

He also made a point of getting CPR training himself.

According to a poll commissioned by the Heart and Stroke Foundation, only 40 per cent of Canadians said they would try to revive a person who had suffered cardiac arrest. Most cited a lack of confidence in their skills, fear of failure and fear of catching a disease.

People are also unduly concerned they will do harm," Dr. Travers said. "You can't hurt someone with CPR. The benefits far outweigh the risks," he said.

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Dr. Travers said the hope is that simplified CPR guidelines will encourage more citizens to act and swiftly. "With cardiac arrest, it's a race against time. You have 6-10 minutes to restart the heart and for each minute lost there is a 10 per cent reduction in survival," he said.

Dr. Travers said that while defibrillators are becoming more commonplace in public spaces like shopping malls, hockey arenas and schools, they do not replace the need for CPR. And, besides, most cases of cardiac arrest occur in the home.

Scott Blostein was awakened at 5 a.m. on a cold January morning by panicked family members. The Ottawa teenager's father, Alan, had stopped breathing and was lying face down on the bed, turning blue.

"I knew what I had to do," he said, and began pumping his chest furiously and giving mouth-to-mouth. "I wasn't panicked at all, I was focused on doing what I had learned in school."

Five years later, the elder Mr. Blostein is in good health and the junior Mr. Blostein is an avid proponent of CPR training.

"I saved my Dad's life because of that CPR course. I don't know why everyone wouldn't want that skill."

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