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New CPR guidelines released

WORTHINGTON -- It was once as easy as A-B-C, but new guidelines released Monday by the American Heart Association (AHA) are stirring things up a bit.

The three basic steps for cardiopulmonary resuscitation, better known as CPR, have been known as the ABCs of CPR since the 1950s, when Peter Safar wrote the book "ABC of Resuscitation." Airway, breathing and chest compression -- later changed to circulation -- formed the mnemonic ABC, a memory aid used to help teach the life-saving technique.

Changes have been made over the years in the ratio of breaths to chest compressions, but now a review of research shows heart attack patients do better when their rescuers skip the rescue breaths and do only chest compressions. The news guidelines call for starting with chest compressions, then switching to breathing, prompting a new acronym -- CAB, for compressions, airway and breathing. The change in sequence applies to adults, children and infants, but excludes newborns.

Murray County Emergency Medical Services Director Jim Gertsema said he got an e-mail notifying him of the upcoming changes Monday morning, but doesn't expect the follow-up documentation for another week or more.

There will be more news forthcoming," he said. "Right now they are just making people aware of it."

Michael Syte, co-author of the guidelines and chairman of the AHA Emergency Cardiovascular Care (ECC) Committee, said the ABCs emphasized opening a victim's airway by tilting their head back, pinching the nose and breathing into the victim's mouth.

"This approach was causing some serious delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body," Syre stated in Monday's release. "Changing the sequence from ABC to CAB for adults and children allows all rescuers to begin chest compressions right away."

There have been rumblings in the emergency medical community of a change in CPR that includes no rescue breathing at all. Since 2008, the AHA has recommended those untrained in CPR use the hands-only CPR method for an adult victim.

"It gets the blood flowing," Gertsema stated, adding that people are more willing to get involved if they don't need to touch their lips to a victim's lips.

The issuance of new guidelines does not mean those currently certified have to rush right out and recertify, Gertsema said. CPR certification expires after a certain length of time, and all instructors will be notified to begin teaching the new CAB guidelines once the standards are complete.

According to AHA, mouth-to-mouth resuscitation was first recommended for drowning victims by the Paris Academy of Sciences in 1740. The first equivocally documented chest compressions in humans were performed in 1891, and the first successful use of resuscitation took place in 1903. In 1954, Dr. James Elam proved expired air was sufficient to maintain adequate oxygenation, and he and Safar invented mouth-to-mouth resuscitation in 1956.

Leonard Cobb hosted the world's first mass citizen training in CPR in Seattle, Wash. in 1972, and helped train more than 100,000 people in the first two years of the program. In 1981, a program to provide telephone instructions in CPR began in King County, Wash. The program used emergency dispatchers to give instant directions while the fire department and emergency personnel were en route to the scene. Dispatcher-assisted CPR is now standard care for dispatch centers throughout the United States.