Keeping more people alive by making CPR simpler
You need only two things to learn cardiopulmonary resuscitation and possibly save a life: a willingness to press hard on someone's chest and familiarity with the Bee Gees' disco hit "Stayin' Alive."
Yes, CPR has changed. The American Heart Association and other organizations, including the American Red Cross, are promoting instruction in an easier, hands-only version of CPR that drops the difficult mouth-to-mouth maneuver they had long been teaching. You press down hard and fast in the center of the chest until the ambulance or someone with an automatic defibrillator arrives to take over.
And the Bee Gees? The beat of their song -- featured on the soundtrack of 1977's "Saturday Night Fever" -- just about matches the optimum CPR rhythm of 100 chest compressions per minute.
The AHA and other groups are trying to make CPR more accessible, and they're spreading the word through flash mobs, classes at fire stations and shopping malls, and even online training videos. The guidelines say it's appropriate to start CPR if you see a person collapse who is not breathing or is gasping.
Cardiac arrest is difficult to survive, no matter the circumstances. Even in the hospital, only about 24 percent of adults do so, according to AHA data from 2012, the most recent available. But about 80 percent of cardiac arrests occur in non-hospital settings, often at home, with fewer than 10 percent of victims surviving, according to the AHA. Basic CPR can sometimes be enough to keep a person alive until first responders arrive.
"People don't have to go to a class or get certified. They can learn the basics online, at a public event or even from a health care provider," says Clifton Callaway, executive vice chairman of emergency medicine at the University of Pittsburgh School of Medicine.
Communities across the country are hosting CPR training parties, and some school systems are making CPR a high school graduation requirement. Dallas/Fort Worth International Airport has a CPR training kiosk for interested travelers.
The AHA updated its guidelines in 2010 to promote hands-only chest compressions, citing studies showing that "for most adults with out-of-hospital cardiac arrest, bystander CPR with chest compression only appears to achieve outcomes similar to those of conventional CPR."
Two studies, one conducted in London and one in Sweden, compared emergencies in which bystanders used either hands-only CPR or CPR with what is called "rescue breathing." The studies, published in the New England Journal of Medicine in 2010, found similar outcomes, conclusions that offered support for compression-only aid. Researchers say that people doing both CPR and breaths would often stop the crucial compressing while concentrating on breathing.
Mouth-to-mouth resuscitation in addition to chest compressions is still recommended for children, teenagers and seniors because they may have a breathing obstruction rather than cardiac arrest, and trained responders are still taught the older method and use it regularly.
The rollout of the new method has been gradual as AHA developed efforts to train what it hopes will eventually be tens of millions of people in the United States. Kits with instructions and a small practice mannequin are given out at mass training events, and materials -- a DVD, a skills reminder card and a mannequin -- can be bought online. An Arizona study found that after authorities promoted compression-only CPR, bystanders went from assisting in 28 percent of collapses to 40 percent of them.
A bystander who sees someone collapse should first ask another person to call 911, direct someone else to look for an automated defibrillator and begin CPR immediately with no stopping until help arrives, says Ahamed Idris, a professor of surgery at the UT Southwestern Medical Center in Dallas, who was a designer of the training kiosk at the Dallas/Fort Worth airport.
The beat of "Stayin' Alive" can be heard as you approach the kiosk, installed in 2013 in Terminal C. About the size of an ATM, the kiosk includes an audio CPR lesson and a chest mannequin for practice. The lesson tells users where to place their hands and how deeply and how fast to pump the mannequin chest. A test at the end produces colored graph bars showing how well the student did. The AHA plans to install kiosks at other airports and public spaces around the country.
Just one minute of video training for bystanders may help save lives, according to a small study whose results were presented at an AHA conference in November 2013.
In the study, 48 adults watched the CPR training video, while 47 sat idle for one minute. All were then asked to do "what they thought best" on a mannequin that had been positioned to simulate a person in cardiac arrest. The participants who had seen the video were more likely to opt to call 911, initiated chest compression sooner, had an increased chest compression rate and a decreased hands-off interval than did those who hadn't watched the video.
"Given the short length of training, these findings suggest that ultra-brief video training may have potential as a universal intervention for public venues to help bystander reaction and improve CPR skills," said Ashish Panchal, lead researcher of the study and an assistant professor of emergency medicine at the University of Arizona School of Medicine.
Flash mobs have been another tool. Nearly two years ago, several groups sponsored one in Washington's Freedom Plaza, where they played "Stayin' Alive" as volunteers danced. When a crowd gathered, the dancers grabbed soft mannequins and demonstrated hands-only CPR.
District of Columbia Council member Yvette Alexander, D-Ward 7, who chairs the council's health committee and helped promote that event, would like to see CPR certification as a requirement for high school graduation. "If we can capture every student, that would make [CPR] ability more extensive," she says.
It's important to dispel the notion that CPR is difficult to learn, says Reginald Robinson, a Washington cardiologist and former president of AHA's Washington, D.C. chapter.
"People have put off learning CPR because they can't find the three or four hours many courses take," he says, "but you don't need that whole long course anymore unless you're planning on being an expert in advanced lifesaving. Lay people need the basics, and that will save lives."