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    CPR Guidelines a Decade Ago vs. CPR Today: What's Changed (Updated for 2023)

    Dr. Mary Williams, RN, DC

    About the author

    Dr. Mary Williams, RN, DC

    Dr. Mary Williams, R.N., D.C is a Doctor of Chiropractic with an extensive background as a Registered Nurse and experienced Core Instructor for the American Heart Association. She has over 30 years of hands-on medical and instructional experience.

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    CPR guidelines are re-examined and updated every five years. The past decade has seen a number of changes, and many of those changes are geared toward making the skill more accessible and easy to learn. In light of the pandemic, the AHA has also come out with new guidelines to keep rescuers as well as patients safe.

    Mouth-to-mouth rescue breathing is no longer recommended.

    In the past, mouth-to-mouth rescue breaths were advised in addition to compressions. That technique has been out of fashion for a while now, but in the past, the AHA recommended that healthcare providers still learn to provide rescue breaths even as it directed laypeople to focus only on compressions.

    There were good reasons for those guidelines: mainly, that including rescue breaths in layperson online CPR training could make bystanders feel intimidated and reluctant to give CPR to a patient outside of a hospital setting, with their life on the line.

    In 2022, the AHA released new guidelines in light of the pandemic. Mouth-to-mouth is no longer recommended during CPR for either laypeople or healthcare providers, mainly to avoid transmission of the virus. And in response to the pandemic, the AHA now recommends that both healthcare providers and laypeople perform CPR while wearing a face mask.

    Student giving chest compressions


    Don’t waste time searching for a pulse.

    The AHA has been telling us that layperson rescuers should not pause to look for a pulse since 2010—instead, if a person collapses, they should immediately assume it’s due to cardiac arrest and start CPR.

    The newest 2020 guidelines reaffirmed that advice, emphasizing that the harm of giving CPR is low if the patient was found to have collapsed for some other reason than cardiac arrest, whereas the risk of harm is high for those experiencing cardiac arrest who don’t get CPR in time.

    You’re never encouraged to give up.

    At one point, CPR was considered futile past a certain point. But there have been a handful of documented cases of people recovering after very long periods of CPR—perhaps the longest known case was a person who revived after 96 minutes of continuous CPR.

    So don’t stop delivering those chest compressions until help arrives and medical professionals can take over, even if it takes a long time.  Every halt in chest compressions is a halt to blood flowing into the brain, which can reduce a patient’s chances of survival.

    ABC is out. CAB is in.

    In older CPR classrooms, students were instructed to follow the order of ABC when performing CPR: first clear the airway (A), then provide rescue breathing (B), and then perform compressions (C). These days, the last item on that list comes first. 

    However, it’s compressions that circulate blood flow to the brain—and lack of oxygenated blood flow is what kills a sudden cardiac arrest victim. Today, most medical professionals and the American Heart Association believe that it’s better to circulate even blood that isn’t fully aerated to the brain, rather than aerating the blood and not delivering it fast enough. Put another way, every pause in chest compressions is a pause in blood flow to a victim’s brain—and every pause is an opportunity for the patient’s health to crash.

    The most recent AHA guidelines say that you should perform compressions before anything else.
    These have been shown to be the most important in saving lives for victims of cardiac arrest.  Sometimes a new order is taught—C-A-B—that advocates chest compressions, then clearing the airway, then rescue breaths.

    However, since rescue breaths are no longer recommended even for healthcare professionals in light of the pandemic, this process has been simplified even further.

    “Look, Listen, and Feel” is out the door

    In the past, you might be taught to “look, listen, and feel” before calling 911 to try and determine whether there’s a problem. These days, instructors want you to start in on CPR as soon as possible—and every second counts.

    Students are usually instructed in today’s classes to call 911 the instant they realize there’s something wrong; better to have to send back the ambulance because the victim is actually fine than to have it arrive just a few seconds too late.

    “Push hard and fast in the center of the chest”

    The American Heart Association used to recommend that rescuers push one and a half to two inches into the chest on each compression. Now, the accepted compression depth is at least two inches—maybe more.

    This is deeper than it seems, and it results in vigorous compressions that might break ribs on a full-grown adult. Still, the American Heart Association believes saving a person’s life is more important than a few cracked ribs.

    The guidelines used to say rescuers should deliver about 100 compressions per minute. Today, the wording has changed—and rescuers are suggested to push down and deliver at least 100 compressions per minute, if not more. For laypeople, it’s now common to be told to “push hard and fast in the center of the chest”—simplifying the directions to the most effective element.

    The quick-and-easy way to tell if your pace is correct is by trying to deliver compressions in time to the Bee Gees song “Stayin’ Alive.” But you don’t have to limit yourself to that song. These days, you can find Spotify playlists with dozens of songs that have the perfect beat to perform CPR to. Here’s one.

    Accessibility is key.

    The AHA has become more and more accepting of video-based online CPR certification for laypeople over the years. In 2020, the new guidelines reaffirmed the position taken in 2015, which stated that blended learning alternatives were an acceptable replacement for layperson CPR classes done entirely in person.

    This is especially important in light of the pandemic, where the risk of viral transmission may be a barrier to laypeople attending in-person CPR classes. Online learning makes CPR classes more accessible to all, and the AHA has prioritized encouraging the largest number of people possible to get trained in layperson CPR.

    If you learned CPR a while ago, now is a great time to recertify. The guidelines have changed, making CPR easier to administer, safer for rescuers, and more effective. Even so, if you haven’t recertified, this isn’t meant to encourage you not to deliver CPR the way you already know how to if you are ever in an emergency situation. Studies are clear on this point as well: when it comes to CPR, any kind is better than none at all.


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