Why Does CPR Change?

Seems to Make it Hard to Remember

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Take any CPR refresher class and you'll probably hear some old geezer (or young geezer, but definitely a geezer) complaining about how they just keep changing CPR so you have to come in and pay for new classes all the time.

"It's a racket!" he'll say. "It's just to get your money."

Have you ever came up with a great idea and tried it, only to discover there was a better way to do it? Did you keep doing it the old, incorrect way? I didn't think so. With that in mind, why would we keep doing CPR the old way?

CPR Is Not That Old

Cardiopulmonary resuscitation (CPR) has been around since 1960. Not long after it was developed, CPR was taught to non-physicians and the training was not exactly standardized. In 1966, several national organizations, including the American Heart Association and the American Red Cross, got together to develop standards for performance and training of CPR.

Sounds easy, but to come up with standards, you have to have proof that something works. When developing a new process, the proof might take a while to gather. It's not like you can just skip teaching or doing CPR until the evidence exists on how to do it right.

It's sort of a catch-22. They had to do CPR to learn if it works. We continue to make small, incremental changes to see what improves the process versus what makes it worse. It's like walking through a maze. It might make sense to go down a certain path, but when you hit a dead end you have to come back and try a new route.

Better Science, More Changes

The science behind CPR has improved through the years, as well. For a very long time, CPR was based mostly on theory and small laboratory studies that often didn't include humans. It's hard to a randomized, controlled trial on people during a time when their lives are in danger. Let's face it, do you want to be the one who got placed in the control group during the CPR or no-CPR trial?

We only consider CPR during cardiac arrest, a condition for which non-treatment has never led to a witnessed, reported, spontaneous recovery. Once your heart stops pumping, there's no turning back without some help. CPR is that help.

CPR didn't start out perfect. The idea had merit and a few doctors ran with it. They practiced on cadavers and, in some cases, medical students with induced cardiac arrest. The first CPR was done with chest compressions only. Separately, a couple of physicians developed the idea of mouth-to-mouth. The two procedures were combined into what we now call CPR.

As CPR gained acceptance through the 70's and 80's, there were more national conferences. Each time, available research was presented and picked apart by experts. Ideas were exchanged and standards adjusted. For the most part, however, CPR didn't change too much. Push on the chest five times and blow in the mouth. Repeat.

Phoning It in

In 1981, 911 dispatchers began providing instructions for CPR to callers over the phone. It helped to get things started right away. Some people lived, but it wasn't a lot. In the back of an ambulance, CPR was seen as going through the motions for the family's benefit. Once in a while, a patient would survive. Any survival was a good thing. The mortality rate for untreated cardiac arrest is 100 percent.

Edison Medicine

Defibrillation made a big difference. Paramedics were defibrillating in the ambulance and doctors were defibrillating in the hospital. Bystanders started using defibrillators in the early 1990s. An automatic defibrillator worked entirely on it's own, you just had to put the pads on. An automated defibrillator, on the other hand, required a human to push the button in order to shock.

Public access defibrillation (PAD) was seen as a panacea for cardiac arrest. But, that wasn't the case. Defibrillation only works in certain circumstances. Sometimes, the patient just needed good, old-fashioned CPR until the professionals arrived with all of the true life-saving equipment and medications.

Around the World

In 1992, the International Committee on Resuscitation (ILCOR) was founded. Countries around the world started active sharing their data and developing CPR guidelines together. All of this research prompted accelerated changes in CPR standards. And, as happens in the scientific community, research begets research. Scientists like results, and that spurs more interest in finding even more results.

Pretty soon, CPR was evolving again. It got faster. Instead of 'one, one-thousand, two, one-thousand, three, one-thousand..." it became "one and two and three and..."

In 2000, the first of the every-5-year guidelines were released. The ball really started to roll after that. Each new update brings significant changes. Electronic health records made it easier than ever to mine charts for clues. A Japanese study determined that the best cardiac arrest outcomes in the country came from patients who got bystander CPR before rescuers arrived without rescue breaths.

Back to Basics: Push on the Chest

In 2008, the AHA broke from the every 5 year release to endorse Hands-Only CPR, which took rescue breathing out of CPR and became the standard for lay rescuers. The avalanche of research continued and the more we learned about CPR the more we realized all the bells and whistles on the ambulance and in the hospital didn't mean squat.

Chest compressions are king. We had to get back to basics. The order of steps changed from A-B-C to C-A-B. Rescuers around the country now perform CPR with the precision of a NASCAR pit crew, focusing on chest compression technique and continuous compressions with limited interruptions. We still give drugs to patients in cardiac arrest, but only if it doesn't interfere with pushing on the chest and delivering shocks.

All of the research and the evolution of CPR improved outcomes in cardiac arrest significantly over the first couple of decades in the 21st Century. But, that improvement only comes with training. It's one thing to see what works and another to develop standards using that information. It's a whole other thing entirely to get the public to stay up to date on the latest improvements.

Like a Fine Wine, CPR Gets Better With Age

In the case of CPR, the best news is that the more we learn, the more we realize that CPR should be simpler, not more complicated. Push on the chest and shock if you can. That's about all that matters. Rescue breathing, one of the parts of CPR that many people never really liked in the first place, now takes a supporting role to chest compressions. In some emergency medical systems around the country, positive-pressure ventilation isn't even performed during resuscitation by professionals unless the heart starts pumping on its own and the patient still isn't breathing.

When you track down a good CPR training course, preferably one tailored to your needs, go into the class without predilections. Throw out what you think you know about CPR, even if you just took the class a year ago. Open your mind to the changes that have happened based on solid research and development. There will be changes. Hopefully, new developments will continue to make CPR simpler and more accessible to the general public.

A Word From Verywell

If you haven't taken a CPR class since Reagan was in office, don't panic. Nearly every 911 center in the country has the ability to provide instructions over the phone when you call. You don't have to have any previous knowledge at all to follow their lead. Their instructions assume you don't know anything about CPR or first aid. That's a good thing, because even if you took CPR a week ago, in the middle of an emergency it's nice to have a guide.

The most important thing to remember is that no matter how long it's been since you learned CPR—if ever—whatever you do, do something. Call 911 and push on the chest. Because if you don't, cardiac arrest is always fatal.

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