How to save a life: The new CPR guidelines

The Pediatric Insider

© 2010 Roy Benaroch, MD

The American Heart Association recently released new 2010 guidelines for performing CPR—cardiopulmonary resuscitation. It’s easier than ever to learn it, and easier than ever to do it.

CPR is what bystanders are supposed to do when someone collapses and stops breathing. Once the heart stops beating and lungs stop breathing, there isn’t a lot of time before the brain will die. The AHA’s new guidelines encourage anyone—even with no formal training—to get the initial steps of CPR started so there is time for trained help to arrive.

I used to be a CPR instructor, and I’ll informally summarize the current instructions here. Reading this will give you some idea of what CPR is all about, but this is no substitute for taking a CPR course.

  1. You see someone collapse, or come upon someone motionless. Don’t panic. You know what to do.
  2. Make sure it’s safe to proceed—don’t run into traffic, or dive into unknown water, until you’re sure you’ll be safe.
  3. See if the person is responsive. Give a little shake. You get style points for saying “Annie are you OK?”, but anything like that is fine.
  4. If the person moves or is otherwise responsive, don’t proceed with CPR. Make sure the situation is safe. Offer to call the person a cab or ambulance or just fluff their pillow, depending.
  5. If the person is truly unresponsive, your first goal is to get trained help. If other people are nearby, tell them to call 911 and get an AED. If no one else is around, you must go do this before proceeding with CPR.
  6. While someone else is getting help, or after you’ve called 911, start chest compressions. Put your hands in the middle of the victim’s chest and push down, hard and fast. Push down about two inches. Try to remember to relax after each push so the chest can re-expand—don’t keep leaning down. A good rate to push is about 100 beats per minute. The AHA suggests thinking about the beat of The BeeGees Stayin’ Alive. I suppose you could even sing it out loud. If you’re feeling macabre, another good song with that 100 beats per minute rhythm is Queen’s Another One Bites the Dust. I do not suggest you sing that aloud.
  7. Unless you have specific training in rescue breathing, don’t even try mouth-to-mouth. Just keep compressing and singing “Stayin’ Aliiiiiive….” until trained help arrives.
  8. Once trained help comes, or the victim starts to move, stop pushing and get out of the way.

Simple, and it works.

One step deserves a little more explanation: if available, you want to use an AED (Automatic External Defibrillator) as soon as possible. This device is basically an automatic way of using those paddles to shock the heart back into a normal rhythm. The devices are designed to be used by anyone. When you turn one on, it will shout instructions to you about exactly how to apply the pads (it’s one big sticker on the chest), and to yell clear, and once no one is near the victim, to push a big button. The device will figure out if a shock is needed, and give the shock if it will help. Studies have shown that untrained middle school students can use these devices correctly, and they’re often available in public places, stadiums, churches, and sometimes restaurants. If it’s possible to grab an AED and use it, do that after you call 911 and before starting the further steps of CPR. If you’re doing CPR and someone runs up with an AED, stop what you’re doing and follow the AED instructions.

For those of you who’ve taken a CPR course, the newest guidelines include several changes that are meant to simplify the process. Studies have shown that even trained personnel often got caught up in the details of trying to remember the exact instructions, rather than just jumping in an starting. It’s more important to do something than to do something exactly right. The major changes are:

  • Forget ABC (airway, breathing, circulation); it’s now CAB: start compressions first. Compressions are the most important part of keeping people alive. Another reason for the change: at least some onlookers have been reluctant to start CPR because they didn’t want to give mouth-to-mouth. Fine. Just start chest compressions, after calling for help.
  • Checking pulses and breathing, which was de-emphasized with the last set of guidelines, has further been pushed to the back of the bus. If the person is unresponsive, assume breathing and heartbeats have stopped, and don’t waste time trying to check.
  • The rates/rhythms/cycles/orders are the same at all ages from infant to adults. Neonatal CPR is different.

Whether or not you’ve had CPR training before, now is a great time to take the course. Even if you don’t think you know what you’re doing, these simple steps are easy to follow. You don’t have to sing out loud. Call for help, then get pushing: that’s how to save a life.

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6 Comments on “How to save a life: The new CPR guidelines”

  1. Dr. Roy Says:


    “Unresponsive” really means “unconscious, and not making a good respiratory effort.” If someone is just sleeping soundly, and breathing fine, please don’t start CPR.

    On the other hand, if someone is not making any effort to breathe, or is breathing only with ineffective gasps– that’s when emergency action is needed.


  2. Don Davenport Says:

    +1 Smooth Criminal reference.


  3. Dr. Roy Says:

    I’ll take the skill point, but I think Michael Jackson’s lyric “Annie are you OK?” comes from a CPR training course with resusi-Anne: During training, you shake the plastic Annie by the shoulders and shout “Annie Annie are you OK?”


  4. Tampa CPR Says:

    Dr. Roy, what’s your opinion on children, drowning, and asthma victims? They all need rescue breaths, and children hold less oxygen in their lungs than adults. I teach CPR Classes in Tampa, and have blogged about the compression only guidelines extensively.


  5. Dr. Roy Says:

    Tampa CPR, there are definitely some important differences between children and adults. Children are less likely to suffer an arrest because of a primary cardiac event. They also have less lung capacity. It may be that compression-only CPR may not be as beneficial for children as adults.

    However, the AHA chose not complicate the CPR guidelines by expecting a rescuer to think as much through the scenario. The overall scheme focuses on action– get busy, do something!– which after all is probably better than standing around, trying to think of the best way to proceed.

    A drowning victim may have suffered laryngospasm, preventing air movement; or the lungs may be filled with water. Ideal treatment of these conditions is different, but there is no way of knowing which way to proceed during the immediate moment.

    Asthma presents its own challenges, but a sudden arrest during an asthma attack may actually be cardiac in nature from dysrhythmia (related to acidosis and electrolyte disturbances) rather than from poor oxygenation. If the victims lungs are affected by severe bronchospasm, rescue breaths may be ineffective. Proceeding with compressions may be helpful until mechanical or at least bag-mask ventilation can begin.


  6. Nothing is as important as staying calm, calling 911 and then doing some type of cpr. Anything is better than standing around…I agree with everyone above. Learn new skills and see videos there. A few first aid skills are also changing, such as not raising their legs during shock, which I find hard to believe.


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