Remember how easy the resuscitation part of CPR was to learn? You just had to memorize A-B-C which stood for AIRWAY-BREATHING-COMPRESSION. (Some people taught that the “C” actually stood for CIRCULATION, but same thing in terms of the goal.) No matter how much the medications changed for the various arrhythmias in the advanced portion of life support, ACLS, you could always count on the ABCs to get you started when someone suddenly became unresponsive. And this was true for years and years.

Until now. The 2010 American Heart Association Guidelines for CPR* state that compressions should be the first step in initiating CPR, therefore changing the prior ABCs to CAB (COMPRESSION-AIRWAY-BREATHING). This isn’t really all that new; it was recommended, based on a review of the most current resuscitation literature, in the various cardiology journals over two years ago. But now it will be talked about more in the mainstream media.

Based on research that confirms the superiority of performing CPR this way, the idea behind it is that there is already oxygen present in the lungs and bloodstream within the first few minutes of an arrest. Therefore, beginning with compressions will push that lifesaving oxygen to the brain and heart immediately, rather than having the thirty second delay caused by first establishing an airway as dictated by the old way of doing CPR.  In addition, the new guidelines recommend that the speed of compressions be increased to a rate of at least 100 times per minute, and that the compressions be made more deeply, to a depth of at least 2 inches in children and adults, and 1.5 inches in infants.

Another important change is that the guidelines advocate that even bystanders untrained in CPR be instructed to perform “Hands Only” CPR, which means that they do only chest compressions for adults who are unresponsive with abnormal or no breathing. You can already hear the sighs of relief from those potential rescuers who were always at best wary, at worst terrified, of having to do mouth-to-mouth resuscitation (and potentially catching a dread disease) should someone arrest in their vicinity. Now everyone can save a life – or at least, begin the process of saving a life, without fear.

So, even though the traditional ABCs will hopefully always remain the same, there’s now a new and better way to perform CPR. Repeat after me…C-A-B (100 per minute/depth 2 inches).

* Circulation. 2010;122[suppl 3]:S640-S656.(November 2, 2010 supplement)