By Melissa Marotta

In mid October, the American Heart Association (AHA) released updated guidelines for the practice of cardiopulmonary resuscitation (CPR). The guidelines, which are updated every five years to reflect the latest efficacy research, were published in Circulation: the Journal of the AHA (1), and endorsed by the American Red Cross (2).

What we”™ve known for a long time:
1. The #1 predictor of survival is how fast you can apply the automatic external defibrillator (AED), a device that comes with easy to follow instructions (even for a layperson) to affix to the victim, analyze his or her heart rhythm for the presence of the fatal arrhythmia called ventricular fibrillation, and use electrical voltage (“shock”) the heart back into normal (“sinus”) rhythm.
2. Chest compressions are vital if circulation has collapsed (evidenced by a lack of pulse).
3. Delaying chest compressions is bad.

So, the new guidelines (1):
1. You still start off by “activating the emergency response system” (i.e., calling for someone to get the AED) and use it as soon as it arrives.
2. We cut out anything that risks delaying chest compressions (i.e., rescue breaths, checking for a pulse). That is, we start with chest compressions.
3. Thus, the age-old (40+ years, at least) sequence of “ABCs” (airway → breathing → circulation) has been replaced with “CAB” (compressions → airway → breathing).

Why? According to one of the new guidelines”™ authors, the previous protocol was off-putting to a lot of the general public: too much to remember, too confused about counting, too wary of “mouth to mouth” (3). As a result, the potential Good Samaritan is up against too much adversity to even begin to get involved to help, and potentially save the life of, a stranger.

Studies have shown that the lay public has a very hard time finding a pulse (i.e., verifying whether circulation has collapsed and, thus, whether chest compressions are necessary (4). Healthcare professionals often take too long to find one, too (5). So, in the new guidelines: non-healthcare professionals are not to waste time looking for a pulse altogether - just start chest compressions; healthcare professionals can take 10 seconds to find one; otherwise, they should just start chest compressions.

(Note: there is no evidence demonstrating greater efficacy of chest compressions alone to the old standard CPR protocol. According to the AHA, the evidence that starting chest compressions sooner is sufficiently compelling (1).)

Much like understanding the new healthcare bill, sometimes all we need in the world is a set of “How Does This Affect Me?” bullet points. Done, and done:
The new guidelines make a distinction between whether you”™re a healthcare professional vs. a trained non-healthcare professional vs. an untrained layperson.

If this is you, it is strongly encouraged that you to get certified in CPR/AED for at least adults… for the safety of your riders!

1. Yell out to someone to “get an AED!” (activate your emergency response system)
2. Initiate chest compression: Place the heel of one hand over the middle of the victim”™s chest (the sternum), midway between the nipples. Stack your other hand on top of the first hand and interlace your fingers for greater force/support. Push hard and fast (think: the tempo of “Stayin”™ Alive,” which is 100 beats per minute). Push down hard enough for the chest to sink 2 inches down, and give time for the chest to rise to baseline before pushing again.
3. Continue until AED arrives or EMS takes over

FOR TRAINED NON-HEALTHCARE PROFESSIONALS (“trained laypersons,” in the guidelines)
“Trained" implies that you have had CPR/AED certification. This is probably you, unless you”™re also a healthcare professional.

1. Activate emergency response system: “get the AED!”
2. Do not check for pulse
3. Begin chest compressions immediately.
4. If able to give rescue breaths, add rescue breaths in ratio of 30 compressions to 2 breaths
5. Continue until AED arrives or EMS takes over

* Follow BLS protocol as per usual
1. Alert emergency response system… “get the AED”
2. Take 10 seconds only to find pulse; otherwise, move to Step 3.
3. Chest compressions 30: 2 ventilations until advanced airway placed. Then, continuous chest compressions with ventilation rate of 8-10 breaths per minute.
4. AED when available
5. If lone healthcare provider, for child victim: follow protocol; for adult, may give 5 cycles of CPR before activating emergency response system

If you want more information than this brief synopsis I”™ve provided, click here for the full text of the 2010 guidelines.

Click here to view a short video on the new guidelines, including a demonstration of chest compressions:

In an upcoming article, I will pay more attention to AEDs themselves. Using one is super-easy: 1) turn it on, 2) follow the diagram to attach the stickers to the patient, 3) listen to the prompts. It talks to you, and walks you through anything it wants you to do.

But in the meantime, the single best thing you can do as an instructor is find out exactly where the closest AED is located to the cycling studio where you teach. Develop a plan for EXACTLY what you”™d do in the event that a student has a cardiac emergency. How would you instruct someone to fetch the AED? How far are you from the front desk? Who would you ask to call 911? Is there a phone in the studio?

We hope you”™ll never need to use this information — but in the event that you do, you”™ll be grateful you took the time to track down these details in advance. As will your student/client!

About the Author
Melissa Marotta, ICI”™s medical research correspondent, is a third-year medical student at the University of Vermont College of Medicine. She is also a STAR 3 Spinning® instructor and a Certified Personal Trainer (American Council on Exercise). She is author of the popular blog, Spintastic (, themed on motivational coaching strategies, which she promises to actually update now that her surgery rotation is over. Her research interests include the psychological effects of heart rate training, and the application of heart rate training to the treatment of anxiety.

(1) Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski, Lerner EB, Rea TD, Sayre MR, Swor RA. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 5 — Adult Basic Life Support. Circulation. 2010;122:S685-S705.)
(2) American Red Cross. Revised American Red Cross Statement on 2010 CPR guidelines. 21 Oct 2010.
(3) Gordon S. New CPR Guidelines Emphasize Compressions First. Business Week. 18 Oct 2010.
(4) Bahr J, Klingler H, Panzer W, Rode H, Kettler D. Skills of lay people in checking the carotid pulse. Resuscitation. 1997;35:23—26
(5) Ochoa FJ, Ramalle-Gomara E, Carpintero JM, Garcia A, Saralegui I. Competence of health professionals to check the carotid pulse. Resuscitation. 1998;37:173—175

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