A Change From A-B-C to C-A-B is one of the highlighted updates in the 2010 AHA Guidelines for CPR and ECC.
A Change From A-B-C to C-A-B
The 2010 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants (excluding the newly born; see Neonatal Resuscitation section). This fundamental change in CPR sequence will require reeducation of everyone who has ever learned CPR, but the consensus of the authors and experts involved in the creation of the 2010 AHA Guidelines for CPR and ECC is that the benefit will justify the effort.
Why: The vast majority of cardiac arrests occur in adults, and the highest survival rates from cardiac arrest are reported among patients of all ages who have a witnessed arrest and an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). In these patients, the critical initial elements of BLS are chest compressions and early defibrillation. In the A-B-C sequence, chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths, retrieves a barrier device, or gathers and assembles ventilation equipment. By changing the sequence to C-A-B, chest compressions will be initiated sooner and the delay in ventilation should be minimal (ie, only the time required to deliver the first cycle of 30 chest compressions, or approximately 18 seconds; when 2 rescuers are present for resuscitation of the infant or child, the delay will be even shorter).
Most victims of out-of-hospital cardiac arrest do not receive any bystander CPR. There are probably many reasons for this, but one impediment may be the A-B-C sequence, which starts with the procedures that rescuers find most difficult, namely, opening the airway and delivering breaths. Starting with chest compressions might encourage more rescuers to begin CPR. Basic life support is usually described as a sequence of actions, and this continues to be true for the lone rescuer.
Most healthcare providers, however, work in teams, and team members typically perform BLS actions simultaneously. For example, one rescuer immediately initiates chest compressions while another rescuer gets an automated external defibrillator (AED) and calls for help, and a third rescuer opens the airway and provides ventilations.
Healthcare providers are again encouraged to tailor rescue actions to the most likely cause of arrest. For example, if a lone healthcare provider witnesses a victim suddenly collapse, the provider may assume that the victim has had a primary cardiac arrest with a shockable rhythm and should immediately activate the emergency response system, retrieve an AED, and return to the victim to provide CPR and use the AED. But for a presumed victim of asphyxial arrest such as drowning, the priority would be to provide chest compressions with rescue breathing for about 5 cycles (approximately 2 minutes) before activating the emergency response system.
Two new parts in the 2010 AHA Guidelines for CPR and ECC are Post–Cardiac Arrest Care and Education, Implementation, and Teams. The importance of post–cardiac arrest care is emphasized by the addition of a new fifth link in the AHA
ECC Adult Chain of Survival (Figure 1). See the sections Post–Cardiac Arrest Care and Education, Implementation, and Teams in this publication for a summary of key recommendations contained in these new parts.
New 2010 Guidelines for CPR and ECC have been published on the AHA website. We are suggesting to review it by following the links below. These will take you to the new Guidelines.
- Click on this link for a summary of changes - Guidelines Highlights
- Click on this link to review the new guidelines - 2010 AHA Guidelines for CPR and ECC
- Click on this link to review a comparison of 2005 and 2010 Guideline changes- Comparison Chart.
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