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CPR最新修正：先胸外按壓再口對口人工呼吸。
By THE ASSOCIATED PRESS
Published: October 18, 2010
New York Times
相關新聞：
2010/10/19 新版CPR�先壓胸 再口對口 聯合新聞網
中文翻譯：
在10月18日新發表的guideline轉換了原先CPR的步驟，急救人員須先胸外按壓，再口對口人工呼吸。美國心臟學會發表這項guideline的作者Michael Sayre博士表示：這個改變將傳統CPR最簡單的步驟(胸外按壓)放置在流程的最前面。近幾年，CPRguideline已經過多次修正，並著重在胸外按壓的部份以拯救心臟驟停者。2008年時，心臟協會就已經表示，對於未經訓練或那些不願意做人工呼吸的救治者，只需施以胸外按壓心肺復甦即可，直至救護人員到達。
而現在，心臟協會表示任何人，不論是專業人員或是旁觀者，在進行標準CPR時，應該以胸外按壓開始，而非暢通患者呼吸道並向患者口中呼氣。
Sayre說「舊式的CPR訓練是採ABC模式：airway(暢通呼吸道)、breathing(口對口人工呼吸)、compression(胸外按壓)。也就是要求救援者先吹兩口氣，接著按壓30次。吹氣和按壓交替使用。
，這樣的方法耗費時間並延誤了胸外按壓使血液循環的時機。對患者胸外按壓時，患者的心臟就像是人工心臟，迫使血液攜帶氧氣至各個器官，使各個器官存活，直到救援到來。」Sayre同時也是Ohio州立大學醫學中心急診醫師。
把一隻手放在另一隻手上面，並且用力的壓。
心臟驟停，通常發生在心臟病發時，或是觸電時，或是溺水者。此時人會癱瘓，停止呼吸並且身體無反應。醫院外心臟驟停的存活率各國不一，約3%至15%不等。
根據最新的guideline，救援者使用CPR時，應該立即施以胸外按壓：30下按壓，接著再吹氣兩次，這項改變適用於大人和小孩，但不適用於新生兒。
但另一項研究卻對新的CPRguideline不滿意。亞利桑那大學Sarver心臟中心Gordon Ewy教授認為，對於心臟驟停的患者，CPR急救時口對口人工呼吸的部份必須刪除，只留下胸外按壓的部份。而guideline可以註記，若患者是因呼吸而引起的心臟驟停(例如溺水、藥物過量)，再加上口對口人工呼吸即可。
Ewy是最近發表在美國的一項研究的作者，該項研究呈現出：相較於加上人工呼吸的CPR，更多的人在心臟驟停時，因被施以只有胸外按壓的CPR而生還。
這個最新的CPRguideline也指出，救援者施以胸外按壓時，必須壓得更深，對於大人至少要2英吋(=5公分)。速度至少每分鐘100下的速度。若想知道這個速度，可以找出懷舊disco音樂：Stayin' Alive來參考它的節拍。
德州大學西南校區Ahamed Idris醫師表示，人們在進行CPR時，通常會害怕傷到病患。有些人會花太多時間評估要壓多用力。因此，我們想要讓人們了解，當他們用力並非傷害病患，而是在進行CPR。
Idris目前指導Dallas-Fort Worth醫學中心的復甦研究，表示最近兩年他們向當地護理人員推廣胸外按壓，並且使他們能持續少間斷的進行按壓。經過密集的訓練，已改善患者存活率。
因為原先他們發現，護理人員通常直到病患坐上救護車、裝上呼吸器後才會開始按壓。但已經浪費太多寶貴時間。
若是在家裡就立即按壓，就更棒了。
英文原文：
New guidelines out Monday switch up the steps for CPR, telling rescuers to start with hard, fast chest presses before giving mouth-to-mouth.
The change puts "the simplest step first" for traditional CPR, said Dr. Michael Sayre, co-author of the guidelines issued by the American Heart Association.
In recent years, CPR guidance has been revised to put more emphasis on chest pushes for sudden cardiac arrest. In 2008, the heart group said untrained bystanders or those unwilling to do rescue breaths could do hands-only CPR until paramedics arrive or a defibrillator is used to restore a normal heart beat.
Now, the group says everyone from professionals to bystanders who use standard CPR should begin with chest compressions instead of opening the victim's airway and breathing into their mouth first.
The change ditches the old ABC training — airway-breathing-compressions. That called for rescuers to give two breaths first, then alternate with 30 presses.
Sayre said that approach took time and delayed chest presses, which keep the blood circulating.
"When the rescuer pushes hard and fast on the victim's chest, they're really acting like an artificial heart. That blood carries oxygen that helps keep the organs alive till help arrives," said Sayre, an emergency doctor at Ohio State University Medical Center.
"Put one hand on top of the other and push really hard," he said.
Sudden cardiac arrest — when the heart suddenly stops beating — can occur after a heart attack or as a result of electrocution or near-drowning. The person collapses, stops breathing normally and is unresponsive. Survival rates from cardiac arrest outside the hospital vary across the country — from 3 percent to 15 percent, according to Sayre.
Under the revised guidelines, rescuers using traditional CPR, or cardiopulmonary resuscitation, should start chest compressions immediately — 30 chest presses, then two breaths. The change applies to adults and children, but not newborns.
One CPR researcher, though, expressed disappointment with the new guidelines. Dr. Gordon Ewy of the University of Arizona Sarver Heart Center thinks everyone should be doing hands-only CPR for sudden cardiac arrest, and skipping mouth-to-mouth. He said the guidelines could note the cases where breaths should still be given, like near-drownings and drug overdoses, when breathing problems likely led to the cardiac arrest.
Ewy is one of the authors of a recently published U.S. study that showed more people survived cardiac arrest when a bystander gave them hands-only CPR, compared to CPR with breaths.
The guidelines issued Monday also say that rescuers should be pushing deeper, at least 2 inches in adults. Rescuers should pump the chest of the victim at a rate of at least 100 compressions a minute — some say a good guide is the beat of the old disco song "Stayin' Alive."
Dr. Ahamed Idris, of the University of Texas Southwestern in Dallas, said people are sometimes afraid that they'll hurt the patient. Others have a hard time judging how hard they are pressing, he said.
"We want to make sure people understand they're not going to hurt the person they're doing CPR on by pressing as hard as they can," he said.
Idris, who directs the Dallas-Fort Worth Center for Resuscitation Research, said that for the last two years, they've been advising local paramedics to start with chest compressions and keep them up with minimal interruptions. That, along with intensive training, has helped improve survival rates, he said.
He said they found paramedics hadn't been starting compressions until the patient was in the ambulance and lost time getting airway equipment together.
"The best chance was to start chest compressions in the house, immediately," he said.
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