CAB in CPR: The Updated CPR Sequence

Cardiopulmonary Resuscitation (CPR) is a vital technique used during cardiac emergencies to restore blood circulation and oxygenation to the brain and other vital organs. While CPR was traditionally taught using the ABC (Airway, Breathing, Compressions) sequence, more recent guidelines emphasize the CAB (Compressions, Airway, Breathing) approach, known as CAB CPR, which is the current standard for performing cardiopulmonary resuscitation. MyCPR NOW recognizes the importance of understanding these updated guidelines to provide the most effective life-saving care. In this guide, we will delve into the CAB sequence, its benefits, proper execution, and why it is now the preferred method during cardiac arrests.

Understanding the Evolution of CPR Sequences

The change from ABC to CAB was implemented to address the need for quicker interventions during cardiac arrest:

1. ABC (Airway, Breathing, Compressions): Previously, rescuers were taught to first check the airway, provide rescue breaths, and then start chest compressions.

2. CAB (Compressions, Airway, Breathing): The updated method reverses the order, prioritizing chest compressions before airway management and rescue breathing. This shift focuses on maintaining blood circulation from the start, a critical factor in survival during cardiac arrest. Knowing when and how to perform CPR using the CAB method is essential for effectively reviving individuals experiencing a heart attack or cardiac arrest.

The Importance of Immediate Performing Chest Compressions

1. Blood Flow and Oxygenation: CAB CPR chest compressions maintain blood circulation, delivering oxygen to the brain and other vital organs. Without compressions, blood flow ceases, rapidly leading to brain damage and organ failure.

2. Time-Sensitive Nature of Cardiac Arrest: When the heart stops, every second counts. By initiating chest compressions immediately, rescuers maximize the chances of survival by keeping blood moving to essential organs.

Proper Execution of the CAB Sequence

The CAB sequence simplifies the process of CPR by focusing on the most urgent action first—performing chest compressions. Here’s how to perform it:

1. Compressions: Start chest compressions immediately. Place your hands in the center of the chest and push hard and fast.

2. Airway: Once compressions are underway, ensure the airway is open using the head-tilt chin-lift or jaw-thrust maneuver.

3. Breathing: Provide rescue breaths after the initial cycle of compressions. If you are trained and equipped, give two breaths after every 30 compressions.

Rationale Behind the CAB Sequence

1. Focus on Compressions: Studies show that immediate chest compressions significantly improve the chances of restoring circulation by facilitating the flow of oxygen-rich blood to critical organs such as the brain, which is crucial in cardiac arrest.

2. Minimizing Delays: The time it takes to open the airway and deliver rescue breaths can delay critical chest compressions. CAB minimizes these interruptions, ensuring continuous blood flow to the brain and heart.

Depth and Rate of Compressions

To ensure effective chest compressions, rescuers must focus on both depth and rate. Starting chest compressions immediately during CPR is crucial to increase the chances of survival in cases of cardiac arrest:

1. Proper Depth: For adults, compressions should be at least 2 inches (5 centimeters) deep to effectively pump blood.

2. Correct Rate: The optimal rate is 100-120 compressions per minute. A fast, consistent pace helps maintain circulation.

Assisted Ventilation

1. Rescue Breaths: After the first cycle of 30 chest compressions, deliver two rescue breaths. Emphasizing the importance of giving rescue breaths in the context of CPR procedures, ensure that the chest rises with each breath, confirming that air is reaching the lungs.

2. Using Devices: Devices like bag-mask ventilation or pocket masks can make providing rescue breaths more effective while also protecting the rescuer from direct contact with the patient.

Recognizing Cardiac Arrest

Before beginning CPR, confirm that the person is experiencing cardiac arrest and ensure the person's airway is clear to maintain effective breathing and oxygen supply to vital organs by looking for these signs:

1. Absence of Normal Breathing: Check to see if the person is not breathing or only gasping (agonal breathing).

2. Unresponsiveness: The victim does not respond to taps or verbal commands.

Importance of Early CPR and Defibrillation

1. The Chain of Survival: The Chain of Survival consists of five critical steps: early recognition, early CPR, early defibrillation, advanced care, and post-cardiac arrest care. Understanding the importance of performing CPR in various contexts, including the proper sequence of actions, is essential to improving the likelihood of survival.

2. Bystander Intervention: Quick action from bystanders is vital. Immediate CPR by a bystander can double or triple the victim’s chances of survival.

Special Considerations for Children and Infants

CPR for children and infants differs slightly from adult CPR:

1. Compression Depth: For children, compressions should be at least one-third the depth of the chest (about 2 inches for children and 1.5 inches for infants).

2. Rescue Breaths: Children and infants are more likely to need rescue breaths because their cardiac arrests often result from respiratory issues. Ensure the proper technique based on the child's size and age.

The Role of AEDs (Automated External Defibrillators)

1. Importance of AEDs: AEDs analyze the heart’s rhythm and can deliver a shock to restore normal heart activity. Defibrillation, when combined with CPR, greatly increases the chances of survival.

2. Ease of Use: AEDs are designed to be user-friendly, with clear audio and visual instructions, making them accessible to both trained and untrained bystanders.

Continuation of CPR

1. Uninterrupted Compressions: Continuous chest compressions are crucial for maintaining blood flow. Only pause briefly for rescue breaths or AED use.

2. Teamwork: If multiple people are available, switch out the person performing compressions every two minutes to avoid fatigue and maintain high-quality CPR.

The Value of CPR Training

1. Practice: CPR is a skill that improves with practice. Training with an experienced instructor ensures that you’re prepared for real-life emergencies.

2. Regular Refreshers: CPR guidelines evolve over time. Attending regular CPR refreshers helps ensure your skills are up-to-date and effective.

Conclusion

The shift from ABC to CAB in CPR highlights the critical role of chest compressions in maintaining blood flow during cardiac arrest. By prioritizing compressions and reducing delays in airway and breathing management, the CAB sequence significantly enhances the chances of survival. MyCPR NOW emphasizes the importance of staying informed about these guidelines and encourages individuals to take CPR training seriously, as knowing the proper execution of the CAB sequence can make all the difference in an emergency. As part of the Chain of Survival, bystanders who perform high-quality CPR can help increase survival rates and contribute to better outcomes during cardiac emergencies.