Cardiopulmonary Resuscitation Guideline Update: A Systematic Review

Joko Tri Atmojo, Aris Widiyanto, Rina Tri Handayani


Background: Every five years, the American Heart Association (AHA) releases new guidelines on CPR. Previous guidelines have focused on Airway-Breathing-Circulation (ABC) advocacy. However, in 2010 guidelines for CPR recommended changes in the sequence of BLS steps to CAB (chest compression, airway, and breathing) for adults, children and infants (excluding newborns). The purpose of this review is to explain the reasons and provide scientific evidence about the results of CAB actions compared to ABC.

Subjects and Method: Systematic reviews were done by searching the database through PubMed, Google Scholar, and Science Direct. Key words for this review include: AHA Guideline AND CPR 2010, CAB in CPR, CAB, and RCT (Randomized Controlled Trial) guidelines and why does ABC turn into CAB? The inclusion criteria are systematic reviews, clinical reviews and guidelines.

Results: The results are in the form of 3 review articles and 1 RCT study. The basic reasons for changing ABC to CAB are (1) The most common case of cardiac arrest in adults, and the initial element of critical BLS (basic life support) is chest compression and early defibrillation by changing sequentially to CAB, chest compression will start faster; (2) Most victims of cardiac arrest outside the hospital do not get CPR observers, this is an obstacle to opening the airway and exhaling; and (3) Chest compression provides vital blood flow to the heart and brain. One RCT study showed that the time to do the first resuscitation with the CAB technique (mean = 25; SD = 10) was faster than the ABC technique (mean = 32; SD = 12) and statistically significant (p = 0.002).

Conclusion: Chest compression is the most important aspect of heart attack management because airway maneuver takes a long time. The time to complete the first resuscitation cycle on CAB action is shorter than using ABC actions.

Keywords: ABC, CAB, CPR guidelines, systematic review

Correspondence: Joko Tri Atmojo. School of Health Sciences Mamba'ul 'Ulum, Surakarta, Jl. Ring Road Utara, Tawangsari, Mojosongo, Jebres, Surakarta, Central Java. Email: Mobile: +6281393319000

Indonesian Journal of Medicine (2019), 4(2): 82-87

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Abella BS, Aufderheide TP, Eigel B, Hickey RW, Longstreth jr, Nadkarni V. et al. (2008). Reducing barriers for implementation of by stander initiated cardiopulmonary resuscitation a scientific statement from the american heart association for health care providers, policymakers, and community leaders regarding the effectiveness of cardiopulmona. Circulation, 117(5): 704–709. doi: 10.1161/CIRCULATIONAHA.107.188486  Crossref  PubMed  Google Scholar 

Affecting MI, Sayre MR, Berg MD, Berg RA, Bhanji F, Billi JE, et al. (2010). Highlights of the 2010 American Heart Association Guidelines for CPR and ECC. American Heart Association. Website

Berg RA, Hemphill R, Abella BS, Cave DM, Hazinki MF, Lemer B. et al. (2010). American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardio-vascular Care. American Health Association. s685-s702. doi: 10.1161/CIRCULATIONAHA.110.970939  Crossref  PubMed  Google Scholar 

Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hem-phill R, Samson RA, Kattwinkel J, et al. (2010). Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 122(18): S640-56. doi: 10.1161/CIR-CULATIONAHA.110.970889. doi: 10.1161/CIRCULATIONAHA.110.970889  Crossref  PubMed  Google Scholar 

Goddard KB, Eppert HD, Underwood EL, Maxwell K, Finks SW, Rogers KC (2010). Basic life support and cardiopulmonary resuscitation training for pharmacy students and the community by a pharmacy student committee. American Journal of Pharmaceutical Education, 74(6): 1–4. doi: 10.5688/aj7406100  Crossref  PubMed  Google Scholar 

Hauk L (2016). AHA updates guidelines for CPR and emergency cardiovascular care. American Family Physician, 93(9): 796–797. PubMed  Google Scholar 

Khalid U, Abdul A, Juma M (2010). Paradigm shift: “ABC” to “CAB” for cardiac arrests. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(1): 59. doi: 10.1186/1757-7241-18-59/a>  Crossref  PubMed  Google Scholar 

Liberati A, et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339(1): b2700–b2700. doi: 10.1371/journal.pmed.1000100  Crossref  PubMed  Google Scholar 

Liu Y, Huang Z, Li H, Zheng G, Ling Q, Tang W, et al. (2018). CPR feedback/prompt device improves the quality of hands only CPR performed in manikin by laypersons following the 2015 AHA guidelines. 1-24. Elsevier Inc. doi: 10.1016/j.ajem.2018.02.034  Crossref  PubMed  Google Scholar 

Marsch S, Tschan F, Semmer NK, Zobrist R, Hunzicker P, Hunzicker S (2013). ABC versus CAB for cardiopulmonary resuscitation: A prospective, randomized simulator based trial. Swiss Medical Weekly. doi: 10.4414/smw.2013.13856  Crossref  PubMed  Google Scholar 

Pedoman P, Heart A (2015). Fokus utama pembaruan pedoman American Heart Association 2015 untuk CPR dan ECC. American heart Association. Website

Rea TD, et al. (2010). Predicting survival after out-of-hospital cardiac arrest: Role of the Utstein Data Elements. Annals of Emergency Medicine. 55(3): 249–257. doi: 10.1016/j.annemergmed.2009.09.018  Crossref  PubMed  Google Scholar 

Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, MManolio T, et al. (2006). Heart Disease and Stroke Statistics 2006 Update, Circulation. American Heart Association. 113(6): e85-151. doi: 10.1161/CIRCULATIONAHA.105.171600">Crossref  PubMed  Google Scholar 


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