Evidence for Changing Cardiopulmonary Resuscitation Guideline from Airway-Breathing-Circulation to Chest Compression-Airway-Breathing

Joko Tri Atmojo


School of Health Science Mamba’ul ‘Ulum, Surakarta



Background: Every five years, the American Heart Association (AHA) releases new guideline regarding cardiopulmonary resuscitation (CPR). The previous guideline had fo­cused on advoca­ting Airway-Breathing-Circulation (ABC). However, in 2010 the guide­­­­line for CPR recommen­ded a change in the BLS sequence of steps to Chest com­pression-Airway-Breathing (CAB) for adults, children, and infants (excluding the newly born). This study aimed to conduct a system­atic review on the evidence for changing CPR guideline from ABC to CAB.

Subjects and Method: A systematic review was conducted by searching the following data­bases: PubMed, Google scholar, and Science Direct. The keywords for this review in­cluded AHA AND CPR guideline 2010, CBA in CPR guideline, CBA AND Randomized Con­trolled Trial (RCT), and why ABC change to CBA. The inclusion criteria were systematic review, clinical re­view, and guideline. After review process, 3 review articles and 1 RCT included 108 teams with two physic­cians each teams, were randomized to re­ceive a graphical display of either the ABC algorithm or the CAB algorithm. Subse­quen­tly teams had to treat a simulated cardiac arrest were included in this review.

Results: The rationale reasons for changing from ABC to CAB were: (1) The most cases of car­diac arrest occur in adults, and the initial element of a critical BLS (basic life support) is chest compression and initial defibrillation then by changing sequentially to C-A-B, chest compression will start faster; (2) Most victims of cardiac arrest outside the hospital do not accept CPR ob­server so one obstacle to open the airway and exhale; and (3) Chest compression provides vital blood flow to the heart and brain. One of the RCT study showed that the time to execution of­ the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (p= 0.002). 18/53 (34%) of ABC teams and none of the 55 CAB teams (p= 0.006) applied more than the recom­men­ded two initial rescue breath. It caused a longer duration of the first cycle of 30 com­pres­sions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; p= 0.001).

Conclusion: Chest compressions are the most important aspect of the cardiac arrest mana­ge­ment because airway maneuvering takes time. Other than that a randomized controlled trial found CAB was superior to ABC with a shorter time to complete the first resus­citation cycle.

Keywords: ABC, CBA, CRP guideline

Correspondence: Joko Tri Atmojo. School of Health Science Mamba’ul ‘Ulum, Surakarta, Jl. Ring Road Utara, Tawang­sari, Mojosongo, Jebres, Surakarta, Central Java. Email: jokotriatmojo1@gmail.com: 081393319000.

DOI: https://doi.org/10.26911/theicph.2019.05.03


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