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Is CPR ABC or CAB?

Published in Cardiopulmonary Resuscitation 3 mins read

CAB (Compressions, Airway, Breathing) is the current recommended order for CPR, according to the American Heart Association.

Why the Change from ABC to CAB?

For many years, CPR training emphasized the ABC sequence: Airway, Breathing, and then Chest Compressions. However, research and experience have shown that starting with compressions is more effective, especially for sudden cardiac arrest. The key reasons for the shift are:

  • Minimize Delay to Compressions: Chest compressions are crucial for circulating blood and oxygen to vital organs. Delaying them while opening the airway and giving breaths can decrease survival rates.
  • Most Cardiac Arrests are Cardiac in Nature: Many adult cardiac arrests are caused by heart problems, meaning the victim's blood is likely already oxygenated. Circulating that blood via compressions becomes the top priority.
  • Simplifies the Process for Bystanders: The CAB sequence is easier to remember and perform, encouraging more bystanders to intervene. Hesitation often stemmed from discomfort or uncertainty about providing rescue breaths.

The CAB Sequence Explained

Here's a breakdown of the CAB sequence:

  1. C - Compressions:

    • Start chest compressions immediately.
    • Push hard and fast in the center of the chest. The recommended rate is 100-120 compressions per minute, and the depth should be at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) for adults.
    • Allow the chest to recoil completely between compressions.

  2. A - Airway:

    • After 30 compressions, open the airway using the head-tilt/chin-lift maneuver (unless trauma is suspected). If trauma is suspected, use the jaw-thrust maneuver.
    • Check for breathing.

  3. B - Breathing:

    • If the person is not breathing or is only gasping, give two rescue breaths. Each breath should last about 1 second and make the chest rise visibly.
    • Continue cycles of 30 compressions and 2 breaths.

Exceptions to the CAB Rule

While CAB is the standard, there are some exceptions:

  • Infants and Children: While CAB is often taught, if the cardiac arrest is known to be from a breathing problem (like choking), starting with airway and breathing might be more appropriate. It's important to follow current guidelines.
  • Drowning/Suffocation: In situations where the cause of arrest is clearly respiratory (like drowning or choking), it might be reasonable to prioritize airway and breathing briefly before starting compressions.

Key Takeaway

The American Heart Association and other leading resuscitation organizations currently recommend CAB (Compressions, Airway, Breathing) as the preferred sequence for CPR in most situations. This approach prioritizes early chest compressions to maximize blood flow and increase the chances of survival.

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