title: ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.
abstract: OBJECTIVE
  After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle.
  
  
  METHODS
  108 teams, consisting of two physicians each, 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. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations.
  
  
  RESULTS
  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 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which 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). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P <0.0001).
  
  
  CONCLUSIONS
  This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.
authors.affiliation: Klinik fÃ¼r Intensivmedizin, UniversitÃ¤tsspital, Basel, SWITZERLAND; smarsch@uhbs.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.forename: Norbert K
authors.initials: NK
authors.lastname: Semmer
authors.forename: Roger
authors.initials: R
authors.lastname: Zobrist
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Hunziker
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D010820:Physicians; D017410:Practice Guidelines as Topic / Q000592:standards*; D012121:Respiration, Artificial / Q000379:methods*; D016037:Single-Blind Method; D013997:Time Factors