ILCOR Consensus of Science and AHA Guidelines for CPR and ECC 2010
The International Liason Committee on Resuscitation (ILCOR), in collaboration with the American Heart Association (AHA) have just published their Consensus on CPR and ECC Science and AHA Guidelines for 2010.
"There was unanimous support for continued emphasis on high-quality CPR, with compressions of adequate rate and depth, allowing complete chest recoil, minimizing interruptions in chest compressions and avoiding excessive ventilation. High-quality CPR is the cornerstone of a system of care that can optimize outcomes beyond return of spontaneous circulation (ROSC). Return to a prior quality of life and functional state of health is the ultimate goal of a resuscitation system of care.”
2010 AHA Guidelines for CPR and ECC Executive Summary
Key changes/recommendations (from Executive Summaries Part 1 unless otherwise stated) include:
1. Adult BLS
- Change in CPR sequence from A-B-C to C-A-B
- Press at least 5cm (2 in)
- Encourage Hands-only CPR for the untrained lay-rescuer but ventilations remain for trained rescuers
Lay rescuers begin CPR if the adult victim is unresponsive and not breathing normally (ignoring occasional gasps) without assessing the victim’s pulse.
Following initial assessment, rescuers begin CPR with chest compressions rather than opening the airway and delivering rescue breathing.
All rescuers, trained or not, should provide chest compressions to victims of cardiac arrest. A strong emphasis on delivering high-quality chest compressions remains essential: push hard to a depth of at least 2 inches (5 cm) at a rate of at least 100 compressions per minute, allow full chest recoil after each compression, and minimize interruptions in chest compressions.
Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. EMS dispatchers should provide telephone instruction in chest compression-only CPR for untrained rescuers.
2. Paediatric BLS
- Importance of ventilations emphasised but AHA guidelines recommend C-A-B sequence for infants and
children (but not newly born) for ease of teaching
- Press at least 1/3 of AP diameter (AHA previously said 1/3 to 1/2). This is said to correspond to approx
4cm in an infant and 5cm in a child
To be effective, chest compressions must be deep, but it is difficult to determine the optimal depth in infants and children; should it be expressed as a fraction of the depth of the chest or an absolute measurement? How can this be made practical and teachable? After much discussion the task force decided that the best current data support a recommended compression depth of at least one third of the chest anterior posterior dimension or approximately 4 cm (1.5 inches) in infants and 5 cm (2 inches) in children.
New evidence documents the important role of ventilations in CPR for infants and children. However, rescuers who are unable or unwilling to provide ventilations should be encouraged to perform compression-only CPR. (Part 10)
- Self-directed learning endorsed as equivalent to traditional courses
- CPR prompt or feedback devices improve skills acquisition and retention and may be useful for training
and for clinical use
- Frequent assessments and refresher training recommended
- Manikins with realistic features may be useful for integrating knowledge, skills and behaviours required in
ALS but insufficient evidence of improvement in outcomes to recommend or refute routine use in ALS
BLS and ALS knowledge and skills can deteriorate in as few as 3 to 6 months after training. Frequent assessments
and, when needed, refresher training is recommended to maintain resuscitation knowledge and skill.
Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led BLS (CPR and AED) courses.
CPR prompt or feedback devices improve CPR skills acquisition and retention and may be considered during CPR training for laypeople and healthcare professionals. These devices may be considered for clinical use as part of an overall strategy to improve the quality of CPR.
There is insufficient evidence to support or refute the use of more realistic techniques (eg, high-fidelity manikins, in situ training) to improve outcomes (eg, skill performance on manikins, skill performance in actual arrest, willingness to perform) compared with standard training (eg, low-fidelity manikins, education centre) in basic and advanced life support courses. (Part 12)
4. CPR before defibrillation / defibrillating strategy
No change. Insufficient evidence to support or refute doing a period of CPR before defibrillation or
changing recommendations on shock strategies.
CPR Before Defibrillation
Whether a period of CPR should be performed before defibrillation in VF, especially after long response times, continues to be the subject of intense debate. The theoretical rationale for performing CPR before shock delivery is to improve coronary perfusion and thereby the chances of achieving sustained ROSC; however, there is inconsistent evidence to support or refute a delay in defibrillation to provide a period (90 seconds to 3 minutes) of CPR for patients in VF/pulseless ventricular tachycardia (VT) cardiac arrest. If more than one rescuer is present, one rescuer should provide chest compressions while the other activates the emergency response system, retrieves the AED and prepares to use it.
Several different biphasic waveforms exist, but no human studies have compared different biphasic waveforms and different energy levels related to defibrillation success or survival. For all waveforms insufficient evidence exists to make clear recommendations; however, it is reasonable to start at an energy level of 150 to 200 J for biphasic truncated exponential waveform for defibrillation of pulseless VT/VF cardiac arrest. There is insufficient evidence to determine the initial energy levels for any other biphasic waveform.
For second and subsequent biphasic shocks the same initial energy level is acceptable. It is reasonable to increase the energy level when possible.
5. CPR Techniques and Devices
Insufficient data to support or refute the use of automatic chest compressors or Impedance Threshold Device.
**Above overview of the ILCOR consensus of science was summarised by Ken Moralee.
Please visit www.ilcor.org for further information on the ILCOR Guidelines for 2010.