The new CPR Guidelines have launched
Some of the highlights for 2010
- Continued Emphasis on high-quality CPR
- Ventilations still recommended for trained rescuers
- Change in sequence from A-B-C to C-A-B
- Compression-only CPR
- CPR Feedback Devices
- Education, implementation and team training
- Defibrillation Strategies
Elements included in high-quality CPR
- Compressing at a rate of at least 100/min. A change from about 100/min. No upper limit on rate is set by ILCOR or the AHA but the ERC set an upper limit of 120/min
- A compression depth of at least 5 cm (2 inches) in adults (was 4 to 5 cm), and for infants and children at least one third of the anterior-posterior diameter of the chest or approximately 4 cm (1,5 inches) in an infant and 5 cm in a child.
- Allowing for complete chest recoil after each compression
- Minimizing all interruptions to chest compressions
- Avoiding excessive ventilation
Ventilations are still recommended for rescuers who have been trained in CPR
ERC state that, ideally, all citizens should be trained to deliver both compressions and ventilations and those trained in compression-only CPR should be encouraged to learn the full CPR. Chest compression combined with rescue breaths remain the method of choice for CPR delivered by both trained lay rescuers and professionals, according to AHA/ERC/ILCOR.
Change in sequence from A-B-C to C-A-B
Because the vast majority of cardiac arrests occur in adults, where the critical initial elements of BLS are chest compressions and defibrillation, the BLS sequence of A (Airway) - B (Breathing) -C (Circulation or Compressions) has been changed to C-A-B by ILCOR and the AHA. This is to ensure that chest compressions will be initiated sooner whilst the blood is still well oxygenated. After 30 compressions, 2 ventilations are performed. This is also recommended for infants and children (but not newly born). The ERC still have checking the airway as the first step in the BLS sequence, but then prioritise compressions over ventilations.
If a bystander is not trained in CPR, or trained but not proficient in ventilations, they should provide hands-only (compression only) CPR for adults, children and infants. The AHA advocates that CPR training programs should teach compression-only CPR as an alternative to conventional CPR for rescuers that are unwilling or unable to provide conventional CPR.
CPR Feedback Devices
CPR feedback devices have been shown to improve skills acquisition and retention and can be considered during training of lay people and healthcare professionals and for clinical use as part of an overall strategy to improve the quality of CPR. Their use is encouraged to store data for monitoring and improving clinical CPR performance and providing feedback to professional rescuers during debriefing sessions.
Education, implementation and teams
Self-directed learning with short video/computer courses and minimal or no instructor coaching plus hands-on practice are considered an effective alternative to instructor -led BLS (CPR and AED) courses.
Laypersons should receive training in CPR that includes recognition of gasping or
abnormal breathing as a sign of adult cardiac arrest when other signs of life are absent. EMS dispatchers should also be specifically trained to identify gasping to improve cardiac arrest recognition.
Because BLS and ALS skills can deteriorate in as few as 3 to 6 months after training, frequent assessments and refresher training are recommended to maintain skills.
BLS healthcare provider training should not only teach individual skills but should also teach rescuers to work in effective teams because resuscitations in most EMS and healthcare systems involve teams of rescuers.
Debriefing is a learner-focused, nonthreatening technique to help individual rescuers and teams reflect on and improve performance. Debriefing should be included in ALS courses to facilitate learning and can be used to review performance in the clinical setting to improve subsequent performance.
Rescuers should start with chest compressions and use the defibrillator as soon as available. Compressions should be interrupted as little as possible before and after defibrillation attempts.
There is no change to the 2005 guidelines regarding the energy levels of the first or subsequent shocks: in essence, follow the manufacturer’s recommendation.
For more details on the 2010 Guidelines:
The 2010 edition of the Handbook of Emergency Cardiovascular Care for Healthare Providers incorporates the latest science and treatment recommendations from the 2010 American Heart Association Guidelines for CPR & ECC.
This pocket-sized reference tool provides quick access to the latest resuscitation science and treatment information. The handbook is organized by basic, advanced adult and pediatric life support and newborn resuscitation. It provides algorithms, protocols, sequences, drug dosages, and much more.
This item ships out 30 November 2010.