This week we will talk about some of the 2015 American Heart Association CPR and ECC guidelines that will be rolled out in 2016.
- The 2015 Guidelines validate what we already know about performing CPR and offer a scientific basis for optimizing CPR quality to save more lives.
- The latest science says quick action, quality training, use of mobile technology, and coordinated efforts can increase survival from cardiac arrest — a leading cause of death in the United States.
- The guidelines recommend more training to develop better systems of care. Everyone from bystanders to advanced healthcare providers should know what to do at every step of a cardiovascular emergency.
2015 American Heart Association Basic Life Support (BLS) and CPR Quality
- For adult victims of cardiac arrest, it is reasonable for lay rescuers and healthcare providers (HCPs) to perform chest compressions at a rate of 100 to 120 per minute.
- The 2015 Guidelines Update adds an upper limit of recommended heart rate, based on preliminary data suggesting that excessive compression rate adversely affects outcomes.
- During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]).
- While a compression depth of at least 2 inches (5 cm) is recommended, the 2015 Guidelines Update incorporates new evidence about the potential for complications to occur beyond an upper threshold of compression depth (greater than 2.4 inches [6 cm]). Compression depth may be difficult to judge without the use of feedback devices, and identification of upper limits of compression depth may be challenging.
- Untrained lay rescuers should provide compression-only (Hands-Only™) CPR, with or without dispatcher guidance, for adult victims of cardiac arrest. The rescuer should continue compression-only CPR until the arrival of an AED or rescuers with additional training. All lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest. In addition, if a trained lay rescuer is able to give rescue breaths, he or she should add rescue breaths in a ratio of 30 compressions to 2 breaths. The rescuer should continue CPR until an AED arrives and is ready for use, EMS providers take over care of the victim, or the victim starts to move.
- Compression-only CPR is easy for an untrained rescuer to perform and can be more effectively guided by dispatchers over the telephone. Moreover, survival rates from adult cardiac arrests of cardiac etiology are similar with either compression-only CPR or CPR with both compressions and rescue breaths when provided before EMS arrival. However, for the trained lay rescuer who is able, the recommendation remains for the rescuer to perform both compressions and breaths.
- To help bystanders recognize cardiac arrest, dispatchers should inquire about a victim’s absence of responsiveness and quality of breathing (normal versus not normal). If the victim is unresponsive with absent or abnormal breathing, the rescuer and the dispatcher should assume that the victim is in cardiac arrest. Dispatchers should be educated to identify unresponsiveness with abnormal and agonal gasps across a range of clinical presentations and descriptions.
- This change from the 2010 Guidelines emphasizes the role that emergency dispatchers can play in helping the lay rescuer recognize absent or abnormal breathing. Dispatchers should be specifically educated to help bystanders recognize that agonal gasps are a sign of cardiac arrest. Dispatchers should also be aware that brief generalized seizures may be the first manifestation of cardiac arrest. Thus, in addition to activating professional emergency responders, the dispatcher should ask straightforward questions about whether the patient is unresponsive and whether breathing is normal or abnormal in order to identify patients with possible cardiac arrest and enable dispatcher-guided CPR.
- For unresponsive patients with known or suspected opioid addiction who are not breathing normally but have a pulse, it is reasonable for appropriately trained lay rescuers and BLS providers, in addition to providing standard BLS care, to administer intramuscular (IM) or intranasal (IN) naloxone. Opioid overdose response education with or without naloxone distribution to persons at risk for opioid overdose in any setting may be considered.
- There is substantial epidemiologic data demonstrating the large burden of disease from lethal opioid overdoses, as well as some documented success in targeted national strategies for bystander-administered naloxone for people at risk. In 2014, the naloxone autoinjector was approved by the U.S. Food and Drug Administration for use by lay rescuers and HCPs. The resuscitation training network requested information about the best way to incorporate such a device into the adult BLS guidelines and training. This recommendation incorporates the newly approved treatment.
Healthcare Provider BLS
- An HCP must call for nearby help upon finding a victim unresponsive, but it would be practical for the HCP to continue to assess the breathing and pulse simultaneously before fully activating the emergency response system (or calling for backup).
- The intent of the recommendation change is to minimize delay and to encourage fast, efficient simultaneous assessment and response, rather than a slow, methodical, step-by-step approach.
- It is reasonable for HCPs to provide chest compressions and ventilation for all adult patients in cardiac arrest, whether from a cardiac or a noncardiac cause. Moreover, it is realistic for HCPs to tailor the sequence of rescue actions to the most likely cause of arrest.
- Compression-only CPR is recommended for untrained rescuers because it is relatively easy for dispatchers to guide with telephone instructions. It is expected that HCPs are trained in CPR and can effectively perform both compressions and ventilation. However, the priority for the provider, especially if acting alone, should still be to activate the emergency response system and to provide chest compressions. There may be circumstances that warrant a change of sequence, such as the availability of an AED that the provider can quickly retrieve and use.
- It may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (i.e., during CPR with an advanced airway).
- This simple single rate for adults, children, and infants — rather than a range of breaths per minute — should be easier to learn, remember, and perform.
Next week we will look at the ACLS changes.
Sourced from: http://aha.channing-bete.com/aha-guidelines-2015.html