Full View
Nor-Cal EMS News

Highlights of the
2010 AHA Guidelines for
CPR and ECC

The 2010 AHA Guidelines for CPR and ECC recommend that you change your A-B-C to C-A-B. This is a MUST READ!

Major Issues Affecting All Rescuers

This “Guidelines Highlights” publication summarizes the key issues and changes in the 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). It has been developed for resuscitation providers and for AHA instructors to focus on resuscitation science and guidelines recommendations that are most important or controversial or will result in changes in resuscitation practice or resuscitation training. In addition, it provides the rationale for the recommendations.

More here...

Lay Rescuer Adult CPR

Summary of Key Issues and Major Changes

Key issues and major changes for the 2010 AHA Guidelines for CPR and ECC recommendations for lay rescuer adult CPR are the following:

  • The simplified universal adult BLS algorithm has been created (Figure 2).
  • Refinements have been made to recommendations for immediate recognition and activation of the emergency response system based on signs of unresponsiveness, as well as initiation of CPR if the victim is unresponsive with no breathing or no normal breathing (ie, victim is only gasping).
  • “Look, listen, and feel for breathing” has been removed from the algorithm.
  • Continued emphasis has been placed on high-quality CPR (with chest compressions of adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation).
  • There has been a change in the recommended sequence for the lone rescuer to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). The lone rescuer should begin CPR with 30 compressions rather than 2 ventilations to reduce delay to first compression.
  • Compression rate should be at least 100/min (rather than “approximately” 100/min).
  • Compression depth for adults has been changed from the range of 1½ to 2 inches to at least 2 inches (5 cm).

More here...

Healthcare Provider BLS

Summary of Key Issues and Major Changes

Key issues and major changes in the 2010 AHA Guidelines for CPR and ECC recommendations for healthcare providers include the following:

  • Because cardiac arrest victims may present with a short period of seizure-like activity or agonal gasps that may confuse potential rescuers, dispatchers should be specifically trained to identify these presentations of cardiac arrest to improve cardiac arrest recognition.
  • Dispatchers should instruct untrained lay rescuers to provide Hands-Only CPR for adults with sudden cardiac arrest.
  • Refinements have been made to recommendations for immediate recognition and activation of the emergency response system once the healthcare provider identifies the adult victim who is unresponsive with no breathing or no normal breathing (ie, only gasping). The healthcare provider briefly checks for no breathing or no normal breathing (ie, no breathing or only gasping) when the provider checks responsiveness. The provider then activates the emergency response system and retrieves the AED (or sends someone to do so). The healthcare provider should not spend more than 10 seconds checking for a pulse, and if a pulse is not definitely felt within 10 seconds, should begin CPR and use the AED when available.
  • “Look, listen, and feel for breathing” has been removed from the algorithm.
  • Increased emphasis has been placed on high-quality CPR (compressions of adequate rate and depth, allowing complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation).
  • Use of cricoid pressure during ventilations is generally not recommended.
  • Rescuers should initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression.
  • Compression rate is modified to at least 100/min from approximately 100/min.
  • Compression depth for adults has been slightly altered to at least 2 inches (about 5 cm) from the previous recommended range of about 1½ to 2 inches (4 to 5 cm).
  • Continued emphasis has been placed on the need to reduce the time between the last compression and shock delivery and the time between shock delivery and resumption of compressions immediately after shock delivery.
  • There is an increased focus on using a team approach during CPR.

More here...

Electrical Therapies

The 2010 AHA Guidelines for CPR and ECC have been updated to reflect new data regarding defibrillation and cardioversion for cardiac rhythm disturbances and the use of pacing in bradycardia. These data largely continue to support the recommendations in the 2005 AHA Guidelines for CPR and ECC. Therefore, no major changes were recommended regarding defibrillation, cardioversion, and pacing. Emphasis on early defibrillation integrated with high-quality CPR is the key to improving survival from sudden cardiac arrest.

More here...

CPR Techniques and Devices

Summary of Key Issues and Major Changes

To date, no CPR device has consistently been shown to be superior to standard conventional (manual) CPR for out-ofhospital BLS, and no device other than a defibrillator has consistently improved long-term survival from out-of-hospital cardiac arrest. This part of the 2010 AHA Guidelines for CPR and ECC does contain summaries of recent clinical trials.

More here...

Advanced Cardiovascular Life Support

Summary of Key Issues and Major Changes

The major changes in advanced cardiovascular life support (ACLS) for 2010 include the following:

  • Quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal tube placement and CPR quality.
  • The traditional cardiac arrest algorithm was simplified and an alternative conceptual design was created to emphasize the importance of high-quality CPR.
  • There is an increased emphasis on physiologic monitoring to optimize CPR quality and detect ROSC.
  • Atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA)/asystole.
  • Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia.
  • Adenosine is recommended as safe and potentially effective for both treatment and diagnosis in the initial management of undifferentiated regular monomorphic widecomplex tachycardia.
  • Systematic post–cardiac arrest care after ROSC should continue in a critical care unit with expert multidisciplinary management and assessment of the neurologic and physiologic status of the patient. This often includes the use of therapeutic hypothermia.

More here...

Acute Coronary Syndromes

Summary of Key Issues and Major Changes

The 2010 AHA Guidelines for CPR and ECC recommendations for the evaluation and management of acute coronary syndromes (ACS) have been updated to define the scope of treatment for healthcare providers who care for patients with suspected or definite ACS within the first hours after onset of symptoms.

More here...

Stroke

Summary of Key Issues and Major Changes

The overall goal of stroke care is to minimize acute brain injury and maximize patient recovery. Treatment of stroke is time sensitive, and these stroke guidelines again emphasize the “D’s of Stroke Care” to highlight important steps in care (and potential steps that may contribute to delays in care). By integrating public education, 911 dispatch, prehospital detection and triage, hospital stroke system development, and stroke unit management, the outcome of stroke care has improved significantly.

More here...

Pediatric Basic Life Support

Summary of Key Issues and Major Changes

Many key issues in pediatric BLS are the same as those in adult BLS. These include the following:

  • Initiation of CPR with chest compressions rather than rescue breaths (C-A-B rather than A-B-C); beginning CPR with compressions rather than ventilations leads to a shorter delay to first compression.
  • Continued emphasis on provision of high-quality CPR.
  • Modification of recommendations regarding adequate depth of compressions to at least one third of the anterior-posterior diameter of the chest; this corresponds to approximately 1½ inches (about 4 cm) in most infants and about 2 inches (5 cm) in most children.
  • Removal of “look, listen, and feel for breathing” from the sequence.
  • De-emphasis of the pulse check for healthcare providers: Additional data suggest that healthcare providers cannot quickly and reliably determine the presence or absence of a pulse. For a child who is unresponsive and not breathing, if a pulse cannot be detected within 10 seconds, healthcare providers should begin CPR.
  • Use of an AED for infants: For infants, a manual defibrillator is preferred to an AED for defibrillation. If a manual defibrillator is not available, an AED equipped with a pediatric dose attenuator is preferred. If neither is available, an AED without a pediatric dose attenuator may be used.

More here...

Pediatric Advanced Life Support

Summary of Key Issues and Major Changes

  • Monitoring capnography/capnometry is again recommended to confirm proper endotracheal tube position and may be useful during CPR to assess and optimize the quality of chest compressions.
  • The PALS cardiac arrest algorithm was simplified to emphasize organization of care around 2-minute periods of uninterrupted CPR.
  • The initial defibrillation energy dose of 2 to 4 J/kg of either monophasic or biphasic waveform is reasonable; for ease of teaching, a dose of 2 J/kg may be used (this dose is the same as in the 2005 recommendation). For second and subsequent doses, give at least 4 J/kg. Doses higher than 4 J/kg (not to exceed 10 J/kg or the adult dose) may also be safe and effective, especially if delivered with a biphasic defibrillator.
  • On the basis of increasing evidence of potential harm from high oxygen exposure, a new recommendation has been added to titrate inspired oxygen (when appropriate equipment is available), once spontaneous circulation has been restored, to maintain an arterial oxyhemoglobin saturation =94% but <100% to limit the risk of hyperoxemia.
  • New sections have been added on resuscitation of infants and children with congenital heart defects, including single ventricle, palliated single ventricle, and pulmonary hypertension.
  • Several recommendations for medications have been revised. These include not administering calcium except in very specific circumstances and limiting the use of etomidate in septic shock.
  • Indications for postresuscitation therapeutic hypothermia have been clarified somewhat.
  • New diagnostic considerations have been developed for sudden cardiac death of unknown etiology.
  • Providers are advised to seek expert consultation, if possible, when administering amiodarone or procainamide to hemodynamically stable patients with arrhythmias.
  • The definition of wide-complex tachycardia has been changed from >0.08 second to >0.09 second.

More here...

Neonatal Resuscitation

Summary of Key Issues and Major Changes

Neonatal cardiac arrest is predominantly asphyxial, so the A-B-C resuscitation sequence with a 3:1 compression-to-ventilation ratio has been maintained except when the etiology is clearly cardiac. The following were the major neonatal topics in 2010:

  • Once positive-pressure ventilation or supplementary oxygen administration is begun, assessment should consist of simultaneous evaluation of 3 clinical characteristics: heart rate, respiratory rate, and evaluation of the state of oxygenation (optimally determined by pulse oximetry rather than assessment of color)
  • Anticipation of the need to resuscitate: elective cesarean section (new topic)
  • Ongoing assessment
  • Supplementary oxygen administration
  • Suctioning
  • Ventilation strategies (no change from 2005)
  • Recommendations for monitoring exhaled CO2
  • Compression-to-ventilation ratio
  • Thermoregulation of the preterm infant (no change from 2005)
  • Postresuscitation therapeutic hypothermia
  • Delayed cord clamping (new in 2010)
  • Withholding or discontinuing resuscitative efforts (no change from 2005)

More here...

Ethical Issues

Summary of Key Issues and Major Changes

The ethical issues relating to resuscitation are complex, occurring in different settings (in or out of the hospital) and among different providers (lay rescuers or healthcare personnel) and involving initiation or termination of basic and/or advanced life support. All healthcare providers should consider the ethical, legal, and cultural factors associated with providing care for individuals in need of resuscitation. Although providers play a role in the decision-making process during resuscitation, they should be guided by science, the preferences of the individual or their surrogates, and local policy and legal requirements.

More here...

Education, Implementation, and Teams

Education, Implementation, and Teams is a new section in the 2010 AHA Guidelines for CPR and ECC to address the growing body of evidence guiding best practices for teaching and learning resuscitation skills, implementation of the Chain of Survival, and best practice related to teams and systems of care. Because this information will likely impact course content and format, the recommendations are highlighted here.

More here...

First Aid

The 2010 First Aid Guidelines were once again codeveloped by the AHA and the American Red Cross (ARC). The 2010 AHA/ARC Guidelines for First Aid are based on worksheets (topical literature reviews) on selected topics, under the auspices of an International First Aid Science Advisory Board made up of representatives from 30 first aid organizations; this process is different from that used for the ILCOR International Consensus on CPR and ECC Science With Treatment Recommendations and was not part of the ILCOR process.

More here...

Summary

In the years since the publication of the 2005 AHA Guidelines for CPR and ECC, many resuscitation systems and communities have documented improved survival for victims of cardiac arrest. However, too few victims of cardiac arrest receive bystander CPR. We know that CPR quality must be high and that victims require excellent post–cardiac arrest care by organized teams with members who function well together. Education and frequent refresher training are likely the keys to improving resuscitation performance. In this 50th year since the publication of the landmark Kouwenhoven, Jude, and Knickerbocker description of successful closed chest compression,4 we must all rededicate ourselves to improving the frequency of bystander CPR and the quality of all CPR and post–cardiac arrest care.

More here...

Note: Some of the above documents may be in Adobe PDF format.
Click HERE for more information on how to view these documents.

 

Back to News

News Archive

Navigation