Changes in CPR guidelines might mean retraining
Guidelines stress compression over ventilation
If employees at your workplace have been certified to deliver CPR and been diligent about maintaining their certification, get ready to start over — the rules have changed.
New emergency care guidelines include dramatic changes to CPR and emphasis on chest compressions. The guidelines were issued in December by the American Heart Association,
one member of an international consensus panel that examines and revises resuscitation guidelines about every five years.
The new guidelines provide recommendations for how lay rescuers and emergency health care providers should resuscitate victims of cardiovascular emergencies. The changes involve CPR, the use of automated external defibrillators (AEDs), advanced cardiovascular life support (ACLS), and pediatric advanced life support (PALS).
"The 2005 guidelines take a 'back to basics' approach to resuscitation," according to Robert W. Hickey, MD, chair of the American Heart Association's Emergency Cardiovascular Care programs and associate professor of pediatrics, pediatric emergency medicine at Children's Hospital of Pittsburgh. "Since the 2000 guidelines, research has strengthened our emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and do, and the association believes the new guidelines will contribute to more people doing CPR effectively." (See figure.)
The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of cardiac arrest patients. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body, buying a few minutes until defibrillation can be attempted or the heart can pump blood on its own. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that rescuers "push hard and push fast" when giving chest compressions.
"What the panel decided was that when CPR was being administered [by trained lay rescuers], there weren't enough compressions, too many ventilations, and too many interruptions to CPR," says Hickey.
Hickey says the most significant change to CPR is the ratio of chest compressions to rescue breaths — from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30:2 ratio is the same whether the rescuer (a single lay rescuer) is providing CPR to an adult, a child or an infant (excluding newborns). The change in guidelines was based on studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions. The only exception to the new ratio is when two health care providers give CPR to a child or infant (except newborns), in which case they should provide 15 compressions for every two rescue breaths.
Another guideline change emphasizes the importance of CPR when AEDs are used. Previously it was recommended to use AEDs to analyze heart rhythm, deliver shock if necessary, re-analyze rhythm, and repeat three times, if necessary, before administering CPR. The new guidelines recommend two minutes of CPR, beginning with chest compressions, after delivery of one shock and before activating the AED to re-analyze the heart rhythm and attempt another shock.
According to Hickey, if the first AED shock stops the abnormal cardiac arrest, a brief period of chest compressions between shocks can deliver oxygen to the heart, increasing the likelihood of successful defibrillation.
While AEDs have become more and more common at work sites and in busy commercial and entertainment venues, they are not a substitute for CPR, he cautions.
"We have seen tragic examples of AEDs being available, but not brought to the patient's side, or brought to the patient's side but not used, or of CPR being withheld until the AED gets there," he says. "All three of those are not the ideal."
He adds the consensus panel also found that defibrillators and cardiac drugs are made "much more effective" when CPR is used.
"Just to use a defibrillator without CPR response really just gets you halfway [to successfully resuscitating a heart attack victim]," Hickey points out.
The new recommendations continue to encourage greater implementation of AED programs in public locations such as airports, casinos, sports facilities, and businesses. For the complete guidelines, go to the American Heart Association web site, www.americanheart.org/eccguidelines or www.c2005.org.
The American Heart Association has developed a CPR training program, "CPR Anytime," that teaches the core elements of CPR in 22 minutes, rather than the three- to four-hour traditional training. CPR Anytime, which includes a video and mannequin and does not require an instructor, is designed for families or small groups. For information, go to www.cpranytime.org.
If employees at your workplace have been certified to deliver CPR and been diligent about maintaining their certification, get ready to start over - the rules have changed.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content