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New CPR Standards

Written by Susan Geoghegan

In 1966, the American Heart Association (AHA) developed the first cardiopulmonary resuscitation (CPR) guidelines in recognition of the benefits of early CPR intervention in cardiac arrest patients. Since then, the coordinated efforts of bystanders and medical care providers during out-of-hospital cardiac arrest have saved countless lives throughout the world.

According to the AHA, a return to a prior quality of life and functional state of health is the ultimate goal of a resuscitation system of care. Based on the most current and comprehensive review of the “2010 ILCOR International Consensus on CPR and ECC Science with Treatment Recommendations,” the 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC) confirm current effective approaches and recognize new developments in resuscitation science.

Modifications in Basic Life Support

Participating scientists and healthcare providers unanimously support the continued emphasis on high-quality CPR that allows complete chest recoil, minimizes interrupted chest compressions and avoids excessive ventilation. The 2010 AHA Guidelines for CPR and ECC reflect a significant change in the basic life support (BLS) sequence of steps from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing).

With the new “C-A-B” sequence, chest compressions are initiated sooner, and ventilation only minimally delayed until completion of the first cycle of chest compressions. Because most bystanders feel more comfortable administering chest compressions than mouth-to-mouth breaths, the revised sequence may also encourage lay rescuers to more readily assist a cardiac arrest victim.

Victims have the best chance of survival when Advanced Cardiovascular Life Support (ACLS) is administered within the first few moments of cardiac arrest. In addition to high-quality CPR, the AHA/ECC guidelines recognize the importance of automated external defibrillators (AEDs) as part of a system of care for out-of-hospital cardiac arrest patients.

The Chain of Survival sequence consists of five steps: early EMS, early CPR and early defibrillation, followed by advanced cardiac life support and post-cardiac care. The implementation of a comprehensive, multidisciplinary cycle of care is critical in achieving an optimal outcome following return of spontaneous circulation (ROSC). Effective post-cardiac arrest care includes a consistently applied extensive therapeutic plan that results in the return of normal or near-normal status.

Recommendations for Acute Stroke and ACS Patients

The 2010 AHA Guidelines for CPR and ECC contain recommendations for the stabilization and management of acute stroke patients and those with suspected or definite acute coronary syndromes (ACS).

Two new Class I recommendations address effective treatment of adult stroke patients: one supports triage of patients directly to designated stroke centers, the other admission to a dedicated stroke unit managed by experienced, multidisciplinary teams. The guidelines also encourage hospitals with an emergency facility to have a written stroke management plan in place that can be readily communicated to EMS systems. Strategies for effective treatment of ACS patients include systems of care for patients with ST-elevation myocardial infarction, pre-hospital 12-lead electrocardiograms, triage to hospitals capable of performing percutaneous coronary intervention, and comprehensive care for patients following cardiac arrest with confirmed STEMI or suspected ACS.

Pediatric BLS

Several new recommendations for pediatric basic life support are contained in the 2010 AHA Guidelines for CPR and ECC. Recognizing that the majority of pediatric cardiac arrests are asphyxial, the AHA continues to support a combination of ventilations and chest compressions for pediatric resuscitation (the exception being adolescents, with CAB as the suggested BLS sequence).

The new guidelines also support a de-emphasis on pulse assessment since determining the presence of a pulse in pediatric cases is often unreliable. The new recommendation is that if a pulse is not detected within 10 seconds, healthcare providers should begin CPR. Other important changes in pediatric advanced life support include an updated formula for selecting the appropriately sized cuffed tube, modification or discontinuation of applied cricoid pressure if it impedes ventilation or speed or ease of intubation, and continued monitoring of capnography/capnometry to confirm proper endotracheal tube (and other advanced airway) position.

Education and Training

Major points of emphasis have been included in a new section of The 2010 AHA Guidelines for CPR and ECC: “Education, Implementation and Teams.” The new recommendations include education and formal CPR training to improve bystander willingness to administer basic life support, AED training, periodic assessment of rescuer knowledge between certification periods, and systems-based approaches to improving resuscitation performance.

CPR prompt and feedback devices, debriefing techniques, and the development of leadership skills are also advocated as effective tools to facilitate training and ongoing education.

Susan Geoghegan is a freelance writer living in Naples, Fla. She can be reached at sgeofl@embarqmail.com.

Published in Law and Order, Oct 2011

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