AHA REVISES CPR GUIDELINES
May 10, 2016
People should continue to jump in quickly to give CPR, using breaths if they’ve been trained in CPR and employing mobile technology to speed up the rescue of cardiac arrest victims, according to the American Heart Association’s (AHA) 2015 Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).
The 2015 guidelines cite high-quality CPR training for both bystanders (lay rescuers) and health care providers to boost confidence and provide better CPR to cardiac arrest victims. This update also recommends that all bystanders should act quickly and use mobile phones to alert dispatchers, with the ultimate goal of having immediate CPR given to all victims of cardiac arrest.
According to the guidelines, there is an increased emphasis on the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (i.e., dispatch-guided CPR).
Key points from the 2015 Guidelines Update:
• Untrained lay rescuers should provide compression-only (Hands-Only) CPR, or CPR without breaths, 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 minimum, provide chest compressions for victims of cardiac arrest. In addition, if the trained lay rescuer is able to perform rescue breath, he or she should add rescue breathes in a ratio of 30 compressions to two 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 unresponsive with abnormal and agonal gasps across a range of clinical presentations and descriptions.
• Bystanders should use mobile phones to immediately call 911 and place the phones on speaker so the dispatcher can help bystanders check for breathing, get the precise location, and provide instructions for performing CPR.
• Mobile dispatch systems that notify potential rescuers of a nearby-presumed cardiac arrest can improve the rate of bystander CPR and shorten the time to first chest compressions.
The recommendations highlighting intervention at dispatch is a perspective the International Academies of Emergency Dispatch (IAED) has always supported in the development of the Medical Priority Dispatch System (MPDS).
“It’s encouraging to see that the AHA is adding more dispatch-specific guidelines,” said Greg Scott, IAED Operations Research Analyst. “These are things that we’ve had in our protocols for years.”
A new hands-on-chest Fast Track was added in MPDS v13.0 and is intended for patients who are initially and obviously described as being in cardiac arrest in the Case Entry sequence. A Dispatch Life Support (DLS) Link from Case Entry to Pre-Arrival Instructions (PAIs) was introduced in MPDS v12.2, but the new Fast Track feature in v13.0 has already proven to further reduce hands-on-chest time, which translates into lives saved.
“This is perhaps the single most important change to v13.0,” said Brett Patterson, Chair, IAED Medical Council of Standards. “The latest research clearly illustrates the vital role EMDs have in providing lifesaving PAIs to people calling 911.”
The Academy relies on its now-famous Standards Council, made up of international DLS experts, and a resuscitation sub-council consisting of renowned cardiopulmonary research physicians—who are dispatch oriented—to assist in the evolution of the MPDS. These experts follow, and in many cases participate in, the research and evaluation that is the backbone of the International Liaison Committee on Resuscitation (ILCOR) recommendations, published every five years by the AHA and the European Resuscitation Council (ERC).
According to Dr. Jeff Clawson, co-founder of the IAED, the evolution of the MPDS is an ongoing process that does not depend on the formal issuance of new guidelines for change; this was evident by the IAED’s implementation of compressions only (400 continuous) in 2004, over 10 years ago, he said.
“You will notice that most of the changes recommended by the new guidelines have already been implemented in the current version of the MPDS,” Clawson said. “Most importantly, you can be assured that your current version of the MPDS reflects the current DLS standard of care and practice.”
The AHA guidelines have been published since 1966 to provide science-based recommendations for treating cardiovascular emergencies—particularly cardiac arrest in adults, children, infants, and newborns.
The last update to the guidelines was in 2010.
The AHA is providing the 2015 update in three forms: the full Guidelines Update, a Guidelines Highlights document summarizing key points, and a mobile-friendly, searchable website compendium of all the association’s scientific findings.
Go to eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf to view and search the blended 2015 and 2010 AHA Guidelines for CPR and ECC.