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DALLAS, Nov. 24 /PRNewswire/ -- New emergency care guidelines include
dramatic changes to cardiopulmonary resuscitation (CPR) and emphasis on chest
compressions, according to authors of the 2005 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care.
The guidelines were published online today in Circulation: Journal of the
American Heart Association. They provide recommendations for how lay rescuers
and emergency healthcare providers should resuscitate victims of
cardiovascular emergencies. Topics include CPR, the use of automated external
defibrillators (AEDs) and recommendations for advanced cardiovascular life
support (ACLS) and pediatric advanced life support (PALS).
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.
"The 2005 guidelines take a back to basics approach to resuscitation,"
said Robert Hickey, M.D., chair of the American Heart Associations Emergency
Cardiovascular Care programs. "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."
The most significant change to CPR is to 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-to-two ratio is the same for CPR that a single lay rescuer
provides to adults, children and infants (excluding newborns). The change
resulted from 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 healthcare providers give CPR to a
child or infant (except newborns), in which case they should provide 15
compressions for every two rescue breaths.
Another guidelines change emphasizing the importance of CPR is the
sequence of rhythm analysis and CPR when using AEDs. Previously, when AED
pads were applied to the chest, the device analyzed the heart rhythm,
delivered a shock if necessary, and analyzed the heart rhythm again to
determine whether the shock successfully stopped the abnormal rhythm. The
cycle of analysis, shock and re-analysis could be repeated three times before
CPR was recommended, resulting in delays of 37 seconds or more. Now, after
one shock, the new guidelines recommend that rescuers provide about two
minutes of CPR, beginning with chest compressions, before activating the AED
to re-analyze the heart rhythm and attempt another shock. Studies have shown
that the first AED shock stops the abnormal cardiac arrest rhythm more than 85
percent of the time and that a brief period of chest compressions between
shocks can deliver oxygen to the heart, increasing the likelihood of
successful defibrillation. The guidelines also recommend that healthcare
providers minimize interruptions to chest compressions by doing heart rhythm
checks, inserting airway devices, and administering of drugs without delaying
CPR.
The new recommendations continue to encourage greater implementation of
AED programs in public locations like airports, casinos, sports facilities and
businesses. The 2005 guidelines reflect results of the Public Access
Defibrillation trial, which reinforced the importance of planned and practiced
response to cardiac emergencies by lay rescuers.
The new guidelines recommend that 911 dispatchers be trained to provide
CPR instructions by phone and help callers correctly identify cardiac arrest
victims. Dispatchers may walk rescuers through compressions-only CPR for most
adult victims of cardiac arrest; however, instructions to do compressions and
rescue breaths will be given for infants and children or adult victims of
asphyxia, caused by near-drowning or other non-cardiac causes. Dispatchers
also should be trained to recognize the symptoms of heart attack and other
Acute Coronary Syndromes, and advise such patients to chew an aspirin while
awaiting EMS.
To increase successful resuscitation, new guidelines advise EMS systems to
evaluate their current protocols, shorten the response time for cardiac arrest
patients, then document the impact of such changes on the number of lives
saved.
The guidelines are based on the Consensus on Science and Treatment
Recommendations (CoSTR), a document developed by the International Liaison
Committee on Resuscitation. This group includes the American Heart
Association and leading international resuscitation councils. The review of
resuscitation literature reflected in CoSTR is the largest ever published. It
took more than 36 months and includes input from 380 international experts
CoSTR serves as the scientific basis for many countries resuscitation
treatment guidelines.
2005 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care
Comparison chart of key changes
2005 Recommendation 2000 Recommendation Explanation
Basic Life Support Emphasized the When chest compressions
Increased emphasis on first three links are interrupted, blood
delivery of effective in the Chain of flow stops. Limiting
chest compressions Survival: early access, interruptions to
early CPR, and early chest compressions
defibrillation. Stated will result in greater
early CPR significantly survival.
improved survival.
Named early defibrillation In any given
as the single greatest series (cycle) of
determinant of survival chest compressions,
for adult victims of earlier compressions
cardiac arrest. are less effective than
later ones. Therefore,
fewer interruptions
increase the percentage
of effective chest
compressions.
Allowing the chest wall
to fully "recoil" or
return to its normal
position between
compressions results
in better re-filling
of blood in the heart,
which allows more blood
to be pumped to the
rest of the body during
the next compression.
Single CPR A compression to A single ratio will
compression-to- ventilation ratio of make learning the
ventilation ratio: 15 to 2 was correct procedure for
30:2 for all recommended for adult responding to victims
rescuers responding CPR; a ratio of 5 to 1 of all ages easier and
alone to victims of for child and infant CPR. increase the likelihood
any age, except that a rescuer will
newborns. Three compressions remember the steps of
for every one breath CPR during an
CPR for newborns is should be given to emergency.
the same as newborns, totaling
2000 guidelines 90 compressions and The new ratio also
recommendation. 30 breaths per minute. helps reduce
interruptions in chest
compressions
(see explanation
above).
AED programs should Key elements of Some AEDs do not
be implemented in successful AED programs require a medical
public locations were recommended, including prescription, so
where theres a healthcare provider healthcare provider
relatively high oversight, training of oversight of AED
likelihood of likely rescuers, link programs is not
witnessed cardiac to local EMS system mandatory.
arrest (eg, airports, and process of
casinos, sports continuous quality The Public Access
facilities and improvement. Defibrillation trial
businesses). reinforced the
importance of planned
and practiced response.
Lay rescuer programs in
airports and casinos
and by police officers
have reported survival
rates as high as
49 percent to
74 percent when
responding to sudden
cardiac arrest caused
by ventricular
fibrillation.
A single shock from Up to three shocks Repeated cycles of
a defibrillator, in a series were rhythm analysis and
followed by immediate recommended to treat shock result in delays
CPR for two minutes, cardiac arrest with of up to 37 or more
beginning with chest a "shockable" rhythm seconds before the
compressions, should before returning to first post-shock chest
be used to treat chest compressions; compressions are
cardiac arrest caused the heart rhythm was delivered. Most
by ventricular evaluated before and defibrillators
fibrillation (VF - after each shock. eliminate VF more than
the abnormal heart 85 percent of the time.
rhythm responsible If the first shock
for most cardiac fails, immediate CPR
arrests). (before trying another
shock) is likely to
contribute to the
success of a subsequent
shock. Even when a
shock eliminates VF, it
may take several
minutes for the heart
to pump blood
effectively, even if a
normal heart rhythm
returns. A brief
period of chest
compressions can
deliver oxygen to the
heart during this post-
shock period,
increasing the
likelihood that the
heart will begin to
effectively pump blood
on its own.
After giving two After giving two rescuer Lay providers cannot
rescue breaths, lay breaths, lay rescuers reliably detect the
rescuers no longer were instructed to presence of circulation
check for signs of check for signs of in a victim. Great
circulation before circulation (normal harm can be done when
beginning chest breathing, coughing rescuers dont do chest
compressions. or movement). Lay compressions when
rescuers gave rescue theyre needed.
breathing without chest Relatively minimal harm
compressions to victims can be done by
with signs of circulation providing chest
who were not breathing compressions when
normally. they arent needed.
Therefore, the new
guidelines do not
recommend that lay
rescuers look for
"signs of circulation"
before delivering chest
compressions. This
eliminates the chance
that lay rescuers
might not recognize
true cardiac arrest,
and reduces delays to
chest compressions.
Eliminating
instructions to look
for signs of
circulation and for
delivering "rescue
breathing without chest
compressions" reduces
the number of skills
required for lay
rescuers. This makes
it more likely that
the lay provider will
learn and remember the
steps of CPR.
Dispatchers should be Dispatchers were not Early administration
trained to recognize instructed to of aspirin has been
the symptoms of Acute recognize ACS or associated with
Coronary Syndromes recommend aspirin. decreased mortality
(ACS), and advise rates in several
patients with symptoms clinical trials.
of ACS without history Many studies have
of aspirin allergy demonstrated the
or gastrointestinal safety of aspirin
bleeding to chew administration.
160 mg - 325 mg of
aspirin while awaiting
the arrival of EMS
providers.
Advanced Cardiac Life Support
Basic Life Support Heart rhythm analysis, Studies show that
(BLS) skills are the delivery of shocks providing continuous
priority in treating and selection of CPR outweighs the
cardiac arrest. drug therapies resulted potential effects of
Providers must in frequent drug therapies, so
minimize interruptions interruptions to interruptions should
to chest compressions. CPR. be minimized.
New neurological No specific neurologic New research suggests
tests and evaluations signs indicated the there are specific
given 24 hours and potential for clinical signs, such
72 hours after successful resuscitation. as certain brain
resuscitation can responses to stimuli,
predict survival that correlate strongly
to hospital discharge. with death or poor
brain function
following resuscitative
efforts. More research
is needed to predict
potential for survival
during resuscitation.
Unconscious adult Mild hypothermia may In two randomized
patients with be beneficial ... but clinical trials,
return of spontaneous hypothermia should not induced hypothermia
circulation after be induced actively (cooling within minutes
out-of-hospital after resuscitation to hours after the
cardiac arrest from cardiac arrest. return of spontaneous
should be cooled (Position was updated circulation) resulted
for 12 to 24 hours in a 2003 science in improved survival
to 32 degrees C - statement from the and brain function in
34 degrees C when International Liaison adults who remained
the initial rhythm Committee on comatose after initial
was ventricular Resuscitation, resuscitation from
fibrillation. which supported induced out of hospital VF
Similar therapy may hypothermia following cardiac arrest.
be beneficial for resuscitation.)
patients with non-VF
arrest out of
hospital or for
in-hospital arrest.
Tissue plasminogen Administration of tPA National Institute of
activator (tPA) is was recommended for Neurological Disorders
recommended for carefully selected and Stroke (NINDS)
carefully selected patients with acute results have been
patients with acute ischemic stroke if they supported by subsequent
ischemic stroke, but had no contraindications one year follow up,
cautions that tPA must to fibrinolytic therapy reanalysis of the NINDS
be administered in and if the drug can be data and a meta
the setting of a administered within analysis. Additional
clearly defined 3 hours of the onset trials supported the
protocol and of stroke symptoms. NINDS results.
institutional Note: Higher
commitment. complications of
hemorrhage following
tPA was reported in one
study when
participating hospitals
did not require strict
adherence to NINDS
protocols.
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