In 2010, the American Heart Association (AHA) released a revision of the BLS Guidelines. Approximately every five years the AHA updates the guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). The content contained herein is based on the most recent AHA publications on BLS and will periodically compare old versus new recommendations for a comprehensive review.1
These changes include:
Previously, the initial steps were A-B-C (Airway, Breathing, Compressions). The literature indicates that starting compressions early in the process will increase survival rates. Therefore, the steps have been changed to C-A-B (Compressions, Airway, Breathing). This is intended to encourage early CPR and avoid bystanders interpreting agonal breathing as signs of life and withholding CPR.
"Look, listen and feel" for breathing is no longer recommended. Instead of assessing the victim’s breathing, begin CPR if the victim is not breathing (or is only gasping for breath), has no pulse (or if you are unsure), or if the victim is unresponsive. Do not perform an initial assessment of respirations. The goal is early delivery of chest compressions to cardiac arrest victims.
High-quality CPR is key and is defined as:
Compression rate of AT LEAST 100 per minute for all victims
Compression depth of AT LEAST 2 inches for adults/children and about 1.5 inches for infants
Allow complete chest recoil after each compression
Minimize interruptions in CPR except to use an AED or change rescuer positions
Do NOT over-ventilate
Provide CPR as a team when possible
Cricoid pressure is NO longer routinely performed.
Pulse checks are shorter – feel for a pulse for 10 seconds then begin compressions if a pulse is absent or if you are not sure you feel a pulse. Even trained clinicians cannot always reliably tell if they can feel a pulse.
For infants, use a manual defibrillator if one is available. If one is NOT available, an AED with pediatric dose attenuator should be used for an infant. If an AED with dose attenuator is not available, you may use an adult AED – even for an infant.
1American Heart Association. Advanced Cardiovascular Life Support Provider Manual. AHA: 2011; p 183.