The American Heart Association (AHA) published their 2015 guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) in the scientific journal Circulation. Resuscitation research continues to show that high-quality CPR is increasing survival rates for hospital discharge. The AHA’s updated 2015 guidelines expand on many of the recommendations made in 2010 and continue to focus on high-quality chest compressions as the intervention is most likely to improve resuscitation outcomes.
The AHA’s analysis of the research conducted since the 2010 guidelines shows that resuscitation outcomes improve when high-quality chest compressions are started immediately. The characteristics that define high-quality compressions remain as pushing hard and fast.
In 2010, the recommended rate was at least 100 compressions per minute. The 2015 update to the CPR guideline now reflects a target compression rate of 100-120 per minute. Increasing the compression rate past 120 compressions/min may decrease cardiac output due to incomplete cardiac filling during chest recoil.
The 2015 guideline now defines the target depth for adult compressions to be between 2-2.4 inches (5-6 centimeters). Research reviewed by the AHA revealed that compressions delivered beyond this depth may result in increased risk of resuscitation related injuries, such as rib fractures, which is what led to this change in 2015 guidelines.
The AHA’s guidelines continue to emphasize that the rescuer technique will play a major role in the quality of compressions delivered. In real life resuscitations, rescuers are likely to provide compressions that are too slow, too shallow, and interrupted too often. Both training and practice are important in developing good technique, with frequent refresher training for skills and knowledge. During training and review, detailed feedback especially on rate and depth of compressions should be provided.
The change from the traditional ABC (Airway, Breathing, Compressions) sequence in 2010 to the CAB (Compressions, Airway, Breathing) sequence was confirmed in the 2015 guidelines. The emphasis on early initiation of chest compressions without delay for airway assessment or rescue breathing has resulted in improved outcomes.
The 2015 guidelines still recommend traditional CPR cycles of 30 chest compressions to two rescue breaths for one-rescuer CPR in all age groups and for two-rescuer CPR in adults. The 15:2 ratio of compressions to breaths remains in the 2015 guidelines for two-rescuer CPR for children and infants.
High-quality chest compressions are most valuable in saving a life. Even if you do not know how to do anything else, chest compressions are better than doing nothing. The AHA points out that most rescuers are likely to have a speakerphone equipped cell phone, and bystanders calling 911 can be instructed by EMS dispatchers to perform hands only CPR. Additionally, the AHA continues to call on communities to increase public access to AEDs.
In 2010, the American Heart Association (AHA) released a revision of the BLS guidelines. Approximately, every five years, the AHA updates the guidelines for CPR and ECC. The content contained herein is based on the most recent AHA publications on BLS and will periodically compare previous and revised recommendations for a comprehensive review.
Below are the details of the changes made to 2015 guidelines for BLS:
- Previously, the initial steps were Airway, Breathing, Compressions, or ABC. The literature indicates that starting compressions early in the process will increase survival rates. Therefore, the steps have been changed to Compressions, Airway, Breathing, or CAB. 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 person’s breathing, begin CPR if the person is not breathing (or is only gasping for breath), has no pulse (or if you are unsure), or is unresponsive. Do not perform an initial assessment of respirations. The goal is early delivery of chest compressions to cardiac arrest persons.
- 2017 updates recommend for adults in out-of-hospital cardiac arrest (OHCA), that untrained lay rescuers should provide chest compression only CPR with or without dispatcher assistance. For lay rescuers trained in chest compression only CPR, it is recommended that they provide chest compression only CPR for adults in CPR. For lay rescuers trained in CPR using chest compressions and ventilation, rescue breaths, it is reasonable to provide ventilation, rescue breaths, and chest compressions for the adult in OHCA.
High-quality CPR is key and consists of doing the following:
- Keep compression rate of at least 100 minute for all persons.
- Keep compression depth of between 2-2.4 inches for adults and 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 to 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; if a pulse is absent or if you are not sure you feel a pulse, then begin compressions. Even trained clinicians cannot always reliably tell if they can feel a pulse.
- For infants, use a manual defibrillator if available. If not available, an AED with pediatric dose attenuator should be used for an infant. If an AED with dose attenuator is not available, then use an adult AED, even for an infant.