AHA Guidelines for CPR and ECC

The American Heart Association 2010 Guidelines for CPR and ECC have recommended several important changes.

1- Change in Sequence- C-A-B, Not A-B-C

One of the most critical changes to the AHA Guidelines is the recommended change in the Basic Life Support sequence of steps. Previously the sequence was A-B-C (Airway-Breathing-Chest Compressions) but the revised sequence of steps is now C-A-B, meaning that the first step is to do chest compressions, followed by securing an airway, and then providing breaths.

This change applies to adult, children and infant CPR. In the past, the A-B-C sequence was less effective because chest compressions were usually deferred while the rescuer secured an airway and gave mouth-to-mouth or began ventilation. With the current C-A-B sequence, rescuers now begin with chest compressions to continue circulating the heart, although the delay in providing breaths should be minimal and no longer than the time needed to deliver the first set of 30 chest compressions. Breaths should not be delayed more than approximately 18 seconds for adult CPR and even shorter for infant or child CPR.

1. For adult CPR- Rescuer should activate emergency response system and begin CPR if the victim is unresponsive and not breathing at all, or not breathing normally (i.e. gasping) and has no pulse.
2. For Child and Infant CPR- Rescuer should begin performing CPR if the victim is unresponsive, not breathing normally and has no pulse.

2- Emphasis on High Quality CPR

When providing CPR, the AHA emphasizes “high-quality” CPR. The following guidelines should be observed and followed:

1. A compression rate of at least 100/min. This indicates a change from “approximately” 100/min.
2. A compression depth of at least 2 inches (5 cm) in adults, approximately 2” (5 cm) in children and approximately 1 1/2” (4 cm) in infants. The range of 1 ½-2” is no longer used for adult compressions and is now at least 2”. The depth specified for children and infants is also deeper than in previous AHA Guidelines.
3. Allow the chest to withdraw completely.
4. Reduce interruptions in compressions.

3- Team Approach to CPR

Training using a team approach to CPR is encouraged because, in many healthcare systems and emergency medical settings, rescue is done in teams of 2 or more. In this manner of training, rescuers are taught to perform several actions at the same time. Examples of actions that can be done simultaneously in a team include:

1. One rescuer activates the emergency response system.
2. One rescuer begins chest compressions.
3. One rescuer handles the bag mask or provides mouth-to-mouth.
4. One rescuer obtains and sets up a defibrillator.

It is important to remember that communication among team members during CPR is vital, especially while performing chest compressions. The rescuer that is performing chest compressions may become tired and need another member of the team to take over. By properly communicating with one another, the team approach ensures that compressions are being done at the proper compression depth and rate. It is highly suggested that the rescuer doing compressions count them aloud, thereby helping coordinate the steps among team members and facilitating a change in roles without interrupting compressions.

4- NO Look, Listen and Feel

A previous step, looking for, listening for and feeling for breathing has been eliminated. The reason for removing this step is that many bystanders would fail to start CPR in a timely manner because they observed agonal gasping. This step has also been deemed time consuming and inconsistent.

It is now suggested that the rescuer check the victim for RESPONSE and BREATHING simultaneously.

5- Continued De-emphasis of the Pulse Check

The de-emphasis of a pulse check is being continued due to the fact that it can be difficult to detect the presence or absence of a pulse within the prescribed 10 seconds, especially in an emergent situation. Additionally, studies have indicated that healthcare providers and lay people are unable to reliably detect a pulse.

Current guideline state that if a victim is unresponsive and not breathing, or not breathing normally, the rescuer can take up to 10 seconds to attempt a pulse check (carotid in adults, carotid or femoral in children and brachial in infants). Chest compressions should be started if the rescuer is unsure if there is a pulse or no pulse is felt within 10 seconds.

6- Cricoid Pressure

Using cricoid pressure in cardiac arrest is no longer recommended.

7- Use of an AED for Infants

A manual defibrillator is preferred for infants as opposed to an AED for defibrillation.

If a manual defibrillator is not available, an AED with a pediatric dose attenuator is the preferred method of defibrillation.

If neither is available, then a standard AED may be used.