AHA CPR guidelines: How they impact AED use and purchasing

Since 1974, the American Heart Association (AHA) has published periodic guidelines for CPR and emergency cardiovascular care (ECC). Those procedures are the basis for cardiac resuscitation protocols in EMS systems and hospital emergency departments throughout the U.S.

Automated external defibrillators (AEDs), similar to today’s models, were first acknowledged by the AHA in their 1992 update. Although circuitry and waveforms have changed since then, fundamental principles for treating pulseless patients have not: get help, start CPR, and defibrillate shockable rhythms as early as possible. The AHA’s 2015 guidelines mostly remind us how important each of those steps are.

If you own an AED, are thinking of buying one, or are just curious about the latest ECC recommendations for BLS providers, you might want to review these highlights from the 2015 update, which are still considered the most current:

Public access defibrillation

The AHA continues to stress the importance of placing AEDs where people are most likely to need them. They’ve adopted the conventional term public access defibrillation (PAD) for the process of identifying target-rich locations for AEDs, making sure potential responders know where defibrillators are and how to use them, linking accessible AEDs with EMS systems, and seeking ongoing quality improvement.

According to AEDSuperstore, “Unlike fire extinguishers, which are required by law, AEDs have been considered an optional safety investment on corporate properties for the most part. Despite the fact there are Good Samaritan laws in all 50 states to protect owners and users of these life-saving devices from litigation, it is still a perceived risk many companies are unwilling to take. Of the 350,000 sudden cardiac deaths each year in the US, OSHA states 10,000 occur in the workplace. If corporations viewed investing in AEDs and training their employees in CPR the same way they looked at any other insurance, they would see the cost is comparatively minimal. “

AED training

Self-directed training in the use of AEDs is an acceptable alternative to instructor-led courses for both professional and lay rescuers. The message here is that any instruction is better than none at all. However, the AHA considers today’s automated defibrillators so easy to use that even someone with zero training can and should grab an AED when indicated.

The AHA adds that refresher classes for CPR and AEDs should be less frequent than every two years for responders likely to encounter cardiac arrests.

Scene management

The 2015 AHA guidelines incorporate recommendations about scene management that most professional rescuers take for granted: ensure scene safety, multitask patient assessment by simultaneously checking breathing and pulse, and choreograph concurrent interventions when there are teams of rescuers. The AHA also acknowledges the variability of scenes and preaches flexibility, rather than rote adherence to cardiac arrest algorithms.

Communication by cellphone

A new suggestion for 2015 is that the lay rescuers who discover the patient or witness the arrest stay by the patient’s side and contact EMS via mobile phone whenever possible. Rescuers are encouraged to maintain two-way communication with dispatchers by activating cellphone speakers. Newer apps and social media platforms are another option for contacting emergency assistance.

When to shock

There has been some debate about whether a minute or two of CPR before defibrillation might increase the chances of resuscitation by improving the metabolic state of the heart. The AHA examined four studies of defibrillation delayed by up to three minutes of CPR, and concluded there were no differences in either short- or long-term survival. The recommendation is still to assess for a shockable rhythm as quickly as possible and defibrillate immediately when indicated.

Chest compressions

Although the 2015 guidelines offer no major changes for CPR, rescuers should note the following fine adjustments to chest compressions:

• The upper limit of acceptable compression rates is now 120 per minute.
• The maximum depth of compressions on adults is 2.4 inches, although 2 inches is still the target.
• Compressions delivered by mechanical devices are not superior to manual compressions.
• Rescuers are reminded not to lean on their patients’ chests between compressions. Full recoil of the chest wall is needed to optimize blood flow to the heart.

Perhaps the best news from the AHA is that they will issue continuous updates rather than periodic ones from now on. Ask suppliers about the capability of any AED unit’s software to be reprogrammed as evolving resuscitation science may require updates. Keep an eye on ECCguidelines.heart.org for the latest research and recommendations.

References

• Neumar RW, Shuster M, Callaway CW, et al. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S315-S367.
• Highlights of the 2015 American Heart Association Guidelines Update for CPR and ECC. 2015.