AHA CPR guidelines released

DALLAS — The American Heart Association’s “2015 Guidelines Update for CPR and ECC” confirms known CPR recommendations with several quality enhancements to help save more lives, including a range for the rate and depth of chest compressions during CPR.

The latest AHA guidelines, published Thursday in Circulation: Journal of the American Heart Association, highlight how quick action, proper training, use of technology and coordinated efforts can increase survival from cardiac arrest.

Bystanders should continue to jump in quickly to give CPR, using breaths if they are trained in CPR and employing mobile technology to speed up the rescue of cardiac arrest victims.

Survival depends on immediate CPR and other actions starting with bystanders.

The 2015 guidelines say high-quality CPR training for both bystanders and health care providers will help them feel more confident to act and provide better CPR to cardiac arrest victims.

“The 2015 update calls for integrated systems of care that participate in continuous quality improvement and that provide a common framework for both community and health care-based resuscitation systems,” said Clifton Callaway, chair of the AHA’s Emergency Cardiovascular Care committee. “We must create a culture of action that benefits the entire community in which it operates, inside and outside the hospital setting.”

The guidelines recommendations for health care professionals are:

• Upper limits of recommended heart rate and compression depth have been added, based on new data suggesting that excessive compression rate and depth are less effective. Rescuers should perform chest compressions at a rate of 100 to 120 per minute and to a depth of at least 2 inches, avoiding depths greater than 2.4 inches.
• Targeted temperature management helps prevent brain degradation during post-cardiac arrest care. New evidence shows a wider range of temperatures are acceptable. Providers should select a temperature between 32-36 degrees Celsius and maintain it for at least 24 hours.
• Health care providers are encouraged to simultaneously perform steps, like checking for breathing and pulse, in an effort to reduce the time to first chest compression.
• There is insufficient evidence to routinely intubate newborns with poor breathing and muscle tone who have been born with meconium in their amniotic fluid. Instead, the new recommendation is to begin CPR under a radiant warmer to get oxygen to the infant faster.

This guidelines update, which is intended to evolve CPR training, also recommends that all bystanders should act quickly and use mobile phones to alert dispatchers, with the ultimate goal of having immediate CPR given to all victims of cardiac arrest.

“Everyone has a role to play in the chain of survival — from bystanders to dispatchers, emergency responders to health care providers,” said AHA president Dr. Mark A. Creager. “When everyone knows their role, knows CPR and works together, we can dramatically improve cardiac arrest victims’ chances of survival.”

The AHA guidelines, which are based off the latest resuscitation research, have been published since 1966 to provide science-based recommendations for treating cardiovascular emergencies — particularly cardiac arrest in adults, children, infants and newborns. The last update to the guidelines was in 2010.

Key points from the 2015 Guidelines Update provide bystanders, dispatchers and communities with practical guidance to improve the effectiveness of their teamwork:

• Untrained bystanders should still call 911 and provide hands-only CPR, pushing hard and fast in the center of the chest to the rate of 100-120 compressions per minute. However, if the bystander is trained in CPR and can perform breaths, he or she should add breaths in a 30:2 compressions-to-breaths ratio.
• Bystanders should use mobile phones to immediately call 911, placing the phones on speaker, so the dispatcher can help bystanders check for breathing, get the precise location and provide instructions for performing CPR.
• Dispatchers should be trained to help bystanders check for breathing and recognize cardiac arrest. Dispatchers should also be aware that brief generalized seizures may be an early sign of cardiac arrest.
• Mobile dispatch systems that notify potential rescuers of a nearby presumed cardiac arrest can improve the rate of bystander CPR and shorten the time to first chest compressions.