Monday, April 4, 2016

2015 American Heart Association (AHA) Basic Life Support (CPR) Guideline Changes

Basic Life Support (BLS)/CPR Quality Changes

The AHA states that High quality CPR continues to be of primary importance in optimizing outcomes for cardiac arrest. Several alterations to the BLS/CPR guidelines have occurred as a result of this end goal of providing high quality CPR.

Compression Depth:
The recommended depth of chest compressions will remain at, at least 2 inches (5 cm). In addition to this, avoiding excessive chest compressions deeper than 2.4 inches (6cm) allowing for complete chest recoil between each compression is emphasized. This compression depth limit was implemented because there is some evidence that complications may arise when compression depth exceeds this limit.

Compression Rate:

During cardiac arrest lay rescuers and health care providers should perform chest compressions at a rate of 100 to 120 per minute. This change added an upper limit of 120 to the recommendation because compression rates greater than 120 per minute negatively affect outcomes for cardiac arrest.

Full Chest Wall Recoil:

Rescuers must avoid leaning on the chest between compressions to ensure that full chest wall recoil is achieved after each compression. Full chest wall recoil ensures that the negative pressure involved in the return of blood flow to the heart and myocardial circulation is present. Leaning on the chest creates a slight positive pressure which can have a detrimental effect on resuscitation outcomes.
Minimizing interruptions:
Emphasis is also being placed on minimizing interruptions in chest compressions. The goal for the percent of time for performing chest compressions is recommended to be at least 60% during CPR. This percent of time is known as the chest compression fraction time. Chest compression fraction is a measurement of the proportion of total resuscitation time that compressions are performed.

Health Care Provider BLS:

Health Care Providers (HCP) must call for nearby help upon finding a victim unresponsive, but it is be practical for the HCP to continue to assess the breathing and pulse simultaneously before fully activating the emergency response system (or calling for backup).
This change should help minimize the delay to chest compressions and encourage fast, flexible, and efficient assessment based responses.
Health Care Providers are encouraged to tailor the sequence of rescue actions to the most likely cause of arrest and they should provide chest compressions and ventilations for all adult patients in cardiac arrest. Compression-only CPR should be limited to untrained rescuers.

Advanced Airway Ventilations:

For all patients from infant to adult, with an advanced airway in place, providers may deliver 1 breath every 6 seconds (10 breaths per minute) while chest compressions are being performed. This changes was implemented to simplify the ventilation requirements during CPR with an advanced airway in place.

Chest Compression Feedback:
It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance. This may facilitate a Chest compression fraction of 60% or greater which has proven to facilitate a better chance at ROSC.