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The American Heart Association, based
in Dallas, Texas recently released it's
newest guidelines for Cardio-Pulmonary
Resuscitation (CPR) and other forms
of Emergency Cardiac Care (ECC), such
as Advanced Cardiac Life Support (ACLS)
and treatment for other forms of cardiac
related emergencies. Many fundamental
changes were made to the guidelines
that were last updated in 2000. These
changes were not based on conjecture
and or any other form of "guessing"
but rather they were based on the use
of both scientific facts as well as
the scientific process.
Everyday the AHA and their worldwide
affiliates conduct CPR and ECC related
research all over the world. Then every
five years they meet and review the
data and make evidence based recommendations
to clinical treatment practices as well
as identify areas where more specific
research is needed for the next cycle.
At the end of that process the AHA publishes
those guidelines in a document called
the "American Heart Association
Guidelines for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care".
While the guidelines are very lengthy
and comprehensive in the area of overall
care of the victim of a cardiac related
emergency the biggest change that "Professional
Rescuers" such as EMS, fire and
police personnel will likely notice
will me the change from 15 compressions
to 30 compressions during CPR with keeping
the 2000 standard of 2 Rescue Breathes
per cycle in the case of "Lone
Rescuer" CPR. The 15:2 Ratio will
remain for Two-Person CPR.
Dr. Michael Sayre, an Ohio State University
emergency medicine professor who helped
develop the new guidelines was quoted
as saying "Basically, the more
times someone pushes on the chest, the
better off the patient is," said.
To add to that Mary Fran Hazinski, a
clinical nurse specialist at Vanderbilt
University Medical Center who also helped
develop the guidelines added "When
you stop compressions, blood flow stops…You
have to make up for that lost ground,"
she said. "We think that the fewer
the interruptions, the better for blood
flow."
The new guidelines also change the
number of times a rescuer needs to use
a defibrillator (automatic or manual)
Instead of using the defibrillator up
to three times (as in the "stacked
shocks" common in ACLS and on AED's)
before beginning CPR, the 2005 guidelines
advise rescuers to just give one shock
and then do two minutes of CPR beginning
with chest compressions before trying
the defibrillator again as studies show
that the first shock works more than
85 percent of the time. The bottom line
advice is to focus on the chest compressions.
Studies show that the chest compressions
create more blood flow through the heart
to the rest of the body, buying time
until a defibrillator can be used or
the heart can pump blood on its own.
Studies have also shown that blood circulation
increases with each chest compression
and must be built back up after an interruption
The AHA has also used the press generated
from the publication of the new Guidelines
to advocate Public Access Defibrillator
(PAD) Programs given the fact that survival
rates have been as high as 49 to 74
percent for lay rescuer programs when
defibrillators are placed in casinos,
airports or even when used by police
agencies.
More than 300,000 Americans die each
year of cardiac arrest and the AHA estimates
that more than 95 percent of cardiac
arrest victims die before they get to
the hospital.
The other factor that will have a direct
effect on public safety agencies is
the renewed push for 9-1-1 operators/dispatchers
to be trained to provide CPR instructions
by phone for lay-person emergency callers.
"For the bystander that witnesses
a collapse, the main danger is inaction,"
Sayre said. "We believe there is
very little downside to trying to attempt
a resuscitation."
According to the AHA, about 75 to 80
percent of all cardiac arrests that
happen outside of a hospital happen
at a home, and effective CPR can double
a victim's chance of survival. "The
bottom line is we think more people
need to learn CPR," Hazinski said.
"We have more and more evidence
that good CPR works. We're doing our
best to increase the number of bystanders
that learn CPR."
The full texts of the Guidelines are
available online at http://circ.ahajournals.org/content/vol112/24_suppl/#INDEX
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