[HARMRED] 2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" CME/CE

[McLean, Rachel (CDPH-CID-DCDC-STD)]

Hi all,


American Heart Association guidelines throw out rescue breathing in
favor of starting with chest compressions. If you look they include
naloxone under in part 12 "special situations" (read full text here:
http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S829) but
it's buried. 


2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" CME/CE 


News Author: Emma Hitt, PhD
CME Author: Laurie Barclay, MD

MedScape,
http://cme.medscape.com/viewarticle/731231?src=cmemp&uac=150256CZ

October 20, 2010 - Chest compressions should be the first step in
addressing cardiac arrest. Therefore, the American Heart Association
(AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of
cardiopulmonary resuscitation (CPR) be changed to C-A-B
(Compressions-Airway-Breathing).

The changes were documented in the 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care, published in the November 2 supplemental issue of
Circulation: Journal of the American Heart Association, and represent an
update to previous guidelines issued in 2005.

"The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care]
are based on the most current and comprehensive review of resuscitation
literature ever published," note the authors in the executive summary.
The new research includes information from "356 resuscitation experts
from 29 countries who reviewed, analyzed, evaluated, debated, and
discussed research and hypotheses through in-person meetings,
teleconferences, and online sessions ('webinars') during the 36-month
period before the 2010 Consensus Conference."

According to the AHA, chest compressions should be started immediately
on anyone who is unresponsive and is not breathing normally. Oxygen will
be present in the lungs and bloodstream within the first few minutes, so
initiating chest compressions first will facilitate distribution of that
oxygen into the brain and heart sooner. Previously, starting with "A"
(airway) rather than "C" (compressions) caused significant delays of
approximately 30 seconds.

"For more than 40 years, CPR training has emphasized the ABCs of CPR,
which instructed people to open a victim's airway by tilting their head
back, pinching the nose and breathing into the victim's mouth, and only
then giving chest compressions," noted Michael R. Sayre, MD, coauthor
and chairman of the AHA's Emergency Cardiovascular Care Committee, in an
AHA written release. "This approach was causing significant delays in
starting chest compressions, which are essential for keeping oxygen-rich
blood circulating through the body," he added.

The new guidelines also recommend that during CPR, rescuers increase the
speed of chest compressions to a rate of at least 100 times a minute. In
addition, compressions should be made more deeply into the chest, to a
depth of at least 2 inches in adults and children and 1.5 inches in
infants.

Persons performing CPR should also avoid leaning on the chest so that it
can return to its starting position, and compression should be continued
as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so
that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers
instruct untrained lay rescuers to provide Hands-Only CPR (chest
compression only) for adults who are unresponsive, with no breathing or
no normal breathing.

Other Key Recommendations 

Other key recommendations for healthcare professionals performing CPR
include the following:

*	Effective teamwork techniques should be learned and practiced
regularly.
*	Quantitative waveform capnography, used to measure carbon
dioxide output, should be used to confirm intubation and monitor CPR
quality.
*	Therapeutic hypothermia should be part of an overall
interdisciplinary system of care after resuscitation from cardiac
arrest.
*	Atropine is no longer recommended for routine use in managing
and treating pulseless electrical activity or asystole.

Pediatric advanced life support guidelines emphasize organizing care
around 2-minute periods of continuous CPR. The new guidelines also
discuss resuscitation of infants and children with various congenital
heart diseases and pulmonary hypertension.

The authors of the guidelines have disclosed no relevant financial
relationships. 

Circulation. 2010;122[suppl 3]:S640-S656.

Additional Resource 
The 2010 AHA guidelines for CPR and emergency cardiovascular care
<http://circ.ahajournals.org/content/vol122/18_suppl_3/#_____AMERICAN_HE
ART_ASSOCIATION_GUIDELINES_FOR_CARDIOPULMONARY_RESUSCITATION_AND_EMERGEN
CY_CARDIOVASCULAR_CARE_SCIENCE>  are available on the AHA Web site.

Rachel McLean, MPH

Adult Viral Hepatitis Prevention Coordinator

STD Control Branch

California Department of Public Health

Phone: (510) 620-3403

Email: Rachel.McLean at cdph.ca.gov

Website: www.cdph.ca.gov/programs/pages/ovhp.aspx 

 

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