Just five years after revising the guidelines for basic life support for cardiac arrest and choking victims, the American Heart Association has done it again.

The new 2005 AHA guidelines for CPR and Emergency Cardiovascular Care are based on the largest review of resuscitation literature ever published. The process was organized by the International Liaison Committee on Resuscitation (ILCOR), and involved 380 international resuscitation experts over a 36-month period. These new guidelines are mandated to go into effect for all Healthcare Provider Classes given by CPR Instructors working under the Austin – Travis County EMS Authority, after August 30, 2006. AHA Heart Saver classes will have the new guidelines implemented at a future date, to be announced.

The highlights of the changes to the Healthcare Provider Course discussed below are not a complete listing, and the science behind these changes is not discussed here. The complete 2005 AHA Guidelines for CPR and ECC (12/13/2005), and the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations (11/29/2006), can be viewed free of charge at www.circulation.org.    

 

The major changes to the AHA Basic Life Support for Healthcare Providers Course are as follows:

 

1.      New emphasis is being placed on the quality and speed of cardiac compressions and the need for minimum interruption of compressions for breaths or AED shocks. This has been shown to greatly increase the effectiveness of CPR. The new ratio of compressions to breaths is 30:2 for adult 1 & 2 rescuer CPR and Child/Infant single rescuer CPR, and 15:2 for 2 rescuer Child/Infant CPR, (the 5:1 ratio has been eliminated completely). Compressions are to be given “Hard and Fast” (at a rate of at least 100/min.), and breaths are to be given over 1 second, rather 1-2 seconds. Renewal Class skills demonstrations will require all students to give 90 chest compressions (compared to 30 before) on the adult simulator without resting. So, students will need to be in good physical condition, or make sure a defibrillator is nearby. (The AED Trainer used in the class will not actually defibrillate!) Students will follow DVD segments, which direct the new BLS course, so be prepared for some work! If you have a valid medical reason for abstaining from this much activity, the TSBDE must exempt you from the CPR requirement, and I think quite a few students who could handle the old course, may not be able to tolerate the new one.

 

2.      Another major change deals with the use of the AED, or Automated External Defibrillator. In 2000, the AED was brought formally into the CPR course, and once connected, would attempt 3 shocks before allowing one minute of CPR. This interruption in CPR was deemed to be too long, however, so the new course recommends only one rhythm analysis and shock, followed by CPR for another 2 minutes before analyzing the victim’s rhythm again. Since all AEDs are programmed to deliver 3 shocks – allow for 1 min. of CPR – 3 shocks - etc., The AED companies are going to have to change the programs for all new and existing AEDs, or the AED will have to be turned off after each shock, and turned on again after 2 minutes of CPR. To add to the confusion, there are also changes in when to bring the AED into the rescue. Before 2006, the AED was to be used ASAP, but the new guidelines give the rescuer a choice to make. If an adult collapse is witnessed, the AED should be used ASAP, but if the response is > 4-5 min., 2 min. of CPR should be given first. In child rescues, 2 min. of CPR should always precede the use of the AED (it was one min. before), and then pediatric pads or settings should be used if available, but if not, adult AED settings are to be used for the child. In the 2000 guidelines, no provisions were made for using adult-only AEDs in child rescues.

 

3.      Other changes include:

·        Defining a “child” as age 1 to puberty instead of ages 1-8 or 55lb.

·        Elimination of the jaw-thrust maneuver in cases of suspected trauma; the head-tilt/chin-lift is now to be used regardless to open the airway.

·        The elimination of abdominal thrusts for adult unconscious choking victims; CPR is now started at this point and prior to each ventilation, the mouth is checked for objects to be removed (blind finger sweeps are no longer allowed).

·        The landmarks for hand placement for Adult/Child chest compressions are changed from 1 finger-width above the xiphoid process to the middle of the sternum at the nipple line.

 

The 2005 AHA Guidelines for CPR and ECC will bring notable changes to the Healthcare Provider Classes that you and your teams have been taking. Renewal classes will be longer than they currently are by approximately one hour, as the DVD has to be adhered to carefully. Skills Testing Checklists must be used by Instructors who now cannot coach students during their skills demonstrations. Inability to perform the required skills will result in the need for remediation at a future date, and thus a delay in the renewal of CPR certification. All students must also purchase the new course book, which is $10.00.  A review of the book must be made by each student prior to the day they take the course. The American Red Cross and The National Safety Council are expected to update their CPR courses in the near future.

Knowledge is power. Improving our ability to handle office emergencies involving cardiac arrest or airway obstruction, will save lives and improve the surviving victims’ prognoses for a full recovery. Thanks to the American Heart Association our power can now be increased.

 

By G. Joe Wright, DDS