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AHA issues updated guideline on CPR, emergency CV care
The American Heart Association released an updated guideline on CPR and emergency CV care, incorporating new research on how best to perform CPR and how to create an integrated system of care for those with cardiac arrest.
“The guidelines represent the definitive science-based and evidence-based platform for providing emergency CV care,” Clifton W. Callaway, MD, PhD, chair of the AHA’s Emergency Cardiovascular Care Committee and a member of the panel that wrote the guidelines, told Cardiology Today. “The [AHA] feels it’s a core part of our mission to train people in [CPR and emergency CV care] and to help different parts of the community and professional providers deliver this care to all people in all places.”
Clifton W. Callaway
Callaway, professor and executive vice chair of the department of emergency medicine at the University of Pittsburgh, said he and colleagues began a scientific review in 2011 and came to many of the same conclusions that the Institute of Medicine did in its report on improving survival rates and quality of life after cardiac arrest, which was published in June.
“Overall, there’s a greater emphasis on systems of care, [culminating in] a complete integrated delivery system where patients receive appropriate evidence-based care from the very first emergency all the way through the end of their hospital care,” he said.
CPR techniques
The committee made several changes to its recommendations on how best to perform CPR and provide basic life support. These include:
- Rescuers of adult victims of cardiac arrest should perform chest compressions at a rate of 100 per minute to 120 per minute. The previous guideline, published in 2010, recommended at least 100 per minute.
- Chest compressions on the average adult should be at a depth of at least 2 in, or 5 cm, and not greater than 2.4 in, or 6 cm. The previous recommendation was at least 2 in.
- Untrained lay rescuers should perform compression-only CPR until the arrival of an automated external defibrillator or personnel trained in CPR.
- Dispatchers receiving a call about a possible cardiac arrest should ask if the victim is responsive and breathing normally, should tell the caller to assume the victim is in cardiac arrest if he or she is unresponsive and has absent or abnormal breathing, and should be trained in how to identify unresponsiveness.
- It is reasonable for trained responders to administer naloxone to patients with known or suspected opioid overdose who are unresponsive and not breathing normally but have a pulse.
Systems of care
The panel made the following new recommendations regarding systems of care and continuous quality improvement:
- A common framework should be provided to stakeholders to assemble an integrated resuscitation system. “An effective system of care comprises … structure, process, system and patient outcomes in a framework of continuous quality improvement,” they wrote.
- Separate “chains of survival” are necessary for patients experiencing in-hospital cardiac arrest and those experiencing out-of-hospital cardiac arrest.
- Based on the results of a program conducted in Sweden, it may be effective for communities to incorporate mobile technologies to summon trained rescuers in close proximity to someone experiencing out-of-hospital cardiac arrest.
Other new or updated recommendations cover basic life support given by health care providers; advanced CV life support; and pediatric CPR, basic life support and advanced life support.
“The guidelines emphasize that every person is part of the systems of care,” Callaway told Cardiology Today. “We value the importance of having every person trained and aware of how they can react in an emergency. Implementation includes education of the public in creating a culture … that empowers people to take action when there is someone in cardiac arrest or having an acute CV event.” – by Erik Swain
For more information:
Clifton W. Callaway, MD, PhD, can be reached at Department of Emergency Medicine, University of Pittsburgh, Iroquois 400A, 3600 Forbes Ave., Pittsburgh, PA 15260; email: callawaycw@upmc.edu.
Disclosure: Callaway reports no relevant financial disclosures. See the full guideline for a list of the relevant financial disclosures of the other authors and reviewers.