CPR Guidelines Updated With Doubling of Chest Compressions

MedPage Today ^ | 11/28/2005 | Katrina Woznicki

[Born Conservative]

DALLAS. Nov. 28 - When it comes to CPR, doubling the number of chest compressions and delivering them more quickly is the key to saving a life, according to the American Heart Association's revised guidelines issued today.

The updated guidelines call for 30 chest compressions delivered hard and fast for every two breaths administered by a single rescuer aiding a patient with cardiac arrest. That's a doubling from the 15:2 ratio, or 15 chest compressions for every two breaths, previously recommended.

The guidelines, intended for everyone from bystanders to trained paramedics, were presented at a press conference here and were published in the online edition of Circulation, Journal of the American Heart Association.

Another major change to the guidelines focuses on the administration of automated electronic defibrillators. The AHA panel is now recommending rescuers reduce the number of shocks they deliver from three to just one.

This new CPR compression ratio applies to cardiac arrest patients of all ages, including infants but not newborns. The recommendations are based on an international review conducted by an AHA panel. A team of 380 researchers analyzed data from more than 20,000 human and animal model studies and found that greater chest compressions led to increased coronary and cerebral blood flow.

While no specific study demonstrated the optimal compression-ventilation ratio for patients of all ages, evidence did show that multiple interruptions to chest compressions reduced the chances of survival.

"Pausing compressions means blood flow stops within just a couple of seconds," Michael Sayre, M.D., of Ohio State University and chair of the AHA's basic life support subcommittee. "The more times a person pushes on the chest, the better off the patient is," he said, and more compressions will help reduce interruptions.

The compression rate recommendation has not changed, Dr. Sayre added, remaining at 100 chest compressions per minute. This should be easier to achieve under the new 30:2 ratio recommendation, he said.

Sudden cardiac arrest claims about 250,000 lives every year in the United States. Worldwide, the survival for out-of-hospital cardiac arrest remains low, averaging about a 6% success rate or less.

However, survival rates are significantly higher, from 49% up to 74%, in places like casinos and airports, where there are lay persons trained in CPR and in using automated electronic defibrillators, the panel said.

The success of these programs included training in high-quality CPR and also defibrillation within five minutes of the patient's collapse, the panel noted.

On the guidelines change for automated electronic defibrillators, no human studies specifically compared the one-shock strategy with the three-shock approach. But evidence, the panel said, indicates that modern biphasic defibrillators have a high first-shock efficacy. This is defined as ending ventricular fibrillation for at least five seconds after the initial shock. It averages more than 90%, the panel said, "so that ventricular fibrillation is likely to be eliminated with one shock."

Data showed that the three-shock sequence produced delays of 29 to 37 seconds or more between the delivery of the initial shock and the start of post-shock compressions. The three-shock technique was also based on older equipment that had a lower first-shock efficacy, the panel said.

If a single shock fails to restore rhythm, rescuers should immediately resume CPR instead of attempting another shock because "effective chest compressions are likely to confer a greater value than an immediate second shock," the panel said.

Chest compressions must be deep and the rescuer must allow for complete recoil of the chest after each compression. The panel said this 'back-to-basics' approach should help boost uniformity in emergency care, which has included too many ventilations, too may interruptions, and not enough focus on chest compressions.

"We did have evidence from real life resuscitations with skilled health care providers that compressions were being interrupted so frequently for legitimate medical treatment," said Mary Fran Hazinski, R.N., M.S.N., the senior science editor of the AHA and a clinical nurse specialist at Vanderbilt University in Nashville.

The revised guidelines are intended to minimize that by instructing health care personnel to reduce interruptions by conducting heart rhythm checks, inserting airway devices, and administering drugs without delaying CPR.

The panel said current evidence indicates it's not the quality of the chest compressions that appears to be the problem, but the quantity and too much time spent off the chest,

The guidelines also addressed post-resuscitation care. The panel said the latest evidence shows promise in using therapeutic hypothermia to improve neurological outcome among adult patients who are comatose, but have survived a cardiac arrest. Brain cooling has also proved effective in treating newborns with asphyxia at birth. How hypothermia may be used for pediatric emergency cardiovascular patients remains unclear, the guidelines said.

They also recommend that 911 dispatchers be trained to provide CPR instructions by phone. Dispatchers may walk rescuers through compressions-only CPR for most adult victims of cardiac arrest; however, instructions to do compressions and rescue breaths will be given for infants and children or adult victims of asphyxia, caused by near-drowning or other non-cardiac causes.

[Born Conservative]

Ping

[keats5]

Whoa! That could be exhausting. When I was an active critical care nurse, the 15:2 ratio got tiring after a few minutes. I was always glad to see the Stat Team arrive.

[RGSpincich]

The compression rate recommendation has not changed, Dr. Sayre added, remaining at 100 chest compressions per minute. This should be easier to achieve under the new 30:2 ratio recommendation, he said.

Reporters are stupid. Why is the emphasis being put on doubling chest compressions when the true change is fewer breathes?

[Living Free in NH]

Why is the emphasis being put on doubling chest compressions when the true change is fewer breathes?

The way I read it, the number of breathes remains the same, but the compression rate is actually doubling - approx 2 compressions per second, instead of one.

[RGSpincich]

The way I read it, the number of breathes remains the same, but the compression rate is actually doubling - approx 2 compressions per second, instead of one.

That's why I mention it. The article is confusing. Dr.Sayre's quote below would seem to dispute your understanding of the article. Achieving the 100 compressions will be easier because less time will be taken for breathes.

The compression rate recommendation has not changed, Dr. Sayre added, remaining at 100 chest compressions per minute.

[wastoute]

Not surprisingly, the Lamestream media gets it wrong again.

wastoute, M.D.

[Stoat]

Anyone wishing to download the current AHA CPR guidelines in PDF format may do so here  :-)

(it might be a bit more coherent than the MSM's "interpretation" of it)

 

Currents Winter 2005-2006 Issue

Download Document Currents Winter 2005-2006 Issue

 

PDF of the 2005-2006 Winter issue of the ECC free quarterly newsletter, Currents.

This special edition of Currents presents the new material most relevant to instructors, compares it with the former guidelines, and gives you the scientific reasoning behind the change in compact and reader-friendly form.

The issue also includes links to the full guidelines document with all the references as well as an article on the evidence evaluation process, both available to you free online.

 
Currents Winter 2005-2006 Issue Adobe PDF, File Size 437.0 KB