New CPR Guidelines
The newest ILCOR / ECC CPR guidelines stick with the same overall order of action, rates, ratios, and depths as the significantly updated 2010 guidelines set, but lay greater emphasis on how quick action, proper CPR training, utilizing readily available CPR technology and coordinated efforts can increase survival from cardiac arrest. Quick assessment The basic steps in preparation for CPR stay the same. Check for unresponsiveness and send someone for an AED if one is not already present on the scene. Compressions first Initiate chest compressions following the C.A.R.E. CPR™ approach. If a defibrillator is not already on the scene or on the way, the lone rescuer should leave the patient before initiating chest compressions in order to retrieve the device. 30 compressions to 2 ventilations New guidelines still recommend delivery of chest compressions and assisted ventilation at a rate of 30 chest compressions for every two assisted ventilations, beginning with chest compressions. Hand position Rescuers should compress on the lower half of the sternum in the adult patient. Rate of compressions The 2010 recommendations altered language from previous years to identify more accurately the minimum rate of chest compressions necessary. Those guidelines recommended a rate of at least 100 chest compressions per minute. Although no new evidence contradicts that recommendation, there is for the first time a recommendation on an upper limit of chest compression rate beyond which survival may be negatively affected. Two studies suggest survival may be improved if rescuers can keep the rate of chest compressions between 100 and 120 per minute. In both studies, survival rates fell when rescuers compressed at a rate above 120 compressions per minute. New recommendations suggest that rescuers attempt to compress at a rate faster than 100 but less than 120 compressions per minute. As many rescuers tend to compress at rates above 120 compressions per minute, Depth of compressions As important as rate is compression depth. The 2010 guidelines altered previous language to stress the need for deeper chest compressions. In those guidelines, the ECC recommended that rescuers push to a depth of at least two inches. Since publication of the 2010 guidelines, the largest study to date to address this question demonstrated that rescuers who compressed between 1.61 inches and 2.2 inches survival rates optimized survival rates. Although not necessarily affecting survival, another study suggested that compression depths greater than 2.4 inches increase the rate of patient injury. After assessing this new information, the new ILCOR / ECC guidelines now recommend that rescuers compress to a depth of at least two inches, but avoid compressing too deeply beyond 2.4 inches. Key points from the 2015 Guidelines Update provides bystanders, dispatchers and communities with practical guidance to improve the effectiveness of their teamwork:
- Untrained bystanders should still call 911 and provide Hands-Only CPR, or CPR without breaths, pushing hard and fast in the center of the chest to the rate of 100-120 compressions per minute. However, if the bystander is trained in CPR and can perform breaths, he or she should add breaths in a 30:2 compressions-to-breaths ratio.
- Bystanders should use mobile phones to immediately call 911, placing the phones on speaker, so the dispatcher can help bystanders check for breathing, get the precise location and provide instructions for performing CPR.
- Dispatchers should be trained to help bystanders check for breathing and recognize cardiac arrest. Dispatchers should also be aware that brief generalized seizures may be an early sign of cardiac arrest.
- Mobile dispatch systems that notify potential rescuers of a nearby presumed cardiac arrest can improve the rate of bystander CPR and shorten the time to first chest compressions.Communities may want to consider this service to improve the chain of survival.