American Heart Association has recently released their new guidelines for CPR & ECC. Although we did not note any major changes there are a fair amount of minor changes, adjustments & clarifications with data to support the recommendations. Below is a synopsis of changes we thought were most relevant. We highly recommend you reading the "Highlights of the 2015 AHA Guidelines Update for CPR and ECC" as it presents a complete list of changes, compares it to the old reccomndation and the reason for the change. You can download the document here.
New training material and subsequent updated instruction will not be available until sometime in early 2016. You are not required to update your certifications until the expiration date listed on your card. As is expected it will take some time for facilities and protocols to adjust to the new recommendations. In the interim any class taught by SMRT Indiana will include discussions of the upcoming changes until the newest training material is made available. This way you are familiar with the changes no matter when you get certified.
- Recommended rate of chest compressions are at a rate 100-120 bpm.
- Adult compressions should be at a depth of at least 2 inches (5 cm) but no more than 2.4 (6 cm).
- Avoid leaning on chest between compressions to allow for effective recoil.
- The new recommendations encourages a simultaneous initial assessment over a methodical, step-by-step approach for health care providers.
- The recommendation continues to push minimizing interruptions with a new goal of providing compressions at least 60% of the time. With that said there is a direct correlation to the amount of quality compressions and good patient outcome so doing better than the minimum is recommended.
- For prehospital advanced care, it may be reasonable for witnessed OHCA with a shockable rhythm to delay PPV by using up to 3 cycles of 200 continuous compressions with passive oxygen insufflation and airway adjuncts (NRB and basic airway) with interposed shocks.
- Simplified ventilation during CPR with an advanced airway with a rate of 1 breath every 6 seconds (10/per minute)
- Allows HCP flexibility to tailor emergency response that best matches setting.
- There is no current change in depth of compressions for infant or child. Recommendations now advice adolescents or patients who have reached puberty should receive the recommended adult depth of at least 2 inches but no more than 2.4.
- Rate of compressions for infant and child reflect the adult rate of 100-120 compressions per minute.
- There are no proven results that vasopressin offers an advantage over epinephrine in a cardiac arrest. Therefore to simplify the ACLS algorithm vasopressin has been removed.
BUT Steroids may provide some benefit when bundled with vasopressin and epinephrine. Pending further studies routine use is not recommended although it is reasonable for a provider to administer the bundle.
- If unable to achieve an ETCO2 reading of over 10 mmHg after 20 minutes of CPR, this can be used as one component of a multimodal approach to decide when to terminate resuscitative efforts.
- Although there is no evidence to support the use of Lidocaine in a cardiac arrest, it may be considered immediately after ROSC in cardiac arrest due to VF/pVT.
- When providing therapeutic hypothermia the target temperature is now 32-36 C for at least 24 hours. Treatment can be continued beyond the 24 hours to prevent fever in comatose patients.
- It is not recommended to provide cold IV fluids prehospital in the event of ROSC.
- It may be reasonable to not immediately correct hypotension during post arrest care.
- It is recommended to withhold O2 therapy in patients with possible ACS and have normal oxygen saturation and no respiratory distress as it has been shown to cause harm in these patients.
- Naloxone administration by lay rescuers and HCP is now recommended in the treatment of suspected overdose but focus should be on providing quality CPR or delay more advanced medical care waiting for patient's response to its administration.
- It has been shown that children suffering from severe febrile illnesses (shock) have had worse outcomes associated with treatment of IV fluids. Because of this recommendations state that an initial 20 ml/kg bolus is reasonable but future blouses should be undertaken with extreme caution, especially if there is limited access to critical care resources.
- There is no evidence to support the use of atropine as a premedication for intubations in pediatric patients. It may be considered in situations when there is a high risk of bradycardia.
- Both Amiodarone and Lidocaine are equally acceptable for the treatment of refractory VF/pVT in pediatric patients.
- The temperature In children who are comatose in the first several days after cardiac arrest should be monitored continuously and fever should be treated aggressively.
- For comatose children from OHCA it is reasonable for caretakers to maintain normothermia (36 C - 47.5) for 5 days or 2 days of continuous hypothermia (32 C - 34 C) followed by 3 days of normothermia.
- Insufficient data to support hypothermia over normothermia treatment for IHCA.
Visit our blog often to keep up to date on any new changes and recommendations. Remember we offer American Heart Association CPR & ECC training through our open enrollment classes located throughout Central Indiana, online and onsite at your location anywhere in Indiana and surrounding areas.