2005 American Heart Association Guidelines For Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Comparison Chart of Key Changes

Download as pdf or txt
Download as pdf or txt
You are on page 1of 4

2005 American Heart Association Guidelines

for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care


Comparison chart of key changes

2005 Recommendation 2000 Recommendation Explanation


Basic Life Support
Increased emphasis on delivery of effective Emphasized the first three links in the When chest compressions are interrupted, blood flow stops.
chest compressions Chain of Survival: early access, early Limiting interruptions to chest compressions will result in
CPR, and early defibrillation. Stated greater survival.
early CPR significantly improved
survival. Named early defibrillation as In any given series (cycle) of chest compressions, earlier
the single greatest determinant of survival compressions are less effective than later ones. Therefore,
for adult victims of cardiac arrest. fewer interruptions increase the percentage of effective chest
compressions.

Allowing the chest wall to fully “recoil” or return to its normal


position between compressions results in better re-filling of
blood in the heart, which allows more blood to be pumped to
the rest of the body during the next compression.
Single CPR compression-to-ventilation A compression to ventilation ratio of 15 A single ratio will make learning the correct procedure for
ratio: 30:2 for all rescuers responding alone to 2 was recommended for adult CPR; a responding to victims of all ages easier and increase the
to victims of any age, except newborns. ratio of 5 to 1 for child and infant CPR. likelihood that a rescuer will remember the steps of CPR
during an emergency.
CPR for newborns is the same as 2000 Three compressions for every one breath
guidelines recommendation.. should be given to newborns, totaling 90 The new ratio also helps reduce interruptions in chest
compressions and 30 breaths per minute. compressions (see explanation above).
AED programs should be implemented in Key elements of successful AED Some AEDs do not require a medical prescription, so
public locations where there’s a relatively programs were recommended, including healthcare provider oversight of AED programs is not
high likelihood of witnessed cardiac arrest healthcare provider oversight, training of mandatory.
(eg, airports, casinos, sports facilities and likely rescuers, link to local EMS system
businesses). and process of continuous quality The Public Access Defibrillation trial reinforced the
improvement. importance of planned and practiced response. Lay rescuer
programs in airports and casinos and by police officers have
reported survival rates as high as 49 percent to 74 percent
when responding to sudden cardiac arrest caused by
ventricular fibrillation.

11/22/05
2005 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Comparison chart of key changes

2005 Recommendation 2000 Recommendation Explanation


A single shock from a defibrillator, Up to three shocks in a series were Repeated cycles of rhythm analysis and shock result in delays
followed by immediate CPR for two recommended to treat cardiac arrest with of up to 37 or more seconds before the first post-shock chest
minutes, beginning with chest a “shockable” rhythm before returning to compressions are delivered. Most defibrillators eliminate VF
compressions, should be used to treat chest compressions; the heart rhythm was more than 85 percent of the time. If the first shock fails,
cardiac arrest caused by ventricular evaluated before and after each shock. immediate CPR (before trying another shock) is likely to
fibrillation (VF-the abnormal heart rhythm contribute to the success of a subsequent shock. Even when a
responsible for most cardiac arrests). shock eliminates VF, it may take several minutes for the heart
to pump blood effectively, even if a normal heart rhythm
returns. A brief period of chest compressions can deliver
oxygen to the heart during this post-shock period, increasing
the likelihood that the heart will begin to effectively pump
blood on its own.
After giving two rescue breaths, lay After giving two rescuer breaths, lay Lay providers cannot reliably detect the presence of
rescuers no longer check for signs of rescuers were instructed to check for signs circulation in a victim. Great harm can be done when rescuers
circulation before beginning chest of circulation (normal breathing, don’t do chest compressions when they’re needed. Relatively
compressions. coughing or movement). Lay rescuers minimal harm can be done by providing chest compressions
gave rescue breathing without chest when they aren’t needed. Therefore, the new guidelines do
compressions to victims with signs of not recommend that lay rescuers look for “signs of
circulation who were not breathing circulation” before delivering chest compressions. This
normally. eliminates the chance that lay rescuers might not recognize
true cardiac arrest, and reduces delays to chest compressions.
Eliminating instructions to look for signs of circulation and for
delivering “rescue breathing without chest compressions”
reduces the number of skills required for lay rescuers. This
makes it more likely that the lay provider will learn and
remember the steps of CPR.

11/22/05
2005 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Comparison chart of key changes

2005 Recommendation 2000 Recommendation Explanation


Dispatchers should be trained to recognize Dispatchers were not instructed to Early administration of aspirin has been associated with
the symptoms of Acute Coronary recognize ACS or recommend aspirin. decreased mortality rates in several clinical trials. Many
Syndromes (ACS), and advise patients with studies have demonstrated the safety of aspirin administration.
symptoms of ACS without history of
aspirin allergy or gastrointestinal bleeding
to chew 160 mg – 325 mg of aspirin while
awaiting the arrival of EMS providers.
Advanced Cardiac Life Support
Basic Life Support (BLS) skills are the Heart rhythm analysis, delivery of shocks Studies show that providing continuous CPR outweighs the
priority in treating cardiac arrest. and selection of drug therapies resulted in potential effects of drug therapies, so interruptions should be
Providers must minimize interruptions to frequent interruptions to CPR. minimized.
chest compressions.
New neurological tests and evaluations No specific neurologic signs indicated the New research suggests there are specific clinical signs, such as
given 24 hours and 72 hours after potential for successful resuscitation. certain brain responses to stimuli, that correlate strongly with
resuscitation can predict survival to death or poor brain function following resuscitative efforts.
hospital discharge. More research is needed to predict potential for survival
during resuscitation.
Unconscious adult patients with return of Mild hypothermia may be In two randomized clinical trials, induced hypothermia
spontaneous circulation after out-of- beneficial….but hypothermia should not (cooling within minutes to hours after the return of
hospital cardiac arrest should be cooled for be induced actively after resuscitation spontaneous circulation) resulted in improved survival and
12 to 24 hours to 32 degrees C - 34 degrees from cardiac arrest. (Position was brain function in adults who remained comatose after initial
C when the initial rhythm was ventricular updated in a 2003 science statement from resuscitation from out of hospital VF cardiac arrest.
fibrillation. Similar therapy may be the International Liaison Committee on
beneficial for patients with non-VF arrest Resuscitation, which supported induced
out of hospital or for in-hospital arrest. hypothermia following resuscitation.)
Tissue plasminogen activator (tPA) is Administration of tPA was recommended National Institute of Neurological Disorders and Stroke
recommended for carefully selected for carefully selected patients with acute (NINDS) results have been supported by subsequent one year
patients with acute ischemic stroke, but ischemic stroke if they had no follow up, reanalysis of the NINDS data and a meta analysis.
cautions that tPA must be administered in contraindications to fibrinolytic therapy Additional trials supported the NINDS results.
the setting of a clearly defined protocol and and if the drug can be administered within Note: Higher complications of hemorrhage following tPA was
institutional commitment. 3 hours of the onset of stroke symptoms reported in one study when participating hospitals did not
require strict adherence to NINDS protocols.

11/22/05
2005 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Comparison chart of key changes

11/22/05

You might also like