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    Cardiovascular Care

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    Geof Enob
    Cardiovascular Care

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    Cardiovascular Care

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    Geof Enob
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    Cardiovascular Care

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    Cardiovascular Care

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views2 pages

    Cardiovascular Care

    Uploaded by

    Geof Enob
    Cardiovascular Care

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    © All Rights Reserved
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    Practice Guidelines

    AHA Updates Guidelines for CPR and Emergency


    Cardiovascular Care
    of high-quality CPR, consisting of compres-
    Key Points for Practice
    sions of a sufficient rate and depth with
    • In adult CPR, 100 to 120 chest compressions per minute at a depth of
    minimal interruptions, allowing full chest
    at least 2 inches, but no greater than 2.4 inches, should be provided.
    recoil between compressions, and avoiding
    • Health care professionals can perform chest compressions and ventilation
    in all patients presenting with cardiac arrest. too much ventilation.
    • In patients with an advanced airway, one breath every six seconds Adults. When providing CPR, 100 to 120
    should be given with continuous chest compressions instead of 30 chest compressions per minute at a depth
    compressions and two breaths. of at least 2 inches, but no greater than 2.4
    • Compression depth in children should be one-third or more of anterior- inches, should be provided. Pauses in com-
    posterior diameter, or about 1.5 inches in infants and 2 inches in children. pressions should be as short as possible. A
    From the AFP Editors goal of a 60% or greater chest compression
    fraction may be reasonable in persons with
    an unprotected airway.
    Coverage of guidelines Providing cardiopulmonary resuscitation If the rescuer suspects that a patient with
    from other organizations
    (CPR) effectively is dependent on a variety of respiratory arrest has an opioid addic-
    does not imply endorse-
    ment by AFP or the AAFP. factors, including immediate action taken by tion, standard basic life support combined
    the rescuer and performance of high-quality with intramuscular or intranasal naloxone
    This series is coordinated
    by Sumi Sexton, MD, maneuvers. The American Heart Association should be provided, assuming the rescuer
    Associate Deputy Editor. (AHA) has updated its 2010 guidelines on CPR is appropriately trained. If the patient is at
    A collection of Practice
    and emergency cardiovascular care to high- risk of overdose, opioid overdose response
    Guidelines published in light important changes. The 2010 guidelines education can be provided at any point
    AFP is available at http:// changed the sequence of CPR from airway, and may be combined with instructions on
    www.aafp.org/afp/ breathing, compressions (ABC) to compres- administering naloxone for prevention. If a
    practguide.
    sions, airway, breathing (CAB) to avoid delays patient has a spinal injury, manual spinal
    in starting chest compressions; this remains restriction such as placing hands on either
    unchanged in the update. Also, for untrained side of the head is preferred over immobili-
    lay rescuers, chest compressions–only CPR is zation devices.
    recommended. This summary practice guide- When cardiac arrest with a shockable
    line focuses on adult and child basic life sup- rhythm occurs outside of a hospital, emer-
    port and CPR quality, as well as alternative gency medical services personnel can delay
    CPR techniques. Additional changes from the use of positive pressure ventilation by per-
    AHA regarding cardiac life support, post–car- forming cycles of 200 continuous compres-
    diac arrest care, acute coronary syndromes, sions (up to three cycles) combined with
    special circumstances, and more can be found passive oxygen insufflation and airway
    in the full guidelines. adjuncts. Although routinely using passive
    ventilation is not recommended when pro-
    New and Updated Recommendations viding conventional CPR because of ques-
    BASIC LIFE SUPPORT AND CPR QUALITY tionable effectiveness, this is a reasonable
    Evidence has indicated that the most com- method for emergency medical services per-
    mon mistakes that occur while providing sonnel who typically provide this combined
    CPR include not performing compressions approach.
    deep or fast enough. Additionally, evidence Emergency dispatchers should first find
    shows improved survival rates with delivery out where the event is occurring, and then
    ▲

    May 1, 2016from
    Downloaded ◆ Volume 93, Number 9 www.aafp.org/afp
    the American Family Physician website at www.aafp.org/afp. 
    Copyright © 2016 American
    American Academy of Family Family
    Physicians. For thePhysician  791
    private, noncom-
    mercial use of one individual user of the website. All other rights reserved. Contact [email protected] for copyright questions and/or permission requests.
    Practice Guidelines

    ask if the patient is unconscious with abnor- performing CPR is not willing or able to
    mal or absent breathing, and, if so, it should provide ventilation, then delivering com-
    be assumed that the patient is experiencing pressions only is appropriate.
    cardiac arrest. Training should be provided
    ALTERNATIVE TECHNIQUES AND ANCILLARY
    about how to recognize unconsciousness
    DEVICES
    using signs such as abnormal or agonal
    gasps and various presentations. Dispatch- Since the 2010 guidelines, additional evi-
    ers should provide callers with guidance on dence about the effectiveness of alternatives
    CPR using only chest compressions. and adjuncts to standard CPR has emerged;
    Health care professionals can perform however, it should be noted that specialized
    chest compressions and ventilation in all equipment and training may be needed when
    patients presenting with cardiac arrest. A alternative techniques are used.
    series of 30 compressions and two breaths is There is no advantage to routinely using an
    no longer necessary if there is an advanced impedance threshold device (a valve used to
    airway, and, instead, one breath every six decrease intrathoracic pressure and increase
    seconds should be given while chest com- venous return) as an adjunct to standard
    pressions are provided continuously. CPR (i.e., compressions and rescue breaths);
    Evaluation of electrocardiography rhythm however, combining its use with active CPR
    with artifact-filtering algorithms while (i.e., compression-decompression) has been
    performing CPR cannot be recommended; shown to improve neurologically intact sur-
    however, it could be useful for research or vival and, therefore, may be a reasonable
    for emergency medical services personnel option, assuming equipment availability and
    who use these algorithms already. Audiovi- proper training. Although no studies have
    sual feedback may be used to improve CPR indicated that mechanical chest compression
    performance. devices are better than standard CPR, they
    Children. Although there are no major may be a reasonable option, again assuming
    basic life support and CPR changes for chil- proper training, and can be considered when
    dren since the 2010 guidelines, new ideas performing high-quality manual compres-
    about how to perform CPR were evaluated. sions may be difficult or dangerous. It should
    For simplicity and consistency in training, be noted that interruptions in CPR should be
    it may be reasonable to keep the order of limited when using and removing the device.
    starting CPR as compressions, airway, and There is no assessment of how extracorporeal
    breathing vs. changing the order to airway, CPR, also called venoarterial extracorporeal
    breathing, and compressions. Compression membrane oxygenation, affects survival.
    depth was affirmed as one-third or more of Guideline source: American Heart Association
    anterior-posterior diameter (i.e., about 1.5
    Evidence rating system used? Yes
    inches in infants and 2 inches in children);
    however, evidence is lacking regarding the Literature search described? Yes
    rate and, therefore, it was not assessed. Guideline developed by participants without rel-
    Instead, the adult rate of 100 to 120 chest evant financial ties to industry? Yes
    compressions per minute is recommended. Published source: Circulation. November 3,
    Ventilation should be included when per- 2015;132(18 suppl 2):S315-S367
    forming CPR, because 30-day outcomes Available at: http://circ.ahajournals.org/
    were found to be worse when only com- content/132/18_suppl_2/S315.long
    pressions were performed. If the rescuer LISA HAUK, AFP Senior Associate Editor ■

    May 1, 2016 ◆ Volume 93, Number 9 www.aafp.org/afp American Family Physician 797

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