UPDATE OCTOBER 15TH, 2015
AHA has a new version of CPR Guidelines, published in Circulation: Journal of the American Heart Association. Our expert Dan Taylor walks you through the latest protocols and answers some of your frequent questions in our latest overview. Read our latest review
A Brief Background and Update
Currently, there is no single designated governing organization that offers accreditation and regulation of CPR guidelines and curricula. However, the International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 as a collaborative effort to bring together organizations from around the world to discuss and review the most current research regarding resuscitation. The organizations that are part of ILCOR are:
- American Heart Association
- Australian and New Zealand Committee on Resuscitation
- European Resuscitation Council
- Heart and Stroke Foundation of Canada
- InterAmerican Heart Foundation
- Resuscitation Council of Asia
- Resuscitation Council of Southern African
ILCOR convenes twice a year, and every 5 years a new set of guidelines is released by the American Heart Association in partnership with ILCOR. The first set of guidelines was released in 2000, and the latest is expected to be released in October of 2015. The 2015 International Consensus Conference on CPR and ECC Science convened in Dallas, Texas, during the first week of February 2015. Over 200 members of ILCOR were present to finalize the discussion for the October release of the Concensus on Science with Treatment Recommendations (CoSTR). The evidence-based CoSTR is expected to be published online in the peer-reviewed scientific journals Resuscitation and Circulation. The American Heart Association and European Resuscitation Council will also publish CPR guidelines at that time.
While these official guidelines will not be published for another six months, many of the questions from the most recent ILCOR convening were made available for public comment until the end of February before moving on to the official review and development of 2015 guidelines. ILCOR has developed seven task forces to review various aspects of resuscitation and emergency cardiovascular care:
- Acute Coronary Syndrome
- Advanced Life Support
- Basic Life Support
- Education, Implementation, and Teams
- First Aid
- Neonatal Resuscitation
- Pediatric Life Support
Each task force reviews the research available worldwide and makes recommendations for various elements of each of the seven focus areas. The process of reviewing the most current guidelines and developing new ones each five years has a clearly defined structure so that no recommendations are made anecdotally or based on scant research, but rather on substantial, scientifically verified evidence.
The review process is as follows:
- Before the ILCOR convenes, each task force reviewed specific issues and developed related research questions
- The task forces then reviewed all the scientific literature available that pertained to each question
- Once all the pertinent publications had been collected, the committees rated each study on the quality of its findings
- The research was then summarized into a topic-specific consensus and a treatment recommendation was drafted
- When ILCOR convened for the Consensus on Science in February 2015, each task force presented their research questions, findings, and recommendations to the other six task forces
- All members of all tasks forces were given three weeks post-conference to pose inquiries and comments to any of the research questions from any of the task forces
- Once the three week comment forum window closed, the process of drafting the official guidelines will begin
The Basic Life Support (BLS) task force, for example, developed and reviewed 21 unique questions regarding the procedures and standards of BLS, including many pertaining to CPR such as:
- Does analysis of heart rhythm during chest compressions change survival and health outcomes?
- What is the optimal chest compression depth?
- What is the optimal chest compression rate?
- Is it better to begin CPR with chest compressions or to begin with ventilation?
- Is the 30:2 chest compressions to ventilation ratio the optimal ratio?
- Is pausing chest compressions every two minutes the optimal interval?
As the task forces moved through the review process, some of these questions were met with little or no research on which to base new recommendations, and others had substantial research with large sample populations on which to base new recommendations. Not only do the new guidelines provide new evidence-based information from which can be developed updated training tools and curricula, but the review process itself can provide information for research institutions to identify where the literature is scant and what studies would be useful to the continual further refinement of the CPR and emergency cardiopulmonary care guidelines.
The draft version of the guideline review shows minimal changes to the basics of CPR such as chest compressions and depth. This is beneficial to the research community as well as field practitioners. It means that research questions can be refined to enhance the scientific investigation, while practitioners can solidify their skill and knowledge of CPR rather than needing to re-learn and memorize a different procedure with new chest compression rate, ratio, and depth, etc.
A promising finding from the initial ILCOR CoSTR review is that as CPR and ECC research advances, we see survival rates increase. The future will also continue to bring more and better technology to help give accurate and real-time feedback to rescuers as administer emergency care to victims. Stay tuned for the AHA’s official release of updated guidelines October 15, 2015.