AHA official guidelines for CPR – Latest as Jan 2014
The AHA is a non-profit organization working to foster appropriate cardiac care. It is one of the organizations that determine what CPR and First Aid procedures should be universally followed. The AHA makes these recommendations in line with the latest advancements in the world of healthcare, science and technology. AHA released the latest version of its guidelines for CPR, Adult First Aid and AED (Automated External Defibrillator) in 2010.
In its latest CPR guidelines, AHA or American Heart association has re-arranged the A-B-C to C-A-B. A-B-C or Airway-Breathing-Compressions required the responder to first open the airway to give mouth-to-mouth breaths. AHA says that in this sequence, chest compressions are often critically delayed, even though the highest survival rates from cardiac arrest are reported among patients who received early chest compressions. Studies show that more than 22 percent lives are saved by hands only (chest compressions)as opposed to any other method. By updating the sequence to C-A-B or Chest-Airway-Breathing, compressions will be initiated earlier, increasing the chances of survival for many patients.
Untrained rescuers should take the Hands-Only approach
The latest AHA guidelines distinguish between an untrained bystander and a trained professional and provide steps for each type of rescuer. The previous version of the AHA guidelines (2005) only recommended that dispatchers should provide compressions-only CPR instructions to bystanders, but did not provide a different set of instructions.
According to the new recommendations if a bystander does not have any training in providing CPR for the patient, the bystander should initiate compression-only CPR also referred to as Hands-Only CPR. The AHA instructs the untrained bystander to “push hard and fast” or follow the instructions provided by the EMS dispatcher. The rescuer should continue the compressions until other responders take over or trained professionals arrive at the scene. The reason for the focus on Hands-Only CPR is because it is easier for dispatchers to provide instructions on the phone and untrained responders find it easier to perform it.
Depth of compression set at 2 inches for adults
The latest AHA guidelines instruct responders that the “adult sternum should be depressed at least 2 inches.” This is a shift from the previous version of the guidelines which defined the depth of compression to be approximately 1½ to 2 inches. Compressions directly pump the heart and create blood flow in the victim, providing oxygen to the brain and heart. The guidelines decided to provide one compression depth to avoid any confusion for rescuers and to make sure they push hard which they usually fail to do so. Also, recent studies found that compressions 2 inches deep were more effective than compressions that were only 1½ inches deep.
Removal of “Look, listen and feel”
Previously the AHA recommended that the responder “Look, listen, and feel” after the airway was opened to make sure that the patient is breathing. Now, in the latest AHA guidelines, the rescuer has to open the patient’s airway and deliver two breaths after conducting 30 compressions on the patient’s chest.
Routine use of Cricoid pressure discontinued
The latest AHA CPR guidelines have discontinued the routine use of cricoid pressure during ventilation. Cricoid pressure is a technique of applying pressure to reduce the risk of regurgitation and aspiration. The previous edition of the AHA guidelines used to suggest the use of Cricoid pressure if the victim was “deeply unconscious.” However, a number of recent studies found that use of this technique can actually impede ventilation. Moreover, it is not an easy technique to master and it is difficult to adequately train rescuers. Therefore, the latest set of instructions coming from the AHA say that the routine use of Cricoid pressure is not recommended.
The new AHA guidelines provide step by step instructions according to the C-A-B sequence. Rescuers should first conduct a brief assessment to determine whether the victim is responding or not. If there is no response, the responder should take ten seconds to check for normal breathing or pulse. If normal breathing or pulse cannot be detected within the ten seconds, immediately initiate CPR, starting with 30 chest compressions. The compressions should be two inches deep, on the center of the victim’s chest. The responders should deliver the compressions at a rate of 100 per minutes, which comes to roughly over 1.5 compressions per second. After delivering 30 compressions, the responder should tilt the victim’s head and lift the chin to open the airway and deliver two breaths. The responder should then go back to the chest compressions and repeat the process in a 30 to 2 ratio, and continue until another responder takes over or professional help arrives at the scene.
Following the new CPR guidelines from the American Heart Association
- First step, call for help.
- Check to see if the victim responds. If there is no response, roll the victim over on to their back.
- Place the heel of one hand on the center of the victim’s chest and the other hand right on top of the first with fingers intertwined. Now start pushing down “hard and fast” ensuring that you are delivering compressions “at least 2 inches deep.”
- Keep counting as you push down and once you complete 30 compressions move on to the airway.
- Tilt the victim’s head by pushing down the forehead and lifting the chin to open the airway.
- Pinch shut the victim’s nose using the forefinger and thumb.
- Take a normal breath in, not a deep one, and give two breaths while making sure that your mouth completely covers the victim’s mouth to create an air-tight seal. Check to see if the victim’s chest rises.
- Move back to deliver chest compressions and continue the pattern of 30 compressions followed by two breaths until the time medical assistance arrives or another responder takes over.
CPR guidelines are constantly changing and improving. Organizations like the AHA and American Red Cross stay on top of all developments in the world of medical research and make sure all CPR procedures recommended by them are up to date and most effective in saving more lives. For CPR certified responders to remain relevant and effective, it is important that they are aware of all updates. This is why CPR certification is valid only for two years and needs to be renewed at the end of this period to remain effective. In order to renew your certification, you should take up the CPR training course again to not only become aware of all the changes, but also to understand the rationale behind the updates. You will then have to sit for a CPR exam to renew your CPR certification.
Cardiac arrest, near-drowning, electrocution, choking etc. are all emergencies that need an instant response. With prior knowledge and adequate training in First Aid and CPR, you can save a life. Incorrect or incomplete information might actually result in making the situation worse and could possibly result in the loss of a life. It should be mandatory for everyone to learn the basic steps of CPR and First Aid, and to not only stay updated about the suggested methods of performing CPR and First Aid but also share the information with family, friends and colleagues. Remember, 80% of all medical emergencies occur in places other than hospitals and are handled by regular people – bystanders!
What do you think about this post? Share your thoughts in our comments section.