AHA CPR Guidelines – Latest Jan 2014

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 Steps

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!

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Comments

  1. Hi, I am working as BLS-ASCLS instuctor in Sagar hospitals, Bangalore since 2yrs. Since all the nursing staff cannot take ACLS course instantly due to staffing problem, I am giving orientation of ACLS & PALS when the staff come for BLS in order to get used to crash trolley items. Periodically I am checking for updates and I found the above mentioned information is also useful for the staff to learn well. Thanks for this information.
    HVSM, AHA-BLS & ACLS Instructor

  2. azadehjou abbas says:

    not shocble cardiac arrest and treatment

  3. I was wondering when the rescue breaths are going to be shortened. Useful info and very applicable and practical as well.
    Thanks from MACEDONIAN RESCUER
    https://www.facebook.com/pages/MACEDONIAN-RESCUER/132098013519995?fref=ts

  4. Hi there. I’ve been oriented then from my nursing school that the rescuer must first ask the victim if she’s OK before asking somebody to call 911. So now calling 911 must come first before making the victim respond. Thanks.

  5. Lawrence Lee says:

    Is that any tutorial video for it? :)

  6. Rajasekharan Nair,
    Public Safty Instructor,(FAST)
    Indian Institute of Emergency Medical Service.
    :Hands on CPR will very effective for General People :

  7. Indian Institute of Emergrency Medical Service Conducting First Aid and Safty training programme (First Responder Course) at all states of India for Govt. Organisations, Schools, Colleges, etc since 2004.

  8. I have been told by my instructor the compression to breath rate is now 30 to 1 however, everything in every book show this as 30 to 2. Which is correct please?

    • kim fawkes says:

      Hi Ellen
      The Australian Resuscitation Council still recommends 30:2. I don’t know where your instructor (what are their qualifications and experience?) got 30:1 from, though they may be thinking that breathing has little value in resuscitation because the average person still has oxygen in their body from normal ventilation. I can see a time in the future where breaths are discarded completely in favour of compressions only for the lay person though the emergency services may still give supplementary oxygen via a mask, cheers Kim

    • 30:2 is correct.

  9. kim fawkes says:

    G’day I’m a first aid trainer and I am still being told to teach my students DRSABCD. But you indicate we should do DRSCABD. Is that right? I don’t know if the Australian Resuscitation Council will be passing this onto us but in any event, it seems that I should now put compressions ahead of checking the airway and doing two breaths. I have been advising my students of this change in CPR practice and they also query why they should have to do two breaths when it has been shown that breathing into an unconscious person’s lungs don’t really do that much, that the fact the person was breathing minutes ago means they should have enough oxygen in their body. Cheers, Kim

  10. Hari krishna says:

    Rescue breaths are given 30:2.
    1) Are these breaths given only for 2 seconds duration each or more. If so whats the duration.
    2) What is the interval or gap between 2 breaths.
    3) Does the duration of each breath varies in children and adults. If so, please mention.

    • kim fawkes says:

      G’day, there is no real duration of breaths. As soon as you finish one, you give the other, making sure you look and feel for the rise and fall of the chest before repeating this action. Breathing into a child or adult’s mouth is pretty much the same (pinch their nostrils, seal their mouth with yours or use a face shield mask) as you will need to give two quick breaths whereas with an infant you only give two puffs so as to not hyper-inflate their lungs. It is interesting that the AHA recommends chest compressions ahead of breaths as the whole process of checking the airway and breathing wastes valuable time that could be better spent on compressing the heart even though this method only increases cardiac output by about a third compared with normal heart function.

      I hope this answers your question.

  11. Really Informative for the update. Thxs a lot

    • kim fawkes says:

      Hi, I know that pushing down on the chest is how one does compressions to simulate the heart’s contraction and relaxation phase so when you say Airway – Breathing – Chest, don’t you mean Airway – Breathing – Compressions? Compressions are more important than airway and breathing if the casualty is in life thtreat, i.e. cardiac arrest, but if they are unconscious from an epileptic seizure for example and are breathing and have a strong pulse then there would be no need for compressions so airway and breathing would be more applicable here. Cheers Kim

      n’t in life threat and had Cheers Kim

  12. wilbernetta says:

    HI SO I TEST FOR MY PN LICENSE JUNE 10 AND I JUST WANTED TO CLARIFY IF COME ACROSS SOMEONE JUST LAYING OUT, DO I ASSESS FOR UNCONSCIOUSNESS FIRST OR CALL FOR HELP FIRST? IT SEEMS LIKE IF I SEE THEM PASS OUT I WOULD CALL OUT OR CALL FOR HELP AND THEN HELP.. I’M JUST SO CONFUSED.. THANK YOU!!

    • kim fawkes says:

      Hello My understanding is based on the current Australian Resuscitation Guidelines. D – Danger, Response – do they respond? Are they conscious/unconscious? If unconscious or they require additional medical assistance, then S – Send for help, cheers Kim

  13. For training purposes always insist that the learner uses his or her own PVC mouth piece with a non return valve. What usually happens is that if a learner is suffering from a contagious disease such as TB he or she may pass the bacterium through the mouth piece into the dummy and the next person can do the same if they are a sufferer until there is a build up of TB sputum in the lungs of the dummy . When chest compressions are performed the contaminated sputum is ejected back to the mouth area and there is a danger of the learner who is not a sufferer of TB or if he or she is not using a non return valve mouth piece can be infected realising that TB is spread by the contaminated sputum from one to another. Take care and be safe.

  14. Hellow , Indian Institute of Emergency Medical Services conducting BLS, ACLS, PALS, ATCN, AREMT, BDLS, ADLS Courses since 2005. We also conducting First Responder level courses for police Force, Fireforce, Motor Vehicle Department, Schools, Colleges, Residential Associations, Charitable Trusts etc.

  15. My friend died two days ago after he collapsed at our school. I was in the building, but no one made me aware this was happening at the time. No one performed CPR. I guess no one knew. I was certified long time ago, but let it expire. I would have done something. At least the compressions. Maybe it was his time to die, but I would have tried! My goal is to get people in our school building to get certified in CPR. No shift in our school should be without at least one person knowing CPR. I am devastated that I was not given a chance to save my friend when compressions alone might have saved him.

    • Miki, I am so sorry for your loss. Yes i think trained and certified people can really help save lives. You should try to educate more about the importance of getting CPR training

  16. Hello!
    Thank you for the updates…just some clarifications for Pediatric resuscitation as its said the most common cause of cardiac arrest in children is hypoxia does the new recommendations imply studies have shown hypoxia is no more the primary problem in children and now the emphasis switch to Circulation.

    And CAB approach with upfront chest compression-does is apply to all patients even those with palpable reasonable pulses i.e. >60/min for example you have unconscious child with no spontaneous breathing but palpable pulse>60/min do you straight go for Chest compression

  17. Martin Wilson says:

    Is the AHA still recommending that a professional health worker such as a registered nurse palpate for a pulse before commencing cardiac compressions ?.

  18. Martin Wilson says:

    Does the AHA recommend that a professional health care worker such as a registered nurse palpate for a pulse before commencing cardiac compressions ?. Thank you.

    • For a start, here in Australia we recommend that rescuers not waste time palpating for a pulse before starting chest compressions for anyone who is unconscious and not breathing (the obvious reasons for initiating CPR). Obviously no pulse goes with this as the pulse will cease soon after breathing stops. In patients I have come across all have had no breathing or barely breathing, hard to read and find) palpable pulse, etc. All have lacked PEARL and some have had dilated pupils. I did atest on some of my students. Using a stop watch I timed their ability to find and palpate a pulse and count beats: most took too long so the person would have been clinically dead by the time they found a pulse so I told them to abandon the pulse (not part of the Primary Survey) and concentrate on CAB and not ABC. Cheers, Kim

  19. Dr Raghav Kapoor says:

    Q1. According to the latest guidelines, is it ABC or CAB? is the sequence same in case of BLS and ALS?
    Q2. Chest compressions are given in the center of the chest or lower 1/3?
    Q3. Actively bleeding patient, first step is to stop the bleeding or secure airway?
    Q4. Neck injury, first step is to secure airway or neck stabilization?
    Q5. In V fib, adr is given after 1st shock or second?

    • Q1. The Australian Rescitatiion Guidelines recommend ABC but other first aid providers go for CAB as does Ambulance Victoria. Yes same as BLS and ALS.
      Q2. Chest compressions are given lower half of sternum, effectively in line with the nipples (on the average person) and above the xiphoid process
      Q3 Maintain airway comes before anything else
      Q4. As above
      Q5. Adrenaline is given after 1st shock or when our ambulance crews get around to it as there may be extenuating circumstanes that prevent adrenaline injection prior to this

  20. 2 person CPR- is ratio still 10 compressions to 1 breath?

  21. kim fawkes says:

    I recently attended a CPR lecture on rescuing a person who had been electrocuted where the trainer advised participants to grasp and use the unconscious person’s hand and fingers to “finger sweep” their mouth to remove vomit, etc. This is incorrect and just plain WRONG! For a start a person who has been electrocuted may have hand/finger burns so using their hand would be an infection control no-no. Secondly, a fair amount of pressure is required to “finger sweep” a person’s mouth and an unconscious person would lack sufficient muscle strength in their hand/fingers to clear their own airway.

    This brings me to the qualifications/experiences of the average first aid trainer. I believe appropriate standards should exist for first aid training and that a professional body is long overdue in Australia. Professional organisations exist for nurses, doctors and other health professionals and thesame should exist for first aid trainers to weed out those who lack appropriate skills and knowledge. Anyone in Australia want to get behind me on this and help set up an appropriate professional organisation for first aid trainers? Cheers Kim

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