AHA official guidelines for CPR – Updated Feb 2019
The American Heart Association (AHA) is a non-profit organization committed to fighting cardiovascular disease and the effects of it including cardiac arrest. Through an ongoing process the AHA reviews all available research regarding cardiopulmonary resuscitation (CPR), First Aid, and Advanced Life Support efforts utilized by healthcare providers. The result of this process is a series of patient care guidelines and improved curriculums for the courses they offer. Although the recommendations are coming from a United States based organization they are based on research from across the world. The most recent report is from 2015 Here are some of the key points, with a focus on the recommendations for the average rescuer, not healthcare providers.
Immediate recognition and reaction to cardiac arrest
Time is critical when someone’s heart has stopped and any delay in starting resuscitation efforts could cost that person their life. History has shown that sometimes an individual in or nearing cardiac arrest may gasp or exhibit significantly abnormal breathing either of which is insufficient to sustain them. That breathing has been mistaken by bystanders as sufficient and CPR was delayed until professional responders arrived. The new guidelines stress the importance of recognizing the signs of cardiac arrest and taking action rapidly.
The ABCs becomes CAB
In the past the process of assessing and rendering aid started with addressing the patient’s Airway, then their Breathing, and finally their Circulation giving rise to the ABC approach. The current process still incorporates those three elements, but in the order of CAB Circulation, then Airway, and then Breathing. Addressing a lack of circulation through compressions is more important initially than addressing airway or breathing. The AHA estimates that the change only delays breathing for a patient by 18 seconds, but dramatically improves how soon compressions start. Now someone immediately provides thirty chest compressions, then tilts the head to open the airway, then gives two breaths. The current guidelines have removed the practice called Cricoid Pressure which involved a rescuer applying pressure to the patient’s windpipe while breathing for them with the hope of decreasing the amount of air that entered the stomach. Research has shown this practice is difficult to teach to rescuers and may not make the difference it was once thought to. For those reasons Cricoid Pressure is no longer recommended.
Streamlined process for providing CPR
Barriers and complications to starting CPR have been removed with the hope of encouraging bystanders to act more quickly. One of the changes was removing the old “Look, Listen, and Feel” process and continuing to insist that lay rescuers do not check for a pulse. Lay rescuers and even experienced healthcare providers may have a hard time finding a pulse and spend too long looking for one before starting CPR. It is far better for someone to have CPR and not need it than go without CPR when it is desperately needed.
Continued emphasis on high quality CPR
Not only must CPR be started quickly it must also be good enough to benefit the patient. For untrained rescuers or those unwilling/unable to provide breaths excellent compressions provided continuously without breaths is highly desired. Compressions, with or without breathing, should be hard and fast and done in the middle of the chest. They should be at a rate of at least 100/min and the depth of them must be at least 2 inches. The new depth is only a slight change from the previous 1 ½ to 2 inches but by encouraging people to compress the chest at least 2 inches there is a greater likelihood that each compression will pump more blood to the brain, heart, and other organs. Providing one number to work towards is part of the AHA’s effort to simplify the process and in turn improve the overall outcome for patients.
The new overall process is this:
As soon as an emergency is recognized someone should call for help and get an AED.
If the victim is not responding to rescuers and does not appear to be breathing normally, CPR should be started.
- CPR begins with compressions delivered hard and fast in the middle of the victims chest. The rescuer should 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.
- Each compression should be at least 2” deep and delivered at a rate of at least 100/minute. After giving 30 compressions a rescuer who is able to breathe for the victim should do so. If a rescuer is unable to breathe for the victim they should provide continuous high quality compressions until professional rescuers arrive.
- Breaths for the victim start by adjusting their airway. Tilt the victim’s head by the forehead back and lifting the chin to open the airway. Pinch shut the victim’s nose using the forefinger and thumb.
- Each breath given to the victim should be a normal breath for the rescuer and delivered over 1 second while looking for the victims chest to rise.
- A total of two breaths should be given to the patient and then the rescuer should immediately start chest compressions again.
- The cycle of 30 compressions and 2 breaths should be continued until the rescuer is physically unable to do so or professional rescuers arrive.
- As soon as an AED becomes available it should be turned on and its instructions followed to connect it to the patient. An AED will only work on someone who will benefit from it and will not harm someone who will not benefit from it.
As more research is conducted about the human body and the ways we treat problems associated with it the CPR standards will likely continue to evolve. It is important for individuals to stay current by renewing their CPR certification every 2-3 years as recommended by the organization issuing the CPR certification. Taking a class on a regular basis also helps to develop the skills and knowledge that must be immediately used during an emergency. At least 88% of cardiac arrests happen outside of hospitals so there is a high likelihood that an average citizen will be the first one on scene and may even be able to save that persons life. Encourage your friends and family to get certified because the life they save may be yours!
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