The American Heart Association (AHA) published their 2015 Guidelines (based on the International Liason Committee on Resuscitation, or ILCOR, recommendations earlier this month) at 12:01 am CST on October 15, 2015. Here is a summary of what you can expect in a future CPR, First Aid, BLS, ACLS, or PALS class:
Basic Life Support (CPR) update--MOSTLY the same.
- AHA has acknowledged that we all have cell phones, so no more "go call 9-1-1"--just "Call 9-1-1."
- All communities should implement a Public Access Defibrillator (PAD) program.
- We may now check breathing and pulse simultaneously
- Sequence remains C-A-B, 30 compression: 2 breaths
- Compression rate now 100-120/minute
- Compression depth now 2-2.4 inches (5-6 cm)
- Full recoil of the chest is mandatory (no leaning)
- Anyone can give naloxone to a potential narcotic overdose
CardioCerebral Resuscitation (CCR), as many of us in EMS know it as, is IN the guidelines! EMS providing continuous compressions without ventilation is now part of the guidelines.
"A bundled package of care that includes up to 3 cycles of passive oxygen insufflation, airway adjust insertion, and 200 continuous chest compressions with interposed shocks, showed improved survival with favorable neurologic status for victims with witnessed arrest or shockable rhythm." – ECC 2015 Guidelines, Page 10
My EMS friends--we have been recommended!
Advanced Cardiovascular Life Support (ACLS) Guidelines:
- Vasopressin is no longer recommended in cardiac arrest patients.
- Steroids may have some use in cardiac arrest patients.
- Epinephrine should be given immediately in non-shock rhythms.
- Lidocaine still not recommended, but may be given in ROSC.
- Beta Blockers may be used in ROSC (but not always).
Immediate Post Resuscitation Guidelines (ROSC):
- To the Cath Lab. Any STEMI and any unstable patient without STEMI.
- Therapeutic Hypothermia is now Targeted Temperature Management (TTM). Target temp is now 32-36 Celcius for 24+ hours.
- Hypotension correction is emphasized more than in past guidelines.
- Organ donation is emphasized for those patients with brain death after ROSC
Pediatric Advanced Life Support (PALS) Guidelines:
- C-A-B, 30 compressions:2 breaths when a lone rescuer, 15:2 in teams reaffirmed.
- 100-120 compressions/minute.
- >1/3 total depth of chest reaffirmed (>1.5 inches in infant, >2 inches in child), but no deeper than 2.4 inches added.
- Both compressions and ventilations are needed for infants or children (hands-only CPR unlikely to work).
- Amiodarone or Lidocaine may be given as antiarrhythmic for refractory VF or pVT.
- Fever should be avoided in ROSC.
- Emphasis on correction of perfusion in ROSC with IV fluids and pressors.
- Target pulse oximetry in ROSC is 94-99%.
First Aid Guidelines:
- Recognize strokes using FAST: Face, Arm, Speech, Time.
- Treat hypoglycemia with any sugar source, not only glucose tablets.
- Do not seal open chest wounds.
- Head injuries should be evaluated by health care providers.
- Teeth broken or extracted can be maintained in multiple solutions, whole milk being most available.
- First aid responders should not routinely administer oxygen.
- Have a chest pain patient chew and swallow any form of aspirin.
- Administer multiple doses of epinephrine for life-threatening allergic reactions when the victim does not respond to the first and EMS has not arrived within 5-10 minutes.
- First aid rescuers should not apply Cervical Collars.
- The best position for a victim not receiving CPR or ventilation is on his or her side.
The full document is available at this link: https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf