2005 Top Ten Major Changes in Treatment Recommendations *

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Mary Reynolds
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1 2005 Top Ten Major Changes in Treatment Recommendations * This document reviews the top ten new treatment recommendations and guidelines for ASHI s basic life support training programs for professional providers. These changes reflect developments in the both the science and performance of emergency medical care. They are based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. ASHI is a collaborating organization of the National First Aid Science Advisory Board co founded by the American Red Cross and American Heart Association, Inc., (AHA) and a participant in the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, hosted by the AHA in Dallas, Texas, January 23 30, Every training organization, medical device manufacturer and textbook publisher needs time to make systematic and organized changes to its recommendations and products, including ASHI. We are well into that process. ASHI is currently revising all of our training materials and will incorporate these guidelines in both basic and advanced life support training programs and materials which will become available throughout Unlike medical devices or drugs that are removed from the market because research shows they are dangerous or potentially dangerous, these new recommendations do not imply that care involving the use of the earlier guidelines is unsafe. There is no need to raise undue concern among your staff or students. Programs will be revised and released in the following order; /AED (Community), Pro, Basic First Aid, Essentials, ACLS, PALS. We are hopeful that this document and the resources referenced with it will provide provisional guidance to both instructors and students during the transition from current to new training materials. Additional guidance may be released as needed. Completely revised training program materials will become available throughout The guidelines described below may be integrated into current training programs by a currently authorized ASHI Instructor. Courses may be conducted using currently available training materials with or without integration of these new treatment recommendations until revised student and instructor materials are available and instructors have been updated (process/requirements to be announced). We encourage all instructors to join the ASHI Instructor Network, a list serve for authorized members. This is a great place to interact with fellow instructors from around the world and take part in discussions involving the new guidelines. To join, go to the Members area of the website and click on ASHI Instructor Network (first time members require password setup and approval). The complete guidelines for cardiopulmonary resuscitation () and emergency cardiovascular care (ECC) published by the AHA cover 25 topic areas over nearly 200 pages (see references below). The AHA has graciously made these important publications available free of charge at Additionally, an excellent overview of significant changes and their rationale are covered in the winter edition of Currents in Emergency Cardiovascular Care Vol16 No.4, Available: Complete Reference: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005; 112:IV 1 IV American Heart Association, Inc International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23 30, Circulation. 2005;112:III 5 III 16 and Resuscitation Volume 67, Supplement 1, Pages S1 S190 (December 2005) 2005 International Liaison Committee on Resuscitation, American Heart Association, Inc. and European Resuscitation Council. Please note: Guidelines for safety and recommendations for treatment cannot be given that will apply to all rescuers, victims, or patients in all cases as the circumstances of each incident often vary widely. All recommended changes are not reflected in this document. Local or organizational physician directed practice protocols may supersede these treatment recommendations. * Editors: Barbara Aehlert, ASHI ACLS Chairperson and Ralph Shenefelt, ASHI Executive Program Director December 5,

2 Age Range Assess/Alert: Airway Child guidelines apply to victims 1 to 8 years old. Rescuer is alone with victim. Knowledgeable and experienced providers should use common sense and ʺphone firstʺ for any apparent sudden cardiac arrest (e.g., sudden collapse at any age) and ʺphone fastʺ in other circumstances in which breathing difficulties are documented or likely to be present (e.g., trauma or an apparent choking event). The jaw thrust technique without head tilt is the safest initial approach to opening the airway of the victim with suspected neck injury because it usually can be done without extending the neck. Carefully support the head without tilting it backward or turning it from side to side. Child guidelines apply to victims from 1 year of age to the onset of puberty. Rescuer who is alone should alter sequence of rescue based on most likely cause. Sudden witnessed collapse (likely VF arrest) activate EMS, get AED, do. Hypoxic arrest (i.e., suffocation) give 5 cycles (about 2 minutes) of before alerting EMS If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension. Use a head tilt chin lift maneuver if the jaw thrust does not open the airway. More practical measure and ease of teaching. Circulation. 2005; 112:IV 156 IV 166. Clarity. Circulation. 2005;112:IV 12 IV 17.) Maintaining airway and adequate ventilation is the overriding priority. All airway maneuvers cause spinal movement. Studies in human cadavers showed that both chin lift (with or without head tilt) and jaw thrusts were associated with similar, substantial movement of the cervical vertebrae. Breathing Give each rescue breath over 1 2 seconds making sure the victim s chest rises with each breath Give each breath over 1 second with enough volume to produce visible chest rise. Circulation. 2005;112:III 5 III 16. Simplification, reduce excessive ventilation which is unnecessary and harmful to both rescuer and victim. Circulation Healthcare providers should perform a pulse check in conjunction with assessment for signs of circulation. If There is no evidence that checking for signs of circulation (breathing, coughing, or movement) is superior Circulation. 2005;112:IV 12 IV 17 Simplification and ease of training. Studies show that healthcare providers and lay rescuers are unable to reliably December 5,

3 you are not confident that circulation is present, begin chest compressions immediately. Compression to ventilation ratio Adult 15:2 Infant/Child 5:1 Speed: 100 compressions per minute for detection of circulation. If you are a healthcare provider, you should try to palpate a pulse (brachial in an infant and carotid or femoral in a child).if a pulse is not definitely felt within 10 seconds, proceed with chest compressions. Compression to ventilation ratio 30:2 for single rescuer, for all ages (except newborn infants). 30:2 for 2 rescuer adult until advanced airway in place, then give continuous chest compressions without pauses for 8 to 10 breaths per minute. 2 rescuers should change roles about every 2 minutes to prevent fatigue 15:2 for 2 rescuer infant/child Note: Important focus on effective chest compressions to maximize the quality of. Effective means push hard, fast, allow complete chest recoil and minimize interruptions. Hard = 11 2 to 2 inches in adult and about one third to one half the depth of chest in child/infant. Fast = 100 compressions per minute. Compression and recoil time should be approximately equal. 2 rescuer infant, squeeze chest detect a pulse and at times will think a pulse is present when there is no pulse. Circulation. 2005; 112: IV 18 IV 34.). Simplification and ease of training. To provide longer periods of uninterrupted chest compressions. Blood flow to heart and brain is better with hard and fast compressions. Complete chest recoil allows blood to return to and refill heart. December 5,

4 when using 2 thumb encircling hands technique Circulation. 2005;112:IV 12 IV 17. Infants and Children AED AED Infants And Children Healthcare providers are taught to provide chest compressions when there are no observed signs of circulation (including absence of a pulse) or when heart rate <60 beats per minute develops in the presence of poor systemic perfusion. The AED is programmed to analyze the victim s rhythm and provide a series of 3 shocks. During the series of 3 shocks the rescuer should not interrupt or interfere with the rapid analysis and shock pattern. AEDs are programmed to pause after each group of 3 shocks to allow 1 minute for. Use of AEDs in infants and children <8 years old is not recommended, primarily because of the lack of data concerning sensitivity, specificity, safety, and efficacy. If heart rate is <60 beats per minute with poor perfusion despite effective ventilation with oxygen, start chest compressions When using an AED, deliver 1 shock followed by immediate, beginning with chest compressions. Recheck the rhythm after 5 cycles of about 2 minutes. Note: New recommendations for rescuers to rapidly integrate with use of the AED. For children 1 to 8 years, rescuer should use a pediatric doseattenuator system if available. If not, use a standard AED. Same, with more clarity and emphasis Circulation. 2005;112:IV 167 IV 187 To minimize interruptions in chest compressions. Heart does not pump blood effectively for a few minutes after shock. Compressions are needed to provide blood flow. Also, newer AEDS are more effective at stopping ventricular fibrillation (the most frequent initial heart rhythm in witnessed cardiac arrest) on the first shock. Circulation. 2005;112:IV 35 IV 46 Many AEDs can accurately detect VF in children of all ages with a high degree of sensitivity and specificity. Some are equipped with pediatric attenuator systems to reduce the delivered energy to a dose suitable for children. There is insufficient data to make a recommendation for or against the use of AEDs for infants >1 year of age. Supports previous ILCOR Advisory Statement Circulation JUL 2003; 107: December 5,

5 Circulation. 2005;112:IV 35 IV 46 FBAO If you observe the victim s collapse and you know it is caused by FBAO: Activate the emergency response system at the proper time in the sequence. If a second rescuer is available, send the second rescuer to activate the EMS system while you remain with the victim. Be sure the victim is supine. Perform a tongue jaw lift, followed by a finger sweep to remove the object. Open the airway and try to ventilate; if you are unable to make the victim s chest rise, reposition the head and try to ventilate again. If you cannot deliver effective breaths (the chest does not rise) even after attempts to reposition the airway consider FBAO. Straddle the victim s thighs and perform the Heimlich maneuver (up to 5 times). Repeat the sequence until the obstruction is cleared and the chest rises with ventilation If the adult victim with FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground, immediately activate EMS, and then begin. Each time the airway is opened during, the rescuer should look for an object in the victim s mouth and remove it. Simplification and ease of training. Studies show that higher sustained airway pressures can be generated using chest thrusts rather than the abdominal thrusts. No evidence that previous complicated recommendation is any more effective than. Circulation. 2005;112:IV 18 IV 34.) December 5,

E C C. American Heart Association. BLS for Healthcare Providers. Written Exams. January 12, 2012

E C C. American Heart Association. BLS for Healthcare Providers. Written Exams. January 12, 2012 E C C American Heart Association BLS for Healthcare Providers Written Exams Contents: Exam Memo Student Answer Sheet Version C Exam Version C Answer Key Version C Reference Sheet Version D Exam Version