Guideline Changes for Emergency Care
Health in Sports Report - Issue 1
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Emphasis on chest compressions
There are dramatic changes in the guidelines for emergency care, especially to CPR with an emphasis on chest compressions. This is according to the 2005 American Heart Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care published in Circulation: Journal of the American Heart Association.
The guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to successful resuscitation. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body. This can "buy" extra minutes until defibrillation can be attempted or the heart can pump blood on its own. The new guidelines recommend that rescuers "push hard and push fast" with minimal interruptions to chest compressions.
"The 2005 guidelines take a back-to-basics approach to resuscitation," said Dr. Robert Hickey, chairman of the American Heart Association's emergency cardiovascular care programs. "Since the 2000 guidelines, research has strengthened our emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and do, and the association believes the new guidelines will contribute to more people doing CPR effectively."
The rate of chest compressions to rescue breaths is the most significant change to CPR. The 2000 guidelines were 15 compressions for every two rescue breaths. It is now 30 compressions for every two rescue breaths. This 30-to-2 ratio is the same for single rescuer CPR to adults, children and infants (excluding newborns). This change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions.
New guidelines change use of Automatic External Defibrillator
Automatic external defibrillator (AED) use also changed with the new guidelines. Previously the AED would analyze the heart rhythm, deliver a shock if needed and reanalyze. This cycle of analysis, shock and reanalysis could be repeated three times before CPR was recommended. This resulted in 37 seconds or more of delay. The new guidelines recommend that after one shock, the rescuers provide two minutes of CPR, beginning with chest compressions, before activating the AED to reanalyze the heart rhythm.
Studies have shown that the first AED shock stops the abnormal cardiac arrest rhythm more than 85 percent of the time and that a brief period of chest compressions between shocks can deliver oxygen to the heart. This increases the likelihood of successful defibrillation.
AED programs encouraged in public locations
The new recommendations continue to encourage AED programs in public locations, such as sports facilities, airports and businesses. The 2005 guidelines reflect the results of the Public Access Defibrillation Trial. It reinforced the importance of planned and practiced response to cardiac emergencies by lay rescuers.
Learn more about the new guidelines
The new guidelines can be downloaded from the American Heart Association.