It’s time to do things differently

• Focus of the 2005 Guidelines: Improve delivery of life-saving CPR
• Not enough victims get CPR, and even fewer get good CPR

1. Emphasis on effective chest compressions
   • “Push hard and push fast” at a rate of 100 per minute
     • Blood flow is critical to keeping vital organs alive.
     • Better chest compressions produce more blood flow which is essential to coronary & cerebral artery perfusion.
2. Allow chest to COMPLETELY recoil
   • During chest recoil blood refills the heart.
   • If the heart does not refill adequately before each compression, blood flow is reduced.
3. Limit interruptions to chest compressions
   • When chest compressions are interrupted, blood flow stops and coronary artery perfusion pressure quickly falls.
     
     Kern et al, Resuscitation, 1998
      
4. Universal compression to ventilation ratio
   • All 1-rescuer CPR ratio of 30:2 compressions to ventilations.
   • Simplifies CPR training, making it easier to learn, remember, and perform better CPR.
   • Ensures that all rescuers deliver longer series of uninterrupted compressions.
5. 1-second Rescue Breaths
   • Applies to all rescuers
   • Should produce visible chest rise.
6. Avoiding Rescuer Fatigue
   • Increased number and duration of compressions can cause rescuer fatigue.
   • Two rescuers should change roles as compressor about every 2 minutes
   • About every 5 cycles of 30:2
   • Change quickly, less than 5 seconds
   • Resume compressions without checking for a pulse
   • AUTOMATED EXTERNAL DEFIBRILLATORS
   •  
7. 1 shock then immediate CPR, instead of up to 3 shocks
   • When attempting defibrillation, deliver 1 shock followed by immediate CPR (beginning with chest compressions).
   • Check victim’s rhythm after giving 5 cycles of CPR (2 min.).
     Reasons for Change
   • Modern biphasic defibrillators can convert VF with one shock more than 90% of the time.
   • If the first shock fails, CPR likely has greater value than an immediate second shock by improving the metabolic state of the heart.
   • The rhythm analysis of 3 shock sequence AEDs can result in a delay of 29-37 seconds between the delivery of the first shock and the first post-shock chest compression.
   • Heart needs the blood flow produced by compressions.
   • After VF is terminated, many victims have a nonperfusing rhythm for several minutes.
   • Post shock rhythm: Ventricular fibrillation (VF) unlikely but Asystole or Pulseless Electrical Activity (PEA) is likely
   • Compressions help deliver oxygen and sources of energy to the heart increasing the likelihood it can effectively pump blood after the shock.

     NOTE: COMPRESSIONS DO NOT CAUSE HARM IF THE HEART HAS AN ORGANIZED HEART RHYTHM.
      

8. What comes First: Compression or Shock?
   • When any rescuer witnesses an adult cardiac arrest & an AED is immediately available the rescuer should use the AED as soon as possible
   • When more than one rescuer is available, one rescuer should begin CPR while until another rescuer brings the AED to the victim’s side. Ideally one rescuer will continue CPR while another rescuer turns the AED on and attaches the AED pads to the victim’s bare chest and the device is ready to analyze the victim’s heart rhythm.
9. Sudden, witnessed or unwitnessed child collapse:
   • All rescuers will use the AED after 5 cycles or 2 minutes of CPR
10. Unwitnessed adult arrest
    • EMS Medical Directors may consider implementing a protocol that would allow
    • EMS responders to provide 2 minutes of CPR first particularly when EMS call-toresponse interval is greater than 4 -5 minutes