Major Changes 2005 CPR Guidelines

[ParamedicDiver1]

The major changes in the 2005 guidelines recommendations for Lay Rescuer CPR are the following:

1. If alone with an unresponsive infant or child, give about 5 cycles of compressions
and ventilations (about 2 minutes) before leaving the child to phone 911.

2. Do not try to open the airway using a jaw thrust for injured victims—use the head
tilt–chin lift for all victims.

3. Take 5 to 10 seconds (no more than 10 seconds) to check for normal breathing in
an unresponsive adult or for presence or absence of breathing in the unresponsive
infant or child.

4. Take a normal (not a deep) breath before giving a rescue breath to a victim.

5. Give each breath over 1 second. Each breath should make the chest rise.

6. If the victim’s chest does not rise when the first rescue breath is delivered,
perform the head tilt–chin lift again before giving the second breath.

7. Do not check for signs of circulation. After delivery of 2 rescue breaths, immediately
begin chest compressions (and cycles of compressions and rescue breaths).

8. No teaching of rescue breathing without chest compressions (exception: rescue
breathing is taught in the Heartsaver Pediatric First Aid Course).

9. Use the same 30:2 compression-to-ventilation ratio for all victims.

10. For children, use 1 or 2 hands to perfor chest compressions and compress at the
nipple line; for infants, compress with 2 fingers on the breastbone just below the
nipple line.

11. When you use an AED, you will give 1 shock followed by immediate CPR,
beginning with chest compressions. Rhythm checks will be performed every 2 minutes.

12. Actions for relief of choking (severe airway obstruction) have been simplified.

13. New first aid recommendations have been developed with more information
included about stabilization of the head and neck in injured victims.

Taken from: http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

 

[DiverBuoy]

I must be missing small distinctions ... some of these seem to be from 2004 guidelines, but again must be a few have subtle changes?

 

[ParamedicDiver1]

Major changes in BLS for Healthcare Provider include the following:

• Healthcare provider “child” CPR guidelines now apply to victims 1 year to
the onset of puberty.

• Lone healthcare providers should tailor their sequence of actions for the most
likely cause of arrest in victims of all ages. “ Phone first” and get the AED and return
to start CPR and use the AED for all adults and any children with out-ofhospital
sudden collapse. “ CPR first” (provide about 5 cycles or 2 minutes of CPR before activating the emergency response number) for unresponsive infants and children
(except infants and children with sudden, witnessed collapse) and for all victims
of likely hypoxic (asphyxial) arrest (eg, drowning, injury, drug overdose).

• Opening the airway remains a priority for an unresponsive trauma victim with
suspected cervical spine injury; if a jaw thrust without head extension does not
open the airway, healthcare providers should use the head tilt–chin lift maneuver.

• Basic healthcare providers check for “adequate” breathing in adults and
presence or absence of breathing in infants and children before giving rescue
breaths. Advanced providers will look for “adequate” breathing in victims of all ages
and be prepared to support oxygenation and ventilation.

• Healthcare providers may need to try “a couple of times” to reopen the airway and
deliver effective breaths (ie, breaths that produce visible chest rise) for infant
and child victims.

• Excessive ventilation (too many breaths per minute or breaths that are too large or
too forceful) may be harmful and should not be performed.

• Chest compressions are recommended if the infant or child heart rate is less
than 60 per minute with signs of poor perfusion despite adequate oxygenation
and ventilation. This recommendation was part of the 2000 guidelines but was
not emphasized in courses. It will now be emphasized in the courses.

• Rescuers must provide compressions of adequate rate and depth and allow adequate
chest recoil with minimal interruptions in chest compressions.

• Use 1 or 2 hands to give chest compressions for a child; press on the sternum at the
nipple line. For the infant, press on the sternum just below the nipple line.

• During 2-rescuer infant CPR, the 2 thumb–encircling hands technique should include
a thoracic squeeze.

• Healthcare providers should use a 30:2 compression-to-ventilation ratio for 1-
rescuer CPR for victims of all ages and for 2-rescuer CPR for adults. Healthcare
providers should use a 15:2 compressionto-ventilation ratio for 2-rescuer CPR for
infants and children.

• During 2-rescuer CPR with an advanced airway in place, rescuers no longer provide
cycles of compressions with pauses for ventilation. The compressor provides
continuous compressions and the rescuer providing rescue breaths gives 8 to10
breaths per minute (1 breath about every 6 to 8 seconds).

• When 2 or more healthcare providers are present during CPR, rescuers should rotate
the compressor role every 2 minutes.

• Actions for FBAO relief were simplified.

Taken from: http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

 

[ParamedicDiver1]

Major changes in defibrillation:

• Immediate defibrillation is appropriate for all rescuers responding to sudden witnessed
collapse with an AED on site (for victims ≥1 year of age). Compression before
defibrillation may be considered when EMS arrival at the scene of sudden collapse
is >4 to 5 minutes after the call.

• One shock followed by immediate CPR, beginning with chest compressions, is used
for attempted defibrillation. The rhythm is checked after 5 cycles of CPR or 2 minutes.

• For attempted defi brillation of an adult, the dose using a monophasic manual
defibrillator is 360 J.

• The ideal defibrillation dose using a biphasic defi brillator is the dose at which
the device waveform has been shown to be effective in terminating VF. The initial
selected dose for attempted defibrillation using a biphasic manual defi brillator is
150 J to 200 J for a biphasic truncated exponential waveform or 120 J for a
rectilinear biphasic waveform. The second dose should be the same or higher. If the
rescuer does not know the type of biphasic waveform in use, a default dose of 200 J
is acceptable.

• Reaffirmation of 2003 ILCOR statement that AEDs may be used in children 1 to 8
years of age (and older). For children 1 to 8 years of age, rescuers should use an AED
with a pediatric dose-attenuator system if one is available.

• Elements of successful community lay rescuer AED programs were revised.

• Instructions for shocking VT were clarified.

Taken From:http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

 

[ParamedicDiver1]

Major changes in ACLS include

• Emphasis on high-quality CPR. See information in the BLS for Healthcare
Providers section, particularly rescue breaths with chest compressions and
emphasis on chest compression depth and rate, chest wall recoil, and minimal
interruptions.

• Increased information about use of LMA and esophageal-tracheal combitube
(Combitube). Use of endotracheal intubation is limited to providers with
adequate training and opportunities to practice or perform intubations.

• Confirmation of endotracheal tube placement requires both clinical
assessment and use of a device (eg, exhaled CO2 detector, esophageal
detector device). Use of a device is part of (primary) confi rmation and is not
considered secondary confi rmation.

• The algorithm for treatment of pulseless arrest was reorganized to include VF/
pulseless VT, asystole, and PEA. The priority skills and interventions during cardiac arrest are BLS skills, including effective chest compressions with minimal interruptions.
Insertion of an advanced airway may not be a high priority. If an advanced airway is inserted, rescuers should no longer deliver cycles of CPR. Chest compressions should be delivered continuously (100 per minute) and rescue breaths delivered at a rate of 8 to 10 breaths per minute (1 breath every 6 to 8 seconds). Providers must organize care to minimize interruptions in chest compressions for rhythm check, shock delivery, advanced airway insertion, or vascular access.

• Intravenous or intraosseous (IO) drug administration is preferred to endotracheal administration.

• Treatment of VF/pulseless VT:
-To attempt defibrillation, 1 shock is delivered (see “Defibrillation” for defibrillation doses using monophasic or biphasic waveforms) followed immediately by CPR (beginning with chest compressions).
-Rescuers should minimize interruptions in chest compressions and particularly minimize the time between compression and shock delivery, and shock delivery and resumption of compressions.
-Compressions should ideally be interrupted only for rhythm checks and shock delivery.
Rescuers should provide compressions (if possible) after the rhythm check, while the defibrillator is charging. Then compressions should be briefly interrupted when it is necessary to “clear” the patient and deliver the shock, but the chest compressions should resume immediately after the shock delivery.
-Providers do not attempt to palpate a pulse or check the rhythm after shock delivery. If an organized rhythm is apparent during rhythm check after 5 cycles (about 2 minutes) of CPR, the provider checks a pulse.
-Drugs should be delivered during CPR, as soon as possible after rhythm checks.
-— If a third rescuer is available, that rescuer should prepare drug doses before they are needed.
-— If a rhythm check shows persistent VF/VT, the appropriate vasopressor or antiarrhythmic should be administered as soon as possible after the rhythm check. It can be administered during the CPR that precedes (until the defi brillator is charged) or follows the shock delivery.
-— The timing of drug delivery is less important than is the need to minimize interruptions in chest compressions.
-Vasopressors are administered when an IV/IO line is in place, typically if VF or pulseless VT persists after the fi rst or second shock. Epinephrine may be given every 3 to 5 minutes. A single dose of vasopressin may be given to replace either the first or second dose of epinephrine.
-Antiarrhythmics may be considered after the fi rst dose of vasopressors (typically if VF or pulseless VT persists after the second or third shock). Amiodarone is preferred to lidocaine, but either is acceptable.

• Treatment of asystole/pulseless electrical activity: epinephrine may be administered every 3 to 5 minutes. One dose of vasopressin may replace either the first or the second dose of epinephrine.

• Treatment of symptomatic bradycardia: the recommended atropine dose is now 0.5 mg IV, may repeat to a total of 3 mg. Epinephrine or dopamine may be administered while awaiting a pacemaker.

• Treatment of symptomatic tachycardia: a single simplified algorithm includes some but not all drugs that may be administered. The algorithm indicates therapies intended for use in the in-hospital setting with expert consultation available.

• Postresuscitation stabilization requires support of vital organs, with the anticipation of postresuscitation myocardial dysfunction. Some reliable prognostic indicators have been reported.

• Avoid hyperthermia for all patients after resuscitation. Consider inducing hypothermia if the patient is unresponsive but with an adequate blood pressure following resuscitation.

Taken from: http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

 

[ParamedicDiver1]

The following are the major PALS changes in the 2005 guidelines:

• There is further caution about the use of endotracheal tubes. LMAs are acceptable when used by experienced providers (Class IIb).

• Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept <20 cm H2 O.

• Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm (Class IIb). Correct placement must be verified when the tube is inserted, during transport, and whenever
the patient is moved.

• During CPR with an advanced airway in place, rescuers will no longer perform “cycles” of CPR. Instead the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6 to 8 seconds). For further information, see the Basic Life Support for Healthcare Providers section.

• More evidence has accumulated to reinforce that vascular access (IV/IO) is preferred to endotracheal drug administration.

• Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for ACLS. See ACLS section for details.

• Routine use of high-dose epinephrine is not recommended (Class III).

• Lidocaine is deemphasized, but it can be used for treatment of VF/pulseless VT if amiodarone is not available.

• Induced hypothermia (32ºC to 34ºC for 12 to 24 hours) may be considered if the child remains comatose after resuscitation (Class IIb).

• Indications for the use of inodilators are mentioned in the postresuscitation section.

• Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged HEALTHCARE PROVIDER BASIC AND ADVANCED LIFE SUPPORT resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine.

Taken from: http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf