Tuesday, November 29, 2005

Major changes in AHA guidelines for CPR and ECC

The 2005 guidelines are available.Full text downloads can be found here.The 15:2 compression-ventilation ratio has morphed into a 30:2 ratio. The shock-shock-shock sequence has been revised to single shock ( with the proper voltage) followed by 2 minutes of CPR initiated without checking for a pulse. The paradigm shift is that with the old way (i.e. what we did yesterday) cardiac compressions were too often interrupted and was too often inadequate.
"Push hard, push fast" is the didactic sound bite of this version of resuscitation instruction.
For HCPs ( this includes the professionals formerly known as doctors and nurses) you should give two rescue breaths,perform CPR at the 30:2 pace,shock,restart CPR for 2 minutes. When an advanced airway is in place give 100 compressions per minute and 8-10 breaths per minutes with no pauses.Not too long ago the emphasis was in getting an airway in place and there were instances where too much time was spent in misguided (literally) efforts to insert an endotracheal tube by folks who were not well practiced at that task,then the emphasis was on repeated defibrillation efforts which at times were carried out and assessed while the CPR was stopped and no oxygen was reaching the brain. And now the emphasis in on effective cardiac compressions. This sounds very reasonable and has to be considered the state of the art. Art here is the operative word.The now discarded approaches seemed very reasonable at the time and were considered the state of the art .It is harder to get things right when we do not have the advantage of multiple useful randomized clinical trials which because of the very nature of sudden cardiac arrest we will likely never have. The pannel emphasized that there are data indicating few victims of cardiac arrest received high-quality CPR. I think this is what you would expect when instruction (and limited practice) typically occurs once every one to two years. I do not believe that is enough practice for HCPs to develop and maintain competency in an exercise that is complex and obviously important.In our clinic we had monthly CPC and ECC reviews with practice exercises lasting about 45 minutes.

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