So the new AHA guidelines have been released. Go here to read them for yourself.
PDF - New Guidelines 2010
From A-B-C to C-A-B
Much research has been done to conclude that the best course of action for all unresponsive and apneic or barely breathing patients is to immediately begin chest compressions. No wasting time checking for a pulse (less than 10 seconds). No, “well I think they are breathing”. If they are unresponsive, you don’t immediately feel a pulse, and there are very few or no respirations, then begin chest compressions. No more Look, Listen, Feel.
- The vast majority of cardiac arrests occur in adults, and the highest survival rates from cardiac arrest are reported among patients of all ages with witnessed arrest and a rhythm of VF or pulseless ventricular tachycardia (VT). In these patients the critical initial elements of CPR are chest compressions and early defibrillation.90
- In the A-B-C sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment. By changing the sequence to C-A-B, chest compressions will be initiated sooner and ventilation only minimally delayed until completion of the first cycle of chest compressions (30 compressions should be accomplished in approximately 18 seconds).
- Fewer than 50% of persons in cardiac arrest receive bystander CPR. There are probably many reasons for this, but one impediment may be the A-B-C sequence, which starts with the procedures that rescuers find most difficult: opening the airway and delivering rescue breaths. Starting with chest compressions might ensure that more victims receive CPR and that rescuers who are unable or unwilling to provide ventilations will at least perform chest compressions.
- It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. For example, if a lone healthcare provider sees a victim suddenly collapse, the provider may assume that the victim has suffered a sudden VF cardiac arrest; once the provider has verified that the victim is unresponsive and not breathing or is only gasping, the provider should immediately activate the emergency response system, get and use an AED, and give CPR. But for a presumed victim of drowning or other likely asphyxial arrest the priority would be to provide about 5 cycles (about 2 minutes) of conventional CPR (including rescue breathing) before activating the emergency response system. Also, in newly born infants, arrest is more likely to be of a respiratory etiology, and resuscitation should be attempted with the A-B-C sequence unless there is a known cardiac etiology.
The changes this year are minute in comparison to the changes back in 2005. One thing noted has been a decreased emphasis on ALS medications during treatment of cardiac arrest. There is still almost no evidence of improved outcomes due to any drug given in cardiac arrest. Post-arrest cardiac catheterization is being advocated. This has shown to increase chances of neurological recovery more than induced hypothermia in some studies. In conjunction with hypothermia, PCI is even more beneficial.
Thanks for stopping by,
Adam Thompson, EMT-P