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Push Hard, Fast, Deep, Continuously

The messages in the 2010 AHA Guidelines are clear


A.J. Heightman, MPA, EMT-P | From the Evolution in Resuscitation Issue


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For a special supplement on the AHA 2010 CPR Guidelines, JEMS and the AHA assembled some of the leading experts on cardiac care. This gallery introduces you to the contributors to this supplement, who were instrumental in synthesizing the new Guidelines and highlighting what you need to know as an EMS professional.
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For this special supplement to JEMS, we assembled some of the leading experts on cardiac care to synthesize and highlight the 2010 American Heart Association Guidelines on Cardiopulmonary Resuscitation and Emergency Cardiac Care. In addition to summarizing the important aspects of cardiac care and cardiac arrest management, the authors carefully outlined important areas that EMS agencies, tasked with implementing the Guidelines, should consider.

The new Guidelines seem simple in several areas, but, in my opinion, they’ll require us to carefully retrain our crews, adopt a new thought process and systems approach to cardiac arrest management, and develop a more integrated citizen, police, fire, EMS and hospital interface.

Key areas to note:

  • It’s critical to get on the chest of a cardiac arrest patient fast (and stay there) to keep the patient’s blood circulating via continuous, high-quality compressions. Without the need for ventilations, it should be easier to get the public “on board” with what I term the new CARE Team initiative (Compressions, AED response, Remain on the chest, Effective 2" compressions).
  • We no longer consider gasps as respirations. We should teach our personnel that the “A” in “agonal” means “almost dead.”
  • We must ensure that adult compressions are at least 2" deep, and delivered at least 100 times per minute—a deeper and faster compression regimen than we have performed in the past. In essence, we’ll have to mimic the calculated depth and rate of mechanical CPR devices and attempt to continue compressions to the optimal depth and rate as consistently as these devices do. Remember: About 65% of the population is overweight or morbidly obese, so the depth of "at least 2 inches" is especially applicable if you want to keep blood circulating to the brains of these individuals.
  • Cardiac and respiratory arrest patients must be managed in a more highly organized and coordinated manner, and the community must be more closely integrated into your EMS system than in the past.

The reality is that these are not simple tasks; they are critical tasks that will require a much more defined, practiced and coordinated approach to cardiac arrest management than we’ve used in the past. Our crews must be vigilant to avoid interrupting compressions once they start a resuscitation. That’s easier said than done.  This area will require the most practice and operational oversight to enable us to affect and improve resuscitation success rates. It’s my opinion that feedback devices and mechanical compression devices will play an important role in this area. 

Many systems have been progressive and have already been testing or have implemented most of the areas now formally recommended or sanctioned by the 2010 Guidelines. For example, systems that have implemented therapeutic hypothermia care into their treatment plans and coordinated them closely with their receiving hospitals are already achieving incredible results.

JEMS will continue to report on the successful efforts of these progressive agencies. Using the new Guidelines, follow the lead of these systems and implement procedures and processes that will give your system/agency improved resuscitation rates.


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Jerry Potts, PhD

Jerry Potts, PhD, served as the lead author of this supplement. He is the director of Research, Development and Innovation for the Emergency Cardiovascular Care (ECC) Programs at the American Heart Association (AHA). His interest in ECC began more than 35 years ago when he worked as an EMT and taught CPR to the public. Dr. Potts has authored dozens of scholarly publications and, during his tenure at the AHA, has been instrumental in many significant achievements of the ECC team, including NRCPR (an in-hospital resuscitation database), ReSS (the annual Resuscitation Science Symposium), the pentennial ILCOR conference for consensus on resuscitation science, three revisions of the AHA Guidelines for CPR and ECC, the “CPR Anytime” self-directed training kit, and the “Hands-Only CPR” and “CPR in Schools” Science Advisory statements. Disclosure: The author is an employee of the AHA.

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Robert A. Berg, MD

Robert A. Berg, MD, is Critical Care Medicine Division Chief and Russell Raphaely Endowed Chair of Anesthesia and Critical Care at The Children’s Hospital of Philadelphia, and professor of anesthesia and critical care and pediatrics at The University of Pennsylvania School of Medicine. He is the chair of the AHA BLS committee and the NRCPR Research committee (“Get With The Guidelines: Resuscitation”). Dr. Berg was involved in developing the 2000, 2005 and 2010 AHA Guidelines for CPR and ECC, and the subsequent AHA PALS and BLS courses. Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

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Bentley J. Bobrow, MD

Bentley J. Bobrow, MD, is an associate professor of emergency medicine and practices at the Maricopa Medical Center in Phoenix. He’s a member of the Arizona Emergency Medicine Research Center and the Sarver Heart Center at the University of Arizona. Dr. Bobrow is the medical director for the Bureau of Emergency Medical Services and Trauma System at the Arizona Department of Health Services and the Scottsdale Fire Department. He is a volunteer member of the AHA’s BLS Subcommittee. Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

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Jose G. Cabanas, MD

Jose G. Cabanas, MD, is a board-certified emergency medicine physician with a special focus on EMS and resuscitation. He is the current deputy medical director for Wake County EMS in Raleigh, N.C., and serves as associate research director for the Emergency Services Institute Clinical Research Unit at WakeMed Health & Hospitals and as adjunct faculty in the Department of Emergency Medicine, University of North Carolina at Chapel Hill. Disclosure: The author has reported receiving indirect research support from Physio-Control.

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Valerie J. De Maio, MD, MSc

Valerie J. De Maio, MD, MSc, is a board-certified emergency medicine physician and clinical epidemiologist with a focus on identification of effective training and management strategies for out-of-hospital resuscitation and trauma. She is currently director of research of the Emergency Services Institute of WakeMed Health & Hospitals and adjunct faculty in the Department of Emergency Medicine, University of North Carolina at Chapel Hill. Her involvement in the AHA’s ECC programs include past membership on the BLS Subcommittee. Disclosure: The author has reported receiving research support from AHA and Laerdal.

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Ed Jauch, MD

Ed Jauch, MD, is professor of medicine in the Division of Emergency Medicine and the Department of Neurosciences at the Medical University of South Carolina (MUSC). At MUSC, he’s involved with the creation of a Comprehensive Stroke Center, a REACH Telemedicine Program, a statewide acute stroke telemedicine network and a statewide stroke system of care. Dr. Jauch also serves as vice-chair of the Leadership Committee for the American Stroke Association and chair of the American College of Emergency Physicians Research Committee. Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

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Kenny Navarro, MEd

Kenny Navarro, MEd, is assistant professor in the Emergency Medicine Education Department at the University of Texas Southwestern Medical Center at Dallas. He serves as a content consultant for the AHA Guidelines 2010 ACLS Project Team, the coordinator for the National EMS Education Standards Project, an expert writer for the National EMS Education Standards Implementation Team and an EMS research columnist for EMS1.com. Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

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Diana Neubecker, RN, BSN, EMT-P

Diana Neubecker, RN, BSN, EMT-P, is the in-field coordinator for the Northwest Community EMS System, a consortium that includes seven hospitals, three private ambulance services and 21 fire departments in the suburbs northwest of Chicago. She is responsible for EMS initial and continuing education, quality improvement, research and development. Previously, Neubecker served as project coordinator for “CPR Chicago,” a prehospital cardiac arrest study funded by the AHA of Metropolitan Chicago. Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

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Joseph P. Ornato, MD, FACP, FACC, FACEP

Joseph P. Ornato, MD, FACP, FACC, FACEP, is professor and chair of the Department of Emergency Medicine at Virginia Commonwealth University Medical Center/Medical College of Virginia in Richmond and medical director of the Richmond Ambulance Authority. He is an editor of Resuscitation and is on the editorial board of the American Journal of Emergency Medicine. Dr. Ornato is currently cardiac co-chairman of the NIH Resuscitation Outcomes Consortium (ROC). Disclosure: The author serves on an advisory board for ZOLL, and his EMS system has received support from sponsors of this supplement.

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Michael R. Sayre, MD

Michael R. Sayre, MD, is associate professor in the Department of Emergency Medicine at The Ohio State University, Columbus. While on the faculty of the Department of Emergency Medicine at the University of Cincinnati, Dr. Sayre focused on EMS and sudden cardiac arrest resuscitation. Since moving to The Ohio State University, he has remained active with out-of-hospital cardiac arrest research. He is currently chair of the AHA’s Emergency Cardiovascular Care Committee. Disclosure: The author is a consultant for Medtronic Foundation, the charitable giving arm of Physio-Control.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Cardiac and Circulation

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A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.


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