What's New & Why
These pictures illustrate concepts highlighted in the American Heart Association’s 2010 CPR Guidelines, including the importance of prioritizing compressions over breaths, the use of capnography and 12-lead ECG, and the need for a coordinated approach to cardiac care. Also included are new AHA algorithms for CPR. Note: Full-size algorithms are available in the supplement PDF at www.jems.com/special/evolution-resuscitation.
The 2010 Guidelines stress compressions over ventilations. Once you start compressions, deliver breaths by mouth-to-mouth or bag-valve mask to provide oxygenation and ventilation. Photo Keith Cullom
Classes of Recommendations
The Guidelines use a recommendation system of classes that balance scientific evidence with contextual factors, such as expert assessment of the magnitude of benefit, usefulness or efficacy; cost; educational and training challenges; and difficulties in implementation.
The original cardiac chain of survival algorithm is reinforced in the 2010 Guidelines.
The 2010 Guidelines promote a new circular algorithm that emphasizes the cyclical nature of action and reassessment in CPR.
Houston Fire Department Medical Director David Persse, MD, (middle, white shirt)assists at a cardiac arrest, ensuring that the response is choregraphed among team members, each performing their assigned tasks without interrupting compressions. Photo Diana Jean Rodriguez/HFD-EMS
Whether delivering compressions manually or via a mechcanical device, strive to limit interruptions. Photo Diana Jean Rodriguez/HFD-EMS
Capnography, used for confirming proper endotracheal tube position, may also be useful to assess and optimize the quality of chest compressions during CPR. Photo Ryche Guerrero
Atropine vs. Adenosine
Atropine is no longer recommended for routine use during cardiac arrest. Intravenous adenosine remains the recommended initial drug therapy for stable narrow-complex tachycardia. Photo A.J. Heightman
Obtain a 12-lead ECG as soon as possible for all resuscitated OHCA patients to detect STEMI or LBBB. Photo Craig Jackson
Evidence of improved or diminished outcomes from using mechanical devices, like the one shown here, was insufficient to form a recommendation about routine use of mechanical CPR devices. But the Guidelines do recognize that they may be considered for use by properly trained personnel in specific settings or circumstances that make manual resuscitation difficult. These devices are designed to assist trained field crews deliver minimally interrupted compressions at an appropriate rate and depth, and with full release. Photo Michigan Instruments
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