In 2010, the International Liaison Committee on Resuscitation (ILCOR) developed new guidelines for emergency cardiac care, based on research from around the world. These guidelines, along with updated 2010 guidelines from the American Heart Association, represent the latest treatment recommendations for CPR, ECC and First Aid.
In late 2010 and early 2011, groups including the Lifesaving Society, the Canadian Red Cross, St. John Ambulance Service, the Heart and Stroke Foundation and the Canadian Ski Patrol worked together on how to apply these new changes to Canadian health care.
For more detailed Information, visit guidelines.ecc.org/2010-guidelines-for-cpr.html to read the 2010 AHA Guidelines for CPR and ECC published online in Circulation and Resuscitation journals in October 2010.
Cardiopulmonary resuscitation (CPR) – a method combining chest compressions and breaths used to restore blood and air circulation in someone whose heart has stopped.
Automated External Defibrillator (AED) – a portable device that uses electrical impulses to establish an effective heart rhythm.
Emergency Cardiac Care (ECC) – a system based on strategies (911 activation, CPR, AED & EMS) designed to treat cardiac arrest, stroke and other life-threatening emergencies.
Studies on emergency cardiac care published before and since 2005 show that:
The recommended changes attempt to address these issues, so that those in crisis are more likely to survive.
This strategy is designed to provide a bare minimum of emergency care to someone whose heart has stopped and to maximize chances of survival. To use it, a bystander would:
Many questions have been asked about how those learning to perform CPR should apply the Hands-Only™ strategy. It is important to note that:
In 2005, the Lifesaving Society only required rescuers to have a bystander search out an AED and someone trained to use it. Any practical training was offered through separate AED courses.
However, for the best chance of survival, 911 must be called, CPR started and an AED used as soon as possible after cardiac arrest. For every minute that passes between collapse and defibrillation, survival rates drop by seven to 10 per cent. Even minimal training has been shown to improve these rates. As a result, practical training in using an AED should be made available as part of first aid training.
The guidelines for a lone person attempting emergency care on an adult is as follows
A new C-A-B (Compression-Airway-Breathing) sequence has been introduced to replace the previous A-B-C (Airway-Breathing-Compression) strategy.
Changing the order allows chest compressions to start sooner. Rescue breathing will only be delayed until the first cycle of chest compressions is complete (30 compressions should be done in about 18 seconds).
Forty per cent of pre-hospital cardiac arrests involve agonal (gasping) breathing. This is often mistaken for effective breathing, meaning that bystanders do not attempt a rescue. Other types of abnormal breathing include severe respiratory distress and cyanosis (where the skin turns blue or purple from lack of oxygen). With agonal breathing, the diaphragm still receives intermittent impulses from the brain resulting in sporadic gasping and ineffectual breaths.
Research shows that oxygen levels in the blood remain adequate for the first several minutes after a sudden cardiac arrest. Survival is more likely if chest compressions are started promptly and are of high quality and uninterrupted. As a result 'Look, Listen, and Feel' is no longer suggested. Instead, trained rescuers are taught to identify ineffective/absent breathing and then immediately apply chest compressions.
In the event of a sudden cardiac arrest, the trained rescuer will call 911 first. It is recognised that in some circumstances there may be an unavoidable delay in activation based on circumstance. Lifesaving recognizes that the rescuer is in the best position to judge when a 911 call can be made.
Once 911 has been called, the rescuer should immediately start CPR with chest compressions followed by rescue breaths. The compression to breath ratio of 30:2 remains the same. C-A-B is the treatment sequence for victims of cardiopulmonary arrest.
The A-B-C (Airway-Breathing-Compression) sequence continues to be recommended for the treatment of drowning victims.
Studies published before and since 2005 show that the quality of chest compressions still needs improvement. Effective chest compressions are essential to providing blood flow during CPR and can significantly increase survival rates.
To ensure high quality, effective CPR, remember the following:
In 2005, the Heart & Stroke Foundation of Canada recommended abdominal thrusts as the best way to clear the airway of a conscious, choking person. This method was chosen over others because it is easy to teach.
The 2010 AHA Guidelines indicate that if abdominal thrusts are not effective, other methods may be used. Studies show that abdominal thrusts, back blows, and chest thrusts are all acceptable ways to clear the airway of responsive adults and children. The recommendations vary slightly depending on whom you are helping:
When performing back blows, make sure that the person's airway is parallel to the ground. Wrapping an arm diagonally across the chest, bend the person forward. If a table or countertop is nearby, it can be used for support. Now, deliver five firm back blows between the shoulder blades using the heel of your hand. Again, it is important that the choking person be conscious before you attempt this procedure.
Although changing recommendations about the best lifesaving techniques does require some retraining, the hope is that more lives will be saved.