“Everyone has a role to play in the ‘Chain of Survival’ — from bystanders to dispatchers, emergency responders to healthcare providers,” Mark A. Creager, MD, president of the American Heart Association, said in a statement. “When everyone knows their role, knows CPR and works together, we can dramatically improve cardiac arrest victims’ chances of survival.”
This is the first guideline update since 2010. Significant guideline recommendations include:
• Untrained bystanders should still call 911 and provide hands-only CPR, or CPR without breaths, pushing hard and fast in the center of the chest to the rate of 100-120 compressions per minute. However, if the bystander is trained in CPR and can perform breaths, he or she should add breaths in a 30:2 compressions-to-breaths ratio.
• Bystanders should use mobile phones to immediately call 911, placing the phones on speaker, so the dispatcher can help bystanders check for breathing, get the precise location and provide instructions for performing CPR.
• Dispatchers should be trained to help bystanders check for breathing and recognize cardiac arrest. Dispatchers should also be aware brief generalized seizures may be an early sign of cardiac arrest.
• Mobile dispatch systems that notify potential rescuers of a nearby presumed cardiac arrest can improve the rate of bystander CPR and shorten the time to first chest compressions. Communities may want to consider this service to improve the chain of survival.
Important guideline points for healthcare professionals include:
• Upper limits of recommended heart rate and compression depth have been added, based on new data suggesting excessive compression rate and depth are less effective. Rescuers should perform chest compressions at a rate of 100 to 120 per minute and to a depth of at least 2 inches, avoiding excessive depths greater than 2.4 inches.
• Targeted temperature management helps prevent brain degradation during post-cardiac arrest care. New evidence shows a wider range of temperatures are acceptable. Providers should select a temperature between 32-36 degrees Celsius and maintain it for at least 24 hours.
• Healthcare providers are encouraged to simultaneously perform steps, like checking for breathing and pulse, in an effort to reduce the time to first chest compression.
• There is insufficient evidence to routinely intubate newborns with poor breathing and muscle tone who have been born with meconium, infants’ first feces, in their amniotic fluid. Instead, the new recommendation is to begin CPR under a radiant warmer to get oxygen to the infant faster.
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