The Lay Medical Man: 10/4/09

This post enumerates the 2005 American Heart Association
(AHA) guidelines for cardiopulmonary resuscitation
(CPR) and emergency cardiovascular care (ECC). The
guidelines are based on the evidence evaluation from the
2005 International Consensus Conference on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendations, hosted by the American
Heart Association in Dallas, Texas, January 23–30,
2005.1 These guidelines supersede the Guidelines 2000 for
Cardiopulmonary Resuscitation
New Developments
The most significant changes in these guidelines were made
to simplify CPR instruction and increase the number of chest
compressions delivered per minute and reduce interruptions
in chest compressions during CPR. Following are some of the
most significant new recommendations in these guidelines:
● Elimination of lay rescuer assessment of signs of circulation
before beginning chest compressions: the lay rescuer
will be taught to begin chest compressions immediately
after delivering 2 rescue breaths to the unresponsive victim
who is not breathing.
● Simplification of instructions for rescue breaths: all breaths
(whether delivered mouth-to-mouth, mouth-to-mask, bagmask,
or bag-to–advanced airway) should be given over 1
second with sufficient volume to achieve visible chest rise.
● Elimination of lay rescuer training in rescue breathing
without chest compressions .
● Recommendation of a single (universal) compression-toventilation
ratio of 30:2 for single rescuers of victims of all
ages (except newborn infants). This recommendation is
designed to simplify teaching and provide longer periods of
uninterrupted chest compressions .
● Modification of the definition of “pediatric victim” to
preadolescent (prepubescent) victim for application of
pediatric BLS guidelines for healthcare providers , but no change to lay rescuer application of child
CPR guidelines (1 to 8 years).
● Increased emphasis on the importance of chest compressions:
rescuers will be taught to “push hard, push fast” (at
a rate of 100 compressions per minute), allow complete
chest recoil, and minimize interruptions in chest compressions.
● Recommendation that Emergency Medical Services (EMS)
providers may consider provision of about 5 cycles (or
about 2 minutes) of CPR before defibrillation for unwitnessed
arrest, particularly when the interval from the call to
the EMS dispatcher to response at the scene is more than 4
to 5 minutes
● Recommendation for provision of about 5 cycles (or about
2 minutes) of CPR between rhythm checks during treatment
of pulseless arrest . Rescuers
should not check the rhythm or a pulse immediately after
shock delivery—they should immediately resume CPR,
beginning with chest compressions, and should check the
rhythm after 5 cycles (or about 2 minutes) of CPR.
● Recommendation that all rescue efforts, including insertion
of an advanced airway (eg, endotracheal tube, esophagealtracheal
combitube [Combitube], or laryngeal mask airway
[LMA]), administration of medications, and reassessment
of the patient be performed in a way that minimizes
interruption of chest compressions. Recommendations for
pulse checks are limited during the treatment of pulseless
arrest
● Recommendation of only 1 shock followed immediately by
CPR (beginning with chest compressions) instead of 3
stacked shocks for treatment of ventricular fibrillation/
pulseless ventricular tachycardia: this change is based on
the high first-shock success rate of new defibrillators and
the knowledge that if the first shock fails, intervening chest
compressions may improve oxygen and substrate delivery
to the myocardium, making the subsequent shock more
likely to result in defibrillation
● Increased emphasis on the importance of ventilation and
de-emphasis on the importance of using high concentrations
of oxygen for resuscitation of the newly born .

References
1. International Liaison Committee on Resuscitation. 2005 International
Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care Science With Treatment Recommendations. Circulation.
2005;112:III-1–III-136.
2. American Heart Association in collaboration with International Liaison
Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. Circulation. 2000;
102(suppl):I1–I384