AHA Update 2010

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Welcome to theAmerican Heart Association

2010 Update for CPR.

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Clinical staff all levels

2010 AHA Update for CPR

1.0

5/24/2011

This module provides the audience with an overview ofthe American Heart Associations 2010 changes to

CPR procedures for healthcare professionals.

The module contains 45 slides and should take ~25minutes to complete. 404-785-6767

Shannon Dunlap

[email protected]

Mark Guerrein

05/24/2011 22011 Childrens Healthcare of Atlanta Inc.

All Rights Reserved.

None

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Childrens Healthcare of Atlanta has developed this module topresent the updated CPR protocol from the American HeartAssociation (AHA) to clinicians who perform CPR.

On April 1, 2011, we will begin utilizing this new protocol when CPR isperformed in our hospitals and neighborhood locations. You will bethoroughly instructed in this protocol during your next CPRrecertification or your initial CPR certification course. Meanwhile,there are some important points you must know so that you and all

those performing CPR are using the same protocol.

If you have any questions about any of these points you can ask youreducator or contact Shannon Dunlap.

Note:The new guidelines are highlighted in red throughout the CBT.



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At the completion of this module you will be able todescribe the American Heart Associations 2010 revisions

to providing basic life support (including CPR) for:

Adult victimsInfant and child victimsVictims with foreign body obstructions in their airways



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In late 2010, the American Heart Association or AHAmodified its recommendations on Cardio PulmonaryResuscitation (CPR) procedures to improve survival

rates of adult and pediatric victims.

These recommendations were based upon empiricalstudies that indicated improved survival. They include:

Changes to the Chain of Survival

Changes to the CPR sequence

In this lesson you will be presented with an overview ofthese changes.

Lesson 1: CPR Overview



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CPR Overview

Immediate recognition of cardiac

arrest and activation of theemergency response system

Early CPR emphasizing chestcompressions

Rapid defibrillation

Effective advanced life support

Integrated post-cardiac care

Successful resuscitation following cardiac arrest requires several key actionsalso know as the Chain of Survival. These are:



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Change in SequenceThe new AHA guidelines recommend afundamental change in CPR sequencefrom A-B-C to C-A-B

C-A-BCompressions: Push hard and fast onthe center of the victims chest.

Airway: Tilt the victims head back and liftthe chin to open the airway.

Breathing: Give mouth-to-mouth orbag/mask rescue breathing.



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Change in Sequence continuedThe new AHA guidelines have also eliminated Look, Listen, and Feel from

the CPR sequence because performing it is inconsistent and time consuming.



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Cardiac Arrest Cardiac arrest in adults is usually

sudden, and the primary cause iscardiac related. Thereforecirculation produced by chest

compressions is crucial.

Cardiac arrest in children ismostly asphyxial which requiresboth compressions andventilations.

Rescue breathing may be moreimportant for children than adultsin cardiac arrest.



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Lesson 1: CPR Overview

In this lesson you learned about general changes toCPR guidelines that the AHA has recommended:

Changes to the Chain of Survival

Changes to the CPR sequence from A-B-C to C-A-B

In the next lesson you will be presented the specificchanges to the AHA CPR guidelines for adults.



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Lesson 2: Adult Basic LifeSupport for Healthcare

Providers

In this lesson you will learn about changes to the CPRprocedures for adults that are provided by ourcaregivers here at Childrens.

These include revisions to:

Chest compressionsPulse checksRescue breaths

You will also learn about revisions on using anAutomated External Defibrillator (AED) in conjunctionwith CPR.



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Adults / Adolescents Basic Life Support (BLS) forHealthcare Providers The rescuer recognizes that the

patient is unresponsive nobreathing or no normal breathing.

Activate the emergency responsesystem and get AED/defibrillatorif second rescuer is available sendher or him to do this.

Check the pulse if definite pulsewithin 10 seconds give 1 breathevery 5 to 6 seconds and re-checkcarotid pulse every 2 minutes.



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Adult BLS for Healthcare Providers If there is no pulse, begin CPR starting with

30 compressions. Then open the airway andgive 2 breaths.

When the AED/defibrillator arrives, checkrhythm.

If rhythm is shockable, give 1 shock andresume CPR immediately for 2 minutes.

If rhythm is not shockable, resume CPR for 2

minutes; check rhythm every 2 minutes andcontinue until advanced life support providerstake over or the patient starts to move.

The AED will automatically prompt you toperform the above actions.



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Chest Compressions in AdultsRescuers should focus on delivery of high qualityCPR Push Hard and Push Fast

Provide chest compressions at an adequate rate (at least 100/min)

Provide Chest compressions to adequate depth

o Adults: Compression depth of at least 2 inches (5cm)

o Allow complete chest recoil after each compression

Minimize interruptions in compressions

Avoid excessive ventilations

If multiple rescuers are available, they should rotate the task of compressionsevery 2 minutes



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Pulse Checks Studies have shown that healthcare

providers and lay rescuers havedifficulty detecting pulses.

To avoid delay in CPR, healthcareproviders should take no more than 10seconds to check for a pulse.

If a pulse is not detected within 5-10seconds then compressions should be

started.



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Rescue Breaths The 2010 AHA Guidelines recommend

the initiation of compressions beforeventilations.

Once compressions have been started,a trained rescuer should deliver rescuebreaths by mouth-to-mouth orbag/mask.



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Rescue Breaths Rescue breaths should be

delivered over 1 second.

Give sufficient tidal volume to

produce visible chest rise.

Use compression to ventilationratio of 30 compressions to 2ventilations.

If there is a pulse give 1 breathevery 5-6 seconds.



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AED/DefibrillationDefibrillation sequence

Turn on the AED.

Follow the AED prompts.

Resume chest compressionsimmediately after the shock;minimize interruptions.

Pad placement

The 4 pad positions areanterolateral, anteroposterior,anterior-left infrascapular, and

anterior-right infrascapular. All ofthese positions are equallyeffective.



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Adult BLS for Healthcare ProvidersThe following slide displays a flow chart of the steps to follow when providingAdult BLS.



Ad lt / Ad l t

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Victim is unresponsive. No breathing or no normal breathing (i.e., only gasping).

Activate the emergency responsesystem and get AED/defibrillator.

Check pulse:DEFINITE pulse within 10 secs.?

Begin cycles of 30 compressionsand 2 breaths.

Give 1 breath every 5 to 6 secs.

Re-check pulse every 2 mins.

AED/defibrillator arrives.

Shockable rhythm?

Shockable rhythm:Give 1 shock and resume

CPR for 2 mins.

No shockable rhythm: ResumeCPR immediately for 2 mins. Checkrhythm every 2 mins. Continue until

ALS providers take over or victimstarts to move.

2

3

3a 4

5

6

7 8

1

Pulse No Pulse

No

High Quality CPRRate at least 100/minute

Compression depth at least 2inches (5cm)

Allow complete chest recoil aftereach compression.

Minimize interruptions in chestcompressions.

Avoid excessive ventilations.

** Indicates achange toAHA protocol

YES

Adult / AdolescentBLS for

Healthcare Providers

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Lesson 2: Adult Basic LifeSupport for Healthcare

Providers

In this lesson you learned about revisions to CPRprocedures for adults including:

Chest compressionsPulse checksRescue breaths

You also learned about revisions on using an Automatedexternal defibrillator (AED) in conjunction with CPR.

In the next lesson information about BLS for childrenand infants is presented.



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Lesson 3: Child andInfant CPR

This lesson presents information about revisions to theCPR procedures for infants and children.

These include:

The differences between CPR for infants and childrenInadequate breathing issuesPoor Perfusion

You will also learn about revisions on using anAutomated External Defibrillator (AED) in conjunctionwith CPR for children and infants.



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Child and Infant CPR Infant BLS guidelines apply to

infants less than approximately 1year of age.

Child BLS guidelines apply tochildren approximately 1 year ofage until puberty.

For teaching purposes, puberty isdefined as breast development in

females and presence of axillaryhair in males.



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Child and Infant CPRThe AHA recommends that the sequence of CPR for adults andinfants/children be the same

Rationale for making the changes inCPR sequence to C-A-B in infants

and children:

The majority of victims who requireCPR are adults. They have a betteroutcome if compressions are startedas early as possible.

Beginning CPR with compressionsrather than ventilations leads to ashorter delay to the first compression.

All rescuers should be able to startchest compressions almost

immediately. Whereas positioningthe head and making sure there isa seal for mouth-tomouth or bag-mask resuscitation takes time anddelays the initiation of chestcompressions

This also offers the advantage ofconsistency in education whetherthe victims are adult, children orinfants.



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Pediatric Chain of Survival Make sure the area is safe for you

and the infant/child

Assess the need for CPR andstart compressions lonerescuers should give about 5cycles of compressions andventilations before leaving thechild to activate the emergencyresponse

Activate emergency responsesystem and get the AED

Effective advanced life support

Integrated post-cardiac care



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Chest Compressions in Infants and ChildrenRescuers should focus on delivery of high quality CPRPush Hard and Push Fast.

Provide chest compressions to adequate rate (at least 100/minute)

Provide chest compressions of adequate depth Infants and children: a depth of at least one third the anterior-posterior

(AP) diameter of the chest or about 1 inches (4cm) in infants and about2 inches (5cm) in children

Allow compete chest recoil after each compression

Minimize interruptions in compressionsAvoid excessive ventilation

If multiple rescuers are available they should rotate the task of compressionsevery 2 minutes.



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Pediatric BLS for Healthcare Providers in Infantsand Children If second rescuer is available send him or her to

activate the emergency response and obtainAED/defibrillator. AEDs have now been

approved for use with infants. Check pulse if definite pulse within 10

seconds give 1 breath every 3 seconds.

Add compressions if pulse remains less than60/min with poor perfusion despite adequate

oxygenation and ventilation. Recheck pulse every 2 minutes.



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Pediatric BLS for Healthcare Providers in Infantsand Children If no pulse is detected, begin cycles of 30

compressions and 2 breaths for one rescuer. For2 rescuers begin cycles of 15 compressions and 2

breaths. If lone rescuer, after about 2 minutes, activate the

emergency response system if not already done.Use an AED as soon as available.

If rhythm is shockable, give 1 shock and resume

CPR immediately for 2 minutes.

If rhythm is not shockable, resume CPRimmediately for 2 minutes. Check rhythm every 2minutes. Continue until Advanced Life Supportproviders take over or victim starts to move.



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Pediatric BLS for Healthcare ProvidersThe following slide displays a flow chart of the steps to follow when providingpediatric BLS.



Vi ti i i N t b thi i S d t ti t

1

Pediatric BLS for

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Victim is unresponsive. Not breathing or gasping. Send someone to activateThe emergency response system and get an AED/defibrillator.

One rescuer:For SUDDEN COLLAPSE activatetheemergency response system and get

AED/defibrillator

Check pulse:DEFINITE pulse within 10 secs.?

One rescuer: Begin cycles of 30compressions and 2 breaths

Two rescuers: Begin cycles of 15compressions and 2 breaths

Give 1 breath every 3 secs. Addcompressions if pulse remains

< 60/min with poor perfusion despiteadequate oxygenation and ventilation

RE-check pulse every 2 mins

After about 2 mins, activate emergencyresponse system and get AED (if not already

done). Use AED ASAP to check rhythm.

Shockable rhythm?

Shockable rhythm:Give 1 shock and resume

CPR for 2 mins.

No shockable rhythm: ResumeCPR immediately for 2 mins. Checkrhythm every 2 mins. Continue until

ALS providers take over or victimstarts to move.

2

3

3a 4

5

6

7 8

1

Pulse No Pulse

No

High Quality CPRRate at least 100/minuteCompression depth at

least 1/3 anterior-posteriordiameter of chest, about 1 inches (4cm) in infantsand 2 inches (5cm) inchildren

Allow complete chest recoilafter each compression.

Minimize interruptions inchest compressions.

Avoid excessive ventilations.

*

* Indicates achange to AHAprotocol

YES

Pediatric BLS forHealthcare Providers

TWO rescuers:For SUDDEN COLLAPSE send someone

to activate the emergency responsesystem and get AED/defibrillator

2

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Chest Compressions for Healthcare Providerof Infants For infants, the single rescuer should

use the 2-finger chest compressiontechnique.

The 2-thumb encircling handstechnique is recommended when CPRis provided by 2 rescuers.

To do this, encircle the infants chest

with both hands. Spread your fingersaround the thorax, and place yourthumbs together over the lower third ofthe sternum. Forcefully compress thesternum with your thumbs.



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Inadequate Breathing with PulseIf there is a palpable pulse > 60 perminute but there is inadequatebreathing:

Give rescue breaths at a rate of about12-20 breaths per minute 1 breathevery 3-5 seconds until spontaneousbreathing resumes.



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Bradycardia with Poor PerfusionIf the pulse is less than 60 beats per minute and there are signs of poor perfusion( i.e., pallor, mottling, cyanosis) begin compressions.



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AED/Defibrillators in Children and Infants If a manual defibrillator is unavailable

then an AED that has a pediatricdose attenuator (pediatric pads) ispreferred for infants.

An AED with a pediatric doseattenuator is also preferred forchildren under 8 years of age.

If neither is available an AED withouta dose attenuator may be used.

In infants, manual defibrillators arepreferred. If a manual defibrillator isnot available then one with apediatric dose attenuator (pediatricpads) is preferred.

AEDs that do not have

pediatric dose attenuators havebeen used in infants with noclear adverse effects.



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Summary of Key BLS Components for Adults Children and Infants*

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Recommendations

Component Adults Children Infants

Recognition

Unresponsive (for all ages)

No breathing or no normalbreathing (i.e., only gasping)

No breathing or only gasping

No pulse palpated within 10 seconds for all ages (HCP only)

CPR Sequence C-A-B

Compression rate At least 100/min

Compression depth At least 2 inches (5cm)At least AP diameterAbout 2 inches (5cm)

At least AP diameterAbout 1 inches (4cm)

Chest wall recoilAllow complete recoil between compressions

HCPs rotate compressions every 2 minutesCompressioninterruptions

Minimize interruptions in chest compressionsAttempt to limit interruptions to < 10 seconds

Airway Head tilt-chin lift (HCP suspected trauma: jaw thrust)

Compression-to-ventilation ratios(until advancedairway placed)

30:21 or 2 rescuers

30:2Single rescuer

15:22 HCP rescuers

Ventilations: whenrescuer untrained or

trained and notproficient

Compressions only

Ventilations withadvanced airway

(HCP)

1 breath every 6-8 seconds (8-10 breaths/min)Asynchronous with chest compressions

About 1 second per breathVisible chest rise

Defibrillation

Attach and use AED as soon as possible. Minimize interruptions in chest compressions

before and after shock;resume CPR beginning with compressions immediately after each shock.Source: Highlights of the 2010AHA Guidelines for CPR & ECC

Summary of Key BLS Components for Adults, Children, and Infants*Excluding the newly born, inwhom the etiology of an arrest isnearly always asphyxiate.

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Lesson 3: Child andInfant CPR

In this lesson you learned about.

The differences between CPR for infants and childrenversus adults

Inadequate breathing issuesPoor perfusion

You also learned about using an Automated ExternalDefibrillator (AED) in conjunction with CPR for childrenand infants.



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Foreign Body Airway Obstruction (Choking) Greater than 90% of childhood

deaths from foreign bodyaspiration occur in children under5 years old.

Foreign body obstruction can beeither mild or severe.

When it is mild, the adult and childrencan cough and make some sounds.

When it is severe, the adult or childcannot cough or make any sound.



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Relief of Foreign Body Obstruction If the foreign body obstruction is

mild, do not interfere. Allow thevictim to clear airway by coughingwhile you observe for signs of

severe foreign body obstruction. If the foreign body obstruction is

severe you must act to relieve theobstruction.

For adults and children, performabdominal thrusts until the objectis expelled or the victim becomesunresponsive.

For infant, deliver repeated cyclesof 5 back blows followed by 5chest compressions until theobject is expelled or the victimbecomes unresponsive.



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Relief of Foreign Body Obstruction (Unresponsive)If the victim becomes unresponsive:

Start CPR with chest compressionsdo not perform a pulse check.

After 30 chest compressions openthe airway.

If you see a foreign body, remove itbut do not perform blind fingersweeps because they may push theobjects further into the pharynx.

Attempt to give 2 breaths andcontinue with cycles of chestcompressions and ventilationsuntil the object is expelled. Look

for the object after each round ofcompressions and sweep if seen.

After 2 minutes, if no one hasdone so, activate the emergencyresponse system.



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Hands-only CPRBecause we are in a healthcare setting, this CBT has focused primarily on CPRfor Healthcare Providers. Hands-only CPR is for layperson cardiac arrestrescue in the community or out of the hospital when unable to provide breaths(no mask/barrier) because:

Lay rescuers are more likely to provide CPR if they do

not have to give ventilations.

It is easier for emergency response personnel toinstruct lay rescuers how to perform chestcompressions when they are untrained.

Survival rates from cardiac arrest are similar for

Hands-only CPR and CPR using both compressionsand ventilations.

If the lay rescuer is trained, it is still recommendedthat the rescuer perform both compressions andventilations.



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Lesson 4: Foreign BodyObstruction (Choking)

This lesson presented information about foreign bodyobstructions in victims airways, including:

Relief for responsive and unresponsive victims

Recognizing and responding appropriately to mild andsevere obstructions

You also learned about Hands-only CPR used by lay-people.



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You have completed this module. In it you learned aboutthe changes to the AHAs new recommendations for

providing CPR. These changes impact providing basic

life support for:Adult victimsInfant and child victimsVictims with foreign body obstructions in their airways


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References

2010 American Heart Association Guidelines for CPR and ECC,

Supplement to Circulation November 2,2010, Volume 122,

Issue 18, Supplement 3.

www.heart.org

2011 Childrens Healthcare of Atlanta Inc
http://www.heart.org/http://www.heart.org/

AHA Update 2010

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