New CPR guidelines emphasize value of chest compression
MedWire News: The European Resuscitation Council (ERC) has issued revised guidelines for cardiopulmonary resuscitation (CPR) that underscore the value of early, uninterrupted chest compressions for victims of cardiac arrest.
The 2010 CPR Guidelines, published in the journal Resuscitation, recommend that lay bystanders who witness a cardiac arrest should deliver chest compressions continuously until medical assistance arrives. The fundamental message is "any CPR is better than no CPR."
The document, written by Jerry Nolan (Royal United Hospital, Bath, UK) and colleagues, is based on the most recent International Consensus on CPR Science with Treatment Recommendations, which incorporated the results of systematic reviews of a wide range of topics relating to CPR.
Since the guidelines were last revised, in 2005, new evidence has come to light supporting the effectiveness of CPR without mouth-to-mouth breathing (ie, compression-only CPR), as described in previous MedWire News reports.
Accordingly, the 2010 guidelines say that non-medically-trained bystanders who witness sudden collapse should deliver chest compressions, pushing down at least 5-cm in the middle of the chest at a rate of at least 100 compressions per minute.
Similarly, if an ambulance dispatcher is giving telephone advice to the bystander, they should recommend compression-only CPR.
However, if the bystander is trained in standard CPR, and they are confident and willing to provide rescue breathing, they should give 30 chest compressions followed by two rescue breaths, then another 30 chest compressions, and so on, in a 30:2 ratio. This is a reversal of previous guidelines, which said that CPR should start with two rescue breaths.
The importance of early, uninterrupted chest compressions is emphasized throughout the guidelines, not only in the section on basic life support but also in conjunction with the use of electrical therapies such as defibrillators and in the setting of advanced life support.
Other new and notable aspects of the 2010 guidelines include an endorsement for therapeutic hypothermia in survivors of cardiac arrest, including comatose patients with non-shockable rhythms, a warning against the delivery of drugs via tracheal tubes, and updated recommendations for pediatric life support and the resuscitation of neonates.
Finally, the guidelines place greater emphasis on post-resuscitation care as the final link in the "Chain of Survival." Post-resuscitation care is targeted at preserving function, particularly of the brain and heart, and is being increasingly recognized as a major determinant of clinical outcomes.
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By Joanna Lyford