Adult Basic Life Support and CPR Quality: LAY RESUCUER CPR Summary of Key Issues and Major Changes

Key issues and major changes in the 2015 Guidelines Update recommendations for adult CPR by lay rescuers include the following:

  • The crucial links in the out-of-hospital adult Chain of Survival are unchanged from 2010, with continued emphasis on the simplified universal Adult Basic Life Support (BLS) Algorithm.  
  • The Adult BLS Algorithm has been modified to reflect the fact that rescuers can activate an emergency response (ie, through use of a mobile telephone) without leaving the victim’s side.
  • It is recommended that communities with people at risk for cardiac arrest implement PAD programs.  
  • Recommendations have been strengthened to encourage immediate recognition of unresponsiveness, activation of the emergency response system, and initiation of CPR if the lay rescuer finds an unresponsive victim is not breathing or not breathing normally (eg, gasping).
  • Emphasis has been increased about the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (ie, dispatch-guided CPR).
  • The recommended sequence for a single rescuer has been confirmed: the single rescuer is to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) to reduce delay to first compression. The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths.
  • There is continued emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation.
  • The recommended chest compression rate is 100 to 120/min (updated from at least 100/min).
  • The clarified recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm).
  • Bystander-administered naloxone may be considered for suspected life-threatening opioid-associated emergencies.

 

Adult Basic Life Support and CPR Quality: HCP BLS

Summary of Key Issues and Major Changes Key issues and major changes in the 2015 Guidelines Update recommendations for HCPs include the following:

  • These recommendations allow flexibility for activation of the emergency response system to better match the HCP’s clinical setting.
  • Trained rescuers are encouraged to simultaneously perform some steps (ie, checking for breathing and pulse at the same time), in an effort to reduce the time to first chest compression.
  • Integrated teams of highly trained rescuers may use a choreographed approach that accomplishes multiple steps and assessments simultaneously rather than the sequential manner used by individual rescuers (eg, one rescuer activates the emergency response system while another begins chest compressions, a third either provides ventilation or retrieves the bag-mask device for rescue breaths, and a fourth retrieves and sets up a defibrillator).
  • Increased emphasis has been placed on high-quality CPR using performance targets (compressions of adequate rate and depth, allowing complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation).
  • Compression rate is modified to a range of 100 to 120/min.
  • Compression depth for adults is modified to at least 2 inches (5 cm) but should not exceed 2.4 inches (6 cm).
  • To allow full chest wall recoil after each compression, rescuers must avoid leaning on the chest between compressions.
  • Criteria for minimizing interruptions is clarified with a goal of chest compression fraction as high as possible, with a target of at least 60%.
  • Where EMS systems have adopted bundles of care involving continuous chest compressions, the use of passive ventilation techniques may be considered as part of that bundle for victims of OHCA.
  • For patients with ongoing CPR and an advanced airway in place, a simplified ventilation rate of 1 breath every 6 seconds (10 breaths per minute) is recommended.