LAY RESUCUER CPR Summary of Key Issues and Major Changes

Key issues and major changes in the 2020 Guidelines Update recommendations for adult CPR by lay rescuers include the following:

  • The crucial links in the out-of-hospital adult Chain of Survival  had a sixth link (Recovery)added, with continued emphasis on the simplified universal Adult Basic Life Support (BLS) Algorithm.  
  • 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:  BLS

Summary of Key Issues and Major Changes Key issues and major changes in the 2020 Guidelines Update recommendations for HCPs include the following:

  • Previous recommendations about epinephrine administration have been reaffirmed , with emphasis on early epinephrine administration.
  • Use of real-time audiovisual feedback is suggested as a means to maintain CPR quality.
  • Continuously measuring arterial blood pressure and ETCO2 during ACLS resuscitation may be useful to improve CPR quality.
  • On the basis of the most recent evidence, routine use of DSD (double sequential defibrillation) is not recommended.
  • IV access is the preferred route of medication administration during ACLS resuscitation.  IO access is acceptable if IV access is not available.
  • Care of patient after ROSC requires close attention of oxygenation, blood pressure control, evaluation for percutaneous coronary  intervention (PCI), targeted temperature management (TTM), and multimodal neuroprognostication.
  • Because recovery from cardiac arrest continues long after the initial hospitalization, patients should have formal assessment and support for their physical, cognitive and psychosocial needs.
  • After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers may be beneficial to support their mental health and well being.
  • Management of cardiac arrest in pregnancy focuses on maternal resuscitation, with preparation for early perimortem caesarean delivery if necessary to save the infant and improve the chances of successful resuscitation of the mother.
  • 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, using CPR feedback devices).
  • 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.
  • 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.