Extracts from the Summary of Resuscitation changes 2010
Compiled by Harry Keown
Adult basic life support
The following changes in the basic life support (BLS) guidelines have been made to reflect the importance placed on chest compression, particularly good quality compressions, and to attempt to reduce the number and duration of pauses during chest compression:
- When obtaining help, ask for an automated external defibrillator (AED), if one is available.
- Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min.
- Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally.
- Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care.
The use of Automated External Defibrillators
There are no major changes to the sequence of actions for AED users in Guidelines 2010. The following changes are aimed mainly at increasing the use of AEDs along with clarification on when to stop CPR:
- An AED can be used safely and effectively without previous training; its use should not be restricted to trained rescuers. Training should however be encouraged to help improve the time to shock delivery and correct pad placement.
- Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led BLS and AED courses. Such courses should be validated to ensure that they achieve equivalent outcomes to instructor-led courses'
- When using an AED minimise interruptions in chest compression. Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally.
Paediatric basic life support
Changes in paediatric life support guidelines have been made partly in response to new scientific evidence, and partly to simplify them in order to assist teaching and retention. As in the past, there remains a paucity of good-quality evidence specifically on paediatric resuscitation, and some conclusions have had to be drawn from experimental work or extrapolated from adult data.
Guidelines
- Pulse palpation for 10 s is unreliable for determining the presence or absence of an effective circulation. This means that palpation of the pulse cannot be the sole determinant of the need for chest compressions. Healthcare providers therefore need to determine the presence or absence of ‘signs of life’, such as response to stimuli, normal breathing (rather than abnormal gasps) or spontaneous movement. They may also feel for a pulse but, if there are no other ‘signs of life’, they should only withhold CPR if they are certain there is a definite pulse.
If the lay person considers that there are no ‘signs of life’, CPR should be started immediately.
- Although ventilation remains a very important component of CPR in asphyxial arrest, rescuers who are unable or unwilling to provide this should be encouraged to perform at least compression-only CPR. A child is far more likely to be harmed if bystanders do nothing at all.
- Chest compressions are frequently too shallow, so there has been a subtle, but important, change in the instruction on chest compressions from ‘approximately one third’ to ‘at least one third’ of the AP diameter of the chest. The mean one-third compression depths for infants and children are 4 and 5 cm respectively. In order to be consistent with the adult BLS guidelines the recommended compression rate is now 100 - 120 min-1.