bls-hcp comparison 2015

8/18/2019 BLS-HCP Comparison 2015

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2015 Interim Training Materials BLS for Healthcare Providers Student Manual Comparison Chart

New Old RationalePart 2:BLS/CPR forAdults

Immediaterecognitionand activationof emergencyresponsesystem

• Call for nearby help upon findingthe victim unresponsive.

• Continue to assess the breathingand pulse simultaneously.

• Activate the emergency responsesystem or call for backup.

• Check for responsiveness.• Check for no breathing or no

normal breathing.• Call for help.• Check for pulse for no longer

than 10 seconds.

The intent of the recommendationchange is to minimize delay and toencourage fast, efficient, simultaneousassessment and response, rather than aslow, methodical, step-by-stepapproach.

BLS for Healthcare Providers Student Manual Comparison Chart 1


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Shock first vsCPR first

For witnessed adult cardiac arrest,chest compressions should be startedimmediately. Use a defibrillator assoon as possible. CPR should be

provided while the AED pads areapplied and until the AED is readyto analyze the rhythm.

When any rescuer witnesses an out-of-hospitalarrest and an AED is immediatelyavailable on-site, the rescuershould start CPR with chest

compressions and use the AEDas soon as possible. HCPs who treatcardiac arrest in hospitalsand other facilities with on-site AEDs ordefibrillators shouldprovide immediate CPR and should usethe AED/defibrillator assoon as it is available. Theserecommendations are designedto support early CPR and earlydefibrillation, particularly whenan AED or defibrillator is available

within moments of the onsetof sudden cardiac arrest. When anOHCA is not witnessedby EMS personnel, EMS may initiateCPR while checking therhythm with the AED or on theelectrocardiogram (ECG) andpreparing for defibrillation. In suchinstances, 1½ to 3 minutesof CPR may be considered beforeattempted defibrillation.Whenever 2 or more rescuers are

present, CPR should beprovided while the defibrillator isretrieved.With in-hospital sudden cardiac arrest,there is insufficientevidence to support or refute CPRbefore defibrillation.However, in monitored patients, thetime from ventricularfibrillation (VF) to shock delivery shouldbe under 3 minutes,

While numerous studies have addressedthe question of whether a benefit isconferred by providing a specified

period (typically 1.5 to 3 minutes) of

chest compressions before shockdelivery, as compared with delivering ashock as soon as the AED can bereadied, no difference in outcome has

been shown.



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New Old Rationaleand CPR should be performed while thedefibrillator is readied.

Chestcompressionrate

In adult victims of cardiac arrest, perform chest compressions at a rate of100 to 120/min.

Lay rescuers and healthcare providers perform chest compressions at a rate ofat least 100/min.

A single large registry series suggestedthat as the compression rate increases tomore than 120/min, compression depthdecreases in a dose-dependent manner.For example, the proportion ofcompressions of inadequate depth wasabout 35% for a compression rate of 100to 119/min but increased to inadequatedepth in 50% of compressions when thecompression rate was 120 to 139/minand to inadequate depth in 70% ofcompressions when the compressionrate was more than 140/min.

Chestcompressiondepth

Perform chest compressions to adepth of at least 2 inches/5 cm for anaverage adult. Avoid excessive chestcompression depths of more than 2.4inches/6 cm when a feedback deviceis available.

The adult sternum should be depressedat least 2 inches (5 cm).

A compression depth of approximately5 cm is associated with greaterlikelihood of favorable outcomescompared with shallower compressions.While there is less evidence aboutwhether there is an upper threshold

beyond which compressions may be toodeep, a recent very small study suggests

potential injuries (none life-threatening)from excessive chest compression depth(greater than 2.4 inches/6 cm).Compression depth may be difficult to

judge without use of feedback devices,and identification of upper limits ofcompression depth may be challenging.It is important for rescuers to know thatchest compression depth is more oftentoo shallow than too deep.



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New Old RationaleChest recoil Avoid leaning on the chest between

compressions to allow full chest wallrecoil for adults in cardiac arrest.

Allow complete recoil of the chest aftereach compression, to allow the heart tofill completely before the nextcompression.

Full chest wall recoil occurs when thesternum returns to its natural or neutral

position during the decompression phase

of CPR. Chest wall recoil creates arelative negative intrathoracic pressurethat promotes venous return andcardiopulmonary blood flow. Leaningon the chest wall between compressions

precludes full chest wall recoil.Incomplete recoil raises intrathoracic

pressure and reduces venous return,coronary perfusion pressure, andmyocardial blood flow and can

influence resuscitation outcomes.Minimizinginterruptionsin chestcompressions

Minimize the frequency andduration of interruptions incompressions to maximize thenumber of compressions delivered

per minute.

For adults in cardiac arrest whoreceive CPR without an advancedairway, perform CPR with the goal

of a chest compression fraction ashigh as possible, with a target of atleast 60%.

Interruptions in chest compressions can be intended as part of required care (ie,rhythm analysis and ventilation) orunintended (ie, rescuer distraction).Chest compression fraction is ameasurement of the proportion of totalresuscitation time that compressions are

performed. An increase in chestcompression fraction can be achieved by

minimizing pauses in chestcompressions. The optimal goal forchest compression fraction has not beendefined. The addition of a targetcompression fraction is intended to limitinterruptions in compressions and tomaximize coronary perfusion and bloodflow during CPR.



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New Old RationalePart 4:BLS/CPR forChildren;

Part 5:BLS/CPR forInfants

C-A-Bsequence

Although the amount and quality ofsupporting data are limited,

providers should maintain the

sequence from the 2010 Guidelines by initiating CPR with C-A-B overA-B-C.

Initiate CPR for infants and childrenwith chest compressions rather thanrescue breaths (C-A-B rather than

A-B-C). CPR should begin with 30compressions (by a single rescuer)or 15 compressions (for resuscitationof infants and children by 2healthcare providers) rather thanwith 2 ventilations.

In the absence of new data, the sequencehas not been changed. Consistency inthe order of compressions, airway, and

breathing for CPR in victims of all agesmay be easiest for rescuers who treat people of all ages to remember and perform. Maintaining the same sequencefor adults and children offersconsistency in teaching.

Chestcompressiondepth

Rescuers should provide chestcompressions that depress the chestat least one third the anteroposteriordiameter of the chest in pediatric

patients (infants [younger than 1year] to children up to the onset of puberty). This equates toapproximately 1.5 inches (4 cm) ininfants to 2 inches (5 cm) inchildren. Once children havereached puberty (ie, adolescents),the recommended adult compressiondepth of at least 2 inches (5 cm) butno greater than 2.4 inches (6 cm) is

used.

To achieve effective chestcompressions, rescuers shouldcompress at least one third of theanteroposterior diameter of the

chest. This corresponds toapproximately 1.5 inches (about 4cm) in most infants and about 2inches (5 cm) in most children.

One adult study suggested harm withchest compressions greater than 6 cm,resulting in a change in the adult BLSrecommendation to include an upper

limit for chest compression depth; the pediatric experts accepted thisrecommendation for adolescents beyond

puberty. A pediatric study observedimproved 24-hour survival whencompression depth was greater than 51mm (2 inches). Judgment ofcompression depth is difficult at the

bedside, and the use of a feedbackdevice that provides such information

may be useful if available.Chestcompressionrate

To maximize simplicity in CPRtraining, the adult chest compressionrate of 100 to 120/min is used forinfants and children.

Push at a rate of at least 100compressions per minute.

One adult registry study demonstratedinadequate chest compression depthwith extremely rapid compression rates.To maximize educational consistencyand retention, in the absence of pediatricdata, pediatric experts adopted the samerecommendation for compression rate asis made for adult BLS.



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New Old RationaleCompression-only CPR

Conventional CPR (rescue breathsand chest compressions) should be

provided for infants and children in

cardiac arrest. The asphyxial natureof most pediatric cardiac arrestsnecessitates ventilation as part ofeffective CPR. However, becausecompression-only CPR can beeffective in patients with a primarycardiac arrest, if rescuers areunwilling or unable to deliver

breaths, we recommend rescuers perform compression-only CPR for

infants and children in cardiac arrest.

Optimal CPR in infants and childrenincludes both compressions andventilations, but compressions alone

are preferable to no CPR.

Large registry studies havedemonstrated worse outcomes for

presumed asphyxial pediatric cardiac

arrest, which comprise the vast majorityof out-of-hospital pediatric cardiacarrest, treated with compression-onlyCPR. In 2 studies, when conventionalCPR (compressions plus breaths) wasnot given in presumed asphyxial arrest,outcomes were no different from whenvictims did not receive any bystanderCPR. When a presumed cardiac etiologywas present, outcomes were similar

whether conventional or compression-only CPR was provided.Part 7: CPRWith anAdvancedAirway

Ventilationduring CPRwith an

advancedairway

With an advanced airway in place,deliver 1 breath every 6 seconds (10

breaths per minute) whilecontinuous chest compressions are

being performed.

When an advanced airway (ie,endotracheal tube, Combitube, orlaryngeal mask airway) is in placeduring 2-person CPR, give 1 breathevery 6 to 8 seconds withoutattempting to synchronize breaths

between compressions (this willresult in delivery of 8 to 10 breaths

per minute).

This simple single rate for adults,children, and infants—rather than arange of breaths per minute—should beeasier to learn, remember, and perform.



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BLS Dos and Don’ts of Adult High-Quality CPR

Rescuers Should Rescuers Should Not Perform chest compressions at a rate of 100to 120/min

Compress at a rate slower than 100/min orfaster than 120/min

Compress to a depth of at least 2 inches (5cm)

Compress to a depth of less than 2 inches(5 cm) or greater than 2.4 inches (6 cm)

Allow full recoil after each compression Lean on the chest between compressionsMinimize pauses in compressions Interrupt compressions for greater than 10

secondsVentilate adequately (2 breaths after 30compressions, each breath delivered over 1second, each causing chest rise)

Provide excessive ventilation (ie, too many breaths or breaths with excessive force)


bls-hcp comparison 2015

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