Highlights of the 2010
Amer i c an Hea r t Assoc i a t i o n
Guidelines for CPR and ECC
Major Issues Affecting
All Rescuers 1
Lay Rescuer Adult CPR 3
Healthcare Provider BLS 5
Electrical Therapies 9
CPR Techniques and Devices 12
Advanced Cardiovascular
Life Support 13
Acute Coronary Syndromes 17
Stroke 18
Pediatric Basic Life Support 18
Pediatric Advanced Life
Support 20
Neonatal Resuscitation 22
Ethical Issues 24
Education, Implementation,
and Teams 25
First Aid 26
Summary 28
Contents
© 2010 American Heart Association
Editor
Mary Fran Hazinski, RN, MSN
Associate Editors
Leon Chameides, MD
Robin Hemphill, MD, MPH
Ricardo A. Samson, MD
Stephen M. Schexnayder, MD
Elizabeth Sinz, MD
Contributor
Brenda Schoolfield
Guidelines Writing Group Chairs and Cochairs
Michael R. Sayre, MD
Marc D. Berg, MD
Robert A. Berg, MD
Farhan Bhanji, MD
John E. Billi, MD
Clifton W. Callaway, MD, PhD
Diana M. Cave, RN, MSN, CEN
Brett Cucchiara, MD
Jeffrey D. Ferguson, MD, NREMT-P
Robert W. Hickey, MD
Edward C. Jauch, MD, MS
John Kattwinkel, MD
Monica E. Kleinman, MD
Peter J. Kudenchuk, MD
Mark S. Link, MD
Laurie J. Morrison, MD, MSc
Robert W. Neumar, MD, PhD
Robert E. O’Connor, MD, MPH
Mary Ann Peberdy, MD
Jeffrey M. Perlman, MB, ChB
Thomas D. Rea, MD, MPH
Michael Shuster, MD
Andrew H. Travers, MD, MSc
Terry L. Vanden Hoek, MD
4Highlights of the 2010 AHA Guidelines for CPR and ECC
T his “Guidelines Highlights” publication summarizes the key issues and changes in the 2010 American Heart Association (AHA) Guidelines for
Cardiopulmonary Resuscitation (CPR) and Emergency
Cardiovascular Care (ECC). It has been developed for
resuscitation providers and for AHA instructors to focus on
resuscitation science and guidelines recommendations that
are most important or controversial or will result in changes in
resuscitation practice or resuscitation training. In addition, it
provides the rationale for the recommendations.
Because this publication is designed as a summary, it does
not reference the supporting published studies and does
not list Classes of Recommendations or Levels of Evidence.
For more detailed information and references, the reader is
encouraged to read the 2010 AHA Guidelines for CPR and
ECC, including the Executive Summary,1 published online
in Circulation in October 2010 and to consult the detailed
summary of resuscitation science in the 2010 International
Consensus on CPR and ECC Science With Treatment
Recommendations, published simultaneously in Circulation2
and Resuscitation.3
This year marks the 50th anniversary of the first peer-reviewed
medical publication documenting survival after closed
chest compression for cardiac arrest,4 and resuscitation
experts and providers remain dedicated to reducing death
and disability from cardiovascular diseases and stroke.
Bystanders, first responders, and healthcare providers all
play key roles in providing CPR for victims of cardiac arrest.
In addition, advanced providers can provide excellent
periarrest and postarrest care.
The 2010 AHA Guidelines for CPR and ECC are based on
an international evidence evaluation process that involved
hundreds of international resuscitation scientists and experts
who evaluated, discussed, and debated thousands of peer-
reviewed publications. Information about the 2010 evidence
evaluation process is contained in Box 1.
MAJOR ISSUES AFFECTING
ALL RESCUERS
This section summarizes major issues in the 2010 AHA
Guidelines for CPR and ECC, primarily those in basic life
support (BLS) that affect all rescuers, whether healthcare
providers or lay rescuers. The 2005 AHA Guidelines for CPR
and ECC emphasized the importance of high-quality chest
compressions (compressing at an adequate rate and depth,
allowing complete chest recoil after each compression, and
minimizing interruptions in chest compressions). Studies
published before and since 2005 have demonstrated that (1) the
quality of chest compressions continues to require improvement,
although implementation of the 2005 AHA Guidelines for CPR
and ECC has been associated with better CPR quality and
greater survival; (2) there is considerable variation in survival
from out-of-hospital cardiac arrest across emergency medical
services (EMS) systems; and (3) most victims of out-of-hospital
sudden cardiac arrest do not receive any bystander CPR. The
changes recommended in the 2010 AHA Guidelines for CPR
and ECC attempt to address these issues and also make
recommendations to improve outcome from cardiac arrest
through a new emphasis on post–cardiac arrest care.
Continued Emphasis on High-Quality CPR
The 2010 AHA Guidelines for CPR and ECC once again
emphasize the need for high-quality CPR, including
• A compression rate of at least 100/min (a change from
“approximately” 100/min)
• A compression depth of at least 2 inches (5 cm) in adults
and a compression depth of at least one third of the anterior-
posterior diameter of the chest in infants and children
(approximately 1.5 inches [4 cm] in infants and 2 inches
[5 cm] in children). Note that the range of 1½ to 2 inches is
no longer used for adults, and the absolute depth specified
for children and infants is deeper than in previous versions of
the AHA Guidelines for CPR and ECC.
1
MAJOR issues
Evidence Evaluation Process
The 2010 AHA Guidelines for CPR and ECC are based on an extensive review of resuscitation literature and many debates and
discussions by international resuscitation experts and members of the AHA ECC Committee and Subcommittees. The ILCOR 2010
International Consensus on CPR and ECC Science With Treatment Recommendations, simultaneously published in Circulation2 and
Resuscitation,3 summarizes the international consensus interpreting tens of thousands of peer-reviewed resuscitation studies. This
2010 international evidence evaluation process involved 356 resuscitation experts from 29 countries who analyzed, discussed, and
debated the resuscitation research during in-person meetings, conference calls, and online sessions (“webinars”) over a 36-month
period, including the 2010 International Consensus Conference on CPR and ECC Science With Treatment Recommendations, held
in Dallas, Texas, in early 2010. Worksheet experts produced 411 scientific evidence reviews of 277 topics in resuscitation and ECC.
The process included structured evidence evaluation, analysis, and cataloging of the literature. It also included rigorous disclosure and
management of potential conflicts of interest. The 2010 AHA Guidelines for CPR and ECC1 contain the expert recommendations for
application of the International Consensus on CPR and ECC Science With Treatment Recommendations with consideration of their
effectiveness, ease of teaching and application, and local systems factors.
BOX 1
major Issues
3 A m e r i c a n H e a r t A s s o c i a t i o n
lay rescuer adult cpr
2 A m e r i c a n H e a r t A s s o c i a t i o n
major Issues
• Allowing for complete chest recoil after each compression
• Minimizing interruptions in chest compressions
• Avoiding excessive ventilation
There has been no change in the recommendation for a
compression-to-ventilation ratio of 30:2 for single rescuers of
adults, children, and infants (excluding newly born infants). The
2010 AHA Guidelines for CPR and ECC continue to recommend
that rescue breaths be given in approximately 1 second. Once
an advanced airway is in place, chest compressions can be
continuous (at a rate of at least 100/min) and no longer cycled
with ventilations. Rescue breaths can then be provided at
about 1 breath every 6 to 8 seconds (about 8 to 10 breaths per
minute). Excessive ventilation should be avoided.
A Change From A-B-C to C-A-B
The 2010 AHA Guidelines for CPR and ECC recommend a
change in the BLS sequence of steps from A-B-C (Airway,
Breathing, Chest compressions) to C-A-B (Chest compressions,
Airway, Breathing) for adults, children, and infants (excluding the
newly born; see Neonatal Resuscitation section). This fundamental
change in CPR sequence will require reeducation of everyone
who has ever learned CPR, but the consensus of the authors and
experts involved in the creation of the 2010 AHA Guidelines for
CPR and ECC is that the benefit will justify the effort.
Why: The vast majority of cardiac arrests occur in adults,
and the highest survival rates from cardiac arrest are reported
among patients of all ages who have a witnessed arrest and
an initial rhythm of ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT). In these patients, the critical
initial elements of BLS are chest compressions and early
defibrillation. In the A-B-C sequence, chest compressions
are often delayed while the responder opens the airway to
give mouth-to-mouth breaths, retrieves a barrier device, or
gathers and assembles ventilation equipment. By changing the
sequence to C-A-B, chest compressions will be initiated sooner
and the delay in ventilation should be minimal (ie, only the time
required to deliver the first cycle of 30 chest compressions, or
approximately 18 seconds; when 2 rescuers are present for
resuscitation of the infant or child, the delay will be even shorter).
Most victims of out-of-hospital cardiac arrest do not receive
any bystander CPR. There are probably many reasons for this,
but one impediment may be the A-B-C sequence, which starts
with the procedures that rescuers find most difficult, namely,
opening the airway and delivering breaths. Starting with chest
compressions might encourage more rescuers to begin CPR.
Basic life support is usually described as a sequence of
actions, and this continues to be true for the lone rescuer.
Most healthcare providers, however, work in teams, and
team members typically perform BLS actions simultaneously.
For example, one rescuer immediately initiates chest
compressions while another rescuer gets an automated
external defibrillator (AED) and calls for help, and a third
rescuer opens the airway and provides ventilations.
Healthcare providers are again encouraged to tailor rescue
actions to the most likely cause of arrest. For example,
if a lone healthcare provider witnesses a victim suddenly
collapse, the provider may assume that the victim has had a
primary cardiac arrest with a shockable rhythm and should
immediately activate the emergency response system,
retrieve an AED, and return to the victim to provide CPR
and use the AED. But for a presumed victim of asphyxial
arrest such as drowning, the priority would be to provide
chest compressions with rescue breathing for about 5 cycles
(approximately 2 minutes) before activating the emergency
response system.
Two new parts in the 2010 AHA Guidelines for CPR and ECC
are Post–Cardiac Arrest Care and Education, Implementation,
and Teams. The importance of post–cardiac arrest care is
emphasized by the addition of a new fifth link in the AHA
ECC Adult Chain of Survival (Figure 1). See the sections
Post–Cardiac Arrest Care and Education, Implementation,
and Teams in this publication for a summary of key
recommendations contained in these new parts.
Figure 1
AHA ECC Adult Chain of Survival
The links in the new AHA ECC Adult
Chain of Survival are as follows:
1. Immediate recognition of cardiac
arrest and activation of the
emergency response system
2. Early CPR with an emphasis on
chest compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post–cardiac arrest care
A m e r i c a n H e a r t A s s o c i a t i o n 4Highlights of the 2010 AHA Guidelines for CPR and ECC
HealtH Care Prov ider bls
Figure 2
Simplified Adult BLS Algorithm
3
lay rescuer adult cpr
LAY RESCUER
ADULT CPR
Summary of Key Issues and Major Changes
Key issues and major changes for the 2010 AHA Guidelines for
CPR and ECC recommendations for lay rescuer adult CPR are
the following:
• The simplified universal adult BLS algorithm has been
created (Figure 2).
• Refinements have been made to recommendations for
immediate recognition and activation of the emergency
response system based on signs of unresponsiveness, as
well as initiation of CPR if the victim is unresponsive with no
breathing or no normal breathing (ie, victim is only gasping).
• “Look, listen, and feel for breathing” has been removed from
the algorithm.
• Continued emphasis has been placed on high-quality CPR
(with chest compressions of adequate rate and depth,
allowing complete chest recoil after each compression,
minimizing interruptions in compressions, and avoiding
excessive ventilation).
• There has been a change in the recommended sequence
for the lone rescuer to initiate chest compressions before
giving rescue breaths (C-A-B rather than A-B-C). The lone
rescuer should begin CPR with 30 compressions rather than
2 ventilations to reduce delay to first compression.
• Compression rate should be at least 100/min (rather than
“approximately” 100/min).
• Compression depth for adults has been changed from the
range of 1½ to 2 inches to at least 2 inches (5 cm).
These changes are designed to simplify lay rescuer training
and to continue to emphasize the need to provide early chest
compressions for the victim of a sudden cardiac arrest. More
information about these changes appears below. Note: In the
following topics, changes or points of emphasis for lay rescuers
that are similar to those for healthcare providers are noted with
an asterisk (*).
Emphasis on Chest Compressions*
2010 (New): If a bystander is not trained in CPR, the bystander
should provide Hands-Only™ (compression-only) CPR for
the adult victim who suddenly collapses, with an emphasis to
“push hard and fast” on the center of the chest, or follow the
directions of the EMS dispatcher. The rescuer should continue
Hands-Only CPR until an AED arrives and is ready for use or
EMS providers or other responders take over care of the victim.
All trained lay rescuers should, at a minimum, provide chest
compressions for victims of cardiac arrest. In addition, if
the trained lay rescuer is able to perform rescue breaths,
compressions and breaths should be provided in a ratio of
30 compressions to 2 breaths. The rescuer should continue
CPR until an AED arrives and is ready for use or EMS providers
take over care of the victim.
2005 (Old): The 2005 AHA Guidelines for CPR and ECC
did not provide different recommendations for trained versus
untrained rescuers but did recommend that dispatchers provide
compression-only CPR instructions to untrained bystanders.
The 2005 AHA Guidelines for CPR and ECC did note that if
the rescuer was unwilling or unable to provide ventilations, the
rescuer should provide chest compressions only.
Why: Hands-Only (compression-only) CPR is easier for an
untrained rescuer to perform and can be more readily guided
by dispatchers over the telephone. In addition, survival rates
from cardiac arrests of cardiac etiology are similar with either
Hands-Only CPR or CPR with both compressions and rescue
breaths. However, for the trained lay rescuer who is able, the
recommendation remains for the rescuer to perform both
compressions and ventilations.
© 2010 American Heart Association
Simplified Adult BLS
Unresponsive
No breathing or
no normal breathing
(only gasping)
Activate
emergency
response
Start CPR
Get
defibrillator
Check rhythm/
shock if
indicated
Repeat every 2 minutes
Push Hard • Push
Fa
st
lay rescuer adult cpr
4 A m e r i c a n H e a r t A s s o c i a t i o n
Change in CPR Sequence: C-A-B Rather
Than A-B-C*
2010 (New): Initiate chest compressions before ventilations.
2005 (Old): The sequence of adult CPR began with opening of
the airway, checking for normal breathing, and then delivery of
2 rescue breaths followed by cycles of 30 chest compressions
and 2 breaths.
Why: Although no published human or animal evidence
demonstrates that starting CPR with 30 compressions
rather than 2 ventilations leads to improved outcome, chest
compressions provide vital blood flow to the heart and
brain, and studies of out-of-hospital adult cardiac arrest
showed that survival was higher when bystanders made
some attempt rather than no attempt to provide CPR. Animal
data demonstrated that delays or interruptions in chest
compressions reduced survival, so such delays or interruptions
should be minimized throughout the entire resuscitation. Chest
compressions can be started almost immediately, whereas
positioning the head and achieving a seal for mouth-to-mouth
or bag-mask rescue breathing all take time. The delay in
initiation of compressions can be reduced if 2 rescuers are
present: the first rescuer begins chest compressions, and the
second rescuer opens the airway and is prepared to deliver
breaths as soon as the first rescuer has completed the first
set of 30 chest compressions. Whether 1 or more rescuers are
present, initiation of CPR with chest compressions ensures that
the victim receives this critical intervention early, and any delay
in rescue breaths should be brief.
Elimination of “Look, Listen, and Feel
for Breathing”*
2010 (New): “Look, listen, and feel” was removed from the
CPR sequence. After delivery of 30 compressions, the lone
rescuer opens the victim’s airway and delivers 2 breaths.
2005 (Old): “Look, listen, and feel” was used to assess
breathing after the airway was opened.
Why: With the new “chest compressions first” sequence, CPR
is performed if the adult is unresponsive and not breathing
or not breathing normally (as noted above, lay rescuers will
be taught to provide CPR if the unresponsive victim is “not
breathing or only gasping”). The CPR sequence begins with
compressions (C-A-B sequence). Therefore, breathing is briefly
checked as part of a check for cardiac arrest; after the first set
of chest compressions, the airway is opened, and the rescuer
delivers 2 breaths.
Chest Compression Rate: At Least
100 per Minute*
2010 (New): It is reasonable for lay rescuers and healthcare
providers to perform chest compressions at a rate of at least
100/min.
2005 (Old): Compress at a rate of about 100/min.
Why: The number of chest compressions delivered per
minute during CPR is an important determinant of return
of spontaneous circulation (ROSC) and survival with good
neurologic function. The actual number of chest compressions
delivered per minute is determined by the rate of chest
compressions and the number and duration of interruptions in
compressions (eg, to open the airway, deliver rescue breaths,
or allow AED analysis). In most studies, more compressions are
associated with higher survival rates, and fewer compressions
are associated with lower survival rates. Provision of adequate
chest compressions requires an emphasis not only on an
adequate compression rate but also on minimizing interruptions
to this critical component of CPR. An inadequate compression
rate or frequent interruptions (or both) will reduce the total
number of compressions delivered per minute. For further
information, see Box 2.
Chest Compression Depth*
2010 (New): The adult sternum should be depressed at least 2
inches (5 cm).
2005 (Old): The adult sternum should be depressed
approximately 1½ to 2 inches (approximately 4 to 5 cm).
Why: Compressions create blood flow primarily by increasing
intrathoracic pressure and directly compressing the heart.
Compressions generate critical blood flow and oxygen and
energy delivery to the heart and brain. Confusion may result
when a range of depth is recommended, so 1 compression
Number of Compressions Delivered
Affected by Compression Rate and
by Interruptions
The total number of compressions delivered during resuscitation
is an important determinant
本文档为【Highlights of the 2010 AHA Guidelines for CPR and ECC】,请使用软件OFFICE或WPS软件打开。作品中的文字与图均可以修改和编辑,
图片更改请在作品中右键图片并更换,文字修改请直接点击文字进行修改,也可以新增和删除文档中的内容。
该文档来自用户分享,如有侵权行为请发邮件ishare@vip.sina.com联系网站客服,我们会及时删除。
[版权声明] 本站所有资料为用户分享产生,若发现您的权利被侵害,请联系客服邮件isharekefu@iask.cn,我们尽快处理。
本作品所展示的图片、画像、字体、音乐的版权可能需版权方额外授权,请谨慎使用。
网站提供的党政主题相关内容(国旗、国徽、党徽..)目的在于配合国家政策宣传,仅限个人学习分享使用,禁止用于任何广告和商用目的。