AED: AHA CPR guidelines: How they impact AED use and purchasing

AHA CPR guidelines: How they impact AED use and purchasing

The 2015 AHA CPR guidelines refresh: still the most current recommendations.  

Oct 20, 2015Since 1974, the American Heart Association (AHA) has published periodic guidelines for CPR and emergency cardiovascular care (ECC). Those procedures are the basis for cardiac resuscitation protocols in EMS systems and hospital emergency departments throughout the U.S.

Automated external defibrillators (AEDs), similar to today’s models, were first acknowledged by the AHA in their 1992 update. Although circuitry and waveforms have changed since then, fundamental principles for treating pulseless patients have not: get help, start CPR, and defibrillate shockable rhythms as early as possible. The AHA’s 2015 guidelines mostly remind us how important each of those steps are.

If you own an AED, are thinking of buying one, or are just curious about the latest ECC recommendations for BLS providers, you might want to review these highlights from the 2015 update, which are still considered the most 

The AHA continues to stress the importance of placing AEDs where people are most likely to need them. They’ve adopted the conventional term public access defibrillation (PAD) for the process of identifying target-rich locations for AEDs, making sure potential responders know where defibrillators are and how to use them, linking accessible AEDs with EMS systems, and seeking ongoing quality improvement.

According to AEDSuperstore, “Unlike fire extinguishers, which are required by law, AEDs have been considered an optional safety investment on corporate properties for the most part. Despite the fact there are Good Samaritan laws in all 50 states to protect owners and users of these life-saving devices from litigation, it is still a perceived risk many companies are unwilling to take.  Of the 350,000 sudden cardiac deaths each year in the US, OSHA states 10,000 occur in the workplace. If corporations viewed investing in AEDs and training their employees in CPR the same way they looked at any other insurance, they would see the cost is comparatively minimal. “

AED TRAINING

Self-directed training in the use of AEDs is an acceptable alternative to instructor-led courses for both professional and lay rescuers. The message here is that any instruction is better than none at all. However, the AHA considers today’s automated defibrillators so easy to use that even someone with zero training can and should grab an AED when indicated.

The AHA adds that refresher classes for CPR and AEDs should be less frequent than every two years for responders likely to encounter cardiac arrests.

SCENE MANAGEMENT

The 2015 AHA guidelines incorporate recommendations about scene management that most professional rescuers take for granted: ensure scene safety, multitask patient assessment by simultaneously checking breathing and pulse, and choreograph concurrent interventions when there are teams of rescuers. The AHA also acknowledges the variability of scenes and preaches flexibility, rather than rote adherence to cardiac arrest algorithms.

COMMUNICATION BY CELLPHONE

A new suggestion for 2015 is that the lay rescuers who discover the patient or witness the arrest stay by the patient’s side and contact EMS via mobile phone whenever possible. Rescuers are encouraged to maintain two-way communication with dispatchers by activating cellphone speakers. Newer apps and social media platforms are another option for contacting emergency assistance.

WHEN TO SHOCK

There has been some debate about whether a minute or two of CPR before defibrillation might increase the chances of resuscitation by improving the metabolic state of the heart. The AHA examined four studies of defibrillation delayed by up to three minutes of CPR, and concluded there were no differences in either short- or long-term survival. The recommendation is still to assess for a shockable rhythm as quickly as possible and defibrillate immediately when indicated.

CHEST COMPRESSIONS

Although the 2015 guidelines offer no major changes for CPR, rescuers should note the following fine adjustments to chest compressions:

• The upper limit of acceptable compression rates is now 120 per minute.
• The maximum depth of compressions on adults is 2.4 inches, although 2 inches is still the target.
• Compressions delivered by mechanical devices are not superior to manual compressions.
• Rescuers are reminded not to lean on their patients’ chests between compressions. Full recoil of the chest wall is needed to optimize blood flow to the heart.

Perhaps the best news from the AHA is that they will issue continuous updates rather than periodic ones from now on. Ask suppliers about the capability of any AED unit's software to be reprogrammed as evolving resuscitation science may require updates. Keep an eye on ECCguidelines.heart.org for the latest research and recommendations.

References

• Neumar RW, Shuster M, Callaway CW, et al. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S315-S367.
• Highlights of the 2015 American Heart Association Guidelines Update for CPR and ECC. 2015.

This article was updated by EMS1 Staff on December 12th, 2016 to reflect the most recent data and information on AEDs.

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Mobile phones should be used to speed help to cardiac arrest victims, guidelines say By AMERICAN HEART ASSOCIATION NEWS

Mobile phones should be used to speed help to cardiac arrest victims, guidelines say
By AMERICAN HEART ASSOCIATION NEWS

Go to the NEW CPR guidelines 2015-2020

New resuscitation guidelines update CPR chest pushes

The History of CPR

Attempts to revive people who have stopped breathing date back centuries. But it was in the late 1950s and early 1960s that modern CPR developed.

By AMERICAN HEART ASSOCIATION NEWS

1740 - Paris Academy of Sciences recommends mouth-to-mouth resuscitation for drowning victims.

1891 - Dr. Friedrich Maass performs the first documented chest compressions on a patient.

1903 - Dr. George Crile reports the first successful use of external chest compressions to revive a patient.

1956   - Dr. James Elam and Dr. Peter Safar develop the modern technique of mouth-to-mouth resuscitation.

1958 - Work begins on the Resusci Anne manikin, developed by toy company owner Asmund Laerdal, Dr. Peter Safar and Dr. Bjorn Lind. The training aid is introduced in 1960.

1960 - Dr. James Jude (from left), Dr. William Kouwenhoven and G. Guy Knickerbocker publish a paper in the Journal of the American Medical Association on “closed-chest cardiac massage,” which evolved into cardiopulmonary resuscitation, or CPR.

1963 - The American Heart Association formally endorses CPR.

1966 - The first CPR guidelines are published by the National Academy of Sciences–National Research Council.

1972 - The world’s first mass CPR training program begins in Seattle, certifying more than 100,000 people in the first two years.

1981 - 911 operators in King County, Washington, begin giving CPR instructions over the phone — a practice that is now recommended nationwide.

1983 - The AHA convenes a national conference to develop CPR guidelines for children and infants.

1990s - Public Access Defibrillation programs begin placing automated external defibrillators, or AEDs, in public places and provide training to the public.

2005 - The AHA develops the Family & Friends CPR Anytime Kit, allowing anyone to learn CPR in 20 minutes.

2008 - The AHA introduces Hands-Only CPR.

2015 - Through a network of about 400,000 instructors and 4,000 training centers worldwide, the AHA trains more than 17 million people in CPR each year.

Twenty-seven states now require hands-on, guidelines-based CPR training for high school graduation. Each year, more than 1.6 million public high school graduates will have been trained in CPR.

Sources: American Heart Association, Journal of the American Medical Association, Laerdal Medical

Cities nationwide should consider using mobile phones and apps to connect people in cardiac arrest with nearby CPR-trained rescuers, say new guidelines from the American Heart Association.

The guidelines, published Thursday in Circulation, claim that such community programs could increase bystander CPR, which, depending on the community, is performed in 10 percent to 65 percent of the roughly 326,000 cardiac arrests that happen outside the hospital each year.

Accessing people through a mobile network can get help to the scene faster, said Raina Merchant, M.D., director of the Social Media and Health Innovation Lab at Penn Medicine.

“While emergency system personnel are on their way, bystanders can come by and start helping out,” said Merchant, an assistant professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine who was not involved in writing the new guidelines.

About 90 percent of American adults have cellphones and two out of three have smartphones, according to the Pew Research Center.

The new recommendation is largely based on a Swedish study that tested a mobile alert system in Stockholm. The study, published in June in The New England Journal of Medicine, found that bystander CPR was initiated in 62 percent of cardiac arrests among the group who received cellphone alerts. In the group that did not receive alerts, CPR was performed 48 percent of the time.

“There’s a lot of work that needs to be done about how to best optimize these programs,” said Merchant. “Simply having the program doesn’t ensure that people will use it.”

About 1,400 U.S. communities are implementing a CPR mobile alert program developed by the nonprofit PulsePoint Foundation, said president Richard Price. When a cardiac arrest happens, 911 dispatch centers alert responders within a quarter mile of the patient.

Potential responders register through a free mobile app, which alerts them when an emergency occurs, maps directions and reminds them how to give chest compressions. After the emergency, the system sends the local EMS agency a detailed report about the incident and surveys responders about their actions.

“By directly alerting those who are qualified and nearby, maybe in the business next door or on the floor above, PulsePoint is able to put the right people in the right place at the right time,” Price said.

Annual costs to implement the system range from $8,000 a year for communities with up to 300,000 residents to $28,000 a year for populations of 1.5 million or more, according to Price.

Communities already using the alert programs will aid in research about why people respond and how to get them to respond, said Merchant.

In addition to summoning rescuers, cellphones also allow people at the scene of a cardiac emergency to get CPR instructions from 911 dispatchers without leaving the victim’s side. Dispatchers should be trained to help callers recognize cardiac arrest quickly and walk them through chest compressions, the guidelines say.

The AHA recommends that anyone who sees a teenager or adult suddenly collapse call 911 and push hard and fast on the center of the chest, a technique known as Hands-Only CPR.

The AHA guidelines have been updated every five years through a complex process involving more than 250 international experts from the AHA and six other resuscitation councils that form the International Liaison Committee on Resuscitation.

At an AHA-hosted ILCOR conference in early 2015, seven expert panels discussed, debated and reached consensus on hundreds of resuscitation topics, based on research published since the 2010 guidelines.

The AHA used that scientific consensus to create the CPR and Emergency Cardiovascular Care guidelines: “how-to” manuals that translate the science into practice. They are used to train millions of potential rescuers and are integrated into state and local emergency medical services protocols.

“CPR saves lives. That’s the big take-home from the guidelines. A lot of the science that works continues to work,” said Merchant.

“We need more people to do CPR,” she said. “Some will be through mobile, some will be through dispatchers … some will be remembering from a training class. [Mobile] is one part of the solution, but not the only piece.”