The New Resuscitation Guidelines 2010

In conjunction with the European Resuscitation Council and the Resuscitation Council UK new guidelines for trainers have been published on the 18th of October

There are no major changes only subtle yet still important modifications

Here are the amendments in brief

1. When obtaining help, ask for an Automated External Defibrillator (AED) if one is available.
2. Compress the chest to a depth of 5–6cm and at a rate of 100–120 per minute.
3. Give each breath over 1 second rather than 2 seconds.
4. 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.
5. Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care.
6. Recognise what is an ‘agonal gasps’.

1) AED

AED’s are becoming more widespread in public places even in offices it may be an AED is available as awareness of the importance of essential live saving equipment is more apparent. In case of a cardiac arrest an AED is the ideal piece of equipment to save life in conjunction with manual CPR and resuscitation techniques.

The AED is the single biggest factor in saving life as time is precious and Emergency Services may not always be able to get to the scene within the golden 5 minutes period it is essential that the life saver can perform effective CPR and to deliver a controlled Electric shock via an AED will more likely save the life of the victim BEFORE the Emergency Services can arrive on the scene.

Therefore it is important to ASK if an AED is available to assist the life saving process.

2) Chest Compressions

Previous guidelines stated the depth of compressions to be between 4-5cm and at a rate of 100 per minute, the new guidelines state this should be increased slightly to 5-6cm and at a rate of 100-120 per minute. The new guidelines confirm that compression depths are less effective and should be deeper and harder and slightly faster at two beats a second which is easier to count.

3) Shorter Breath’s

Whilst this is not really a change more of a statement that breaths given should be sharper and shorter allowing for the chest to rise to minimize the chest compressions which are vital to improve the chances of recovery.

4) Don’t Stop CPR

The essential message here is to ensure you continue to deliver effective CPR and not stop UNLESS the victim shows signs of regaining consciousness and interaction such as opening their eyes, coughing and speaking or trying to move purposefully and or begins to breathe normally.

Under the new guidelines this is confirmed you should only cease delivering CPR if the victim shows signs of life and regaining consciousness. Please Note the added phrase ‘moving purposely’ which excludes anoxic convulsions or spasms that can happen normally during a cardiac arrest.

This again reflects the need to prevent unnecessary interruptions in chest compressions, but also highlights the need to teach first aid students about ‘agonal gasps’ (see below).

5) CPR – Everyone Should Know

Teaching as many people as possible how to deliver CPR will invariably save more life’s and provide the tremendous satisfaction of personal involvement as opposed to standing around feeling helpless whilst awaiting the arrival of the Emergency Services. Saving the life of a stranger is one thing but to be able to save the life of a loved one or partner or even child is personally the ultimate achievement.

This is a welcome clarification that teaching CPR should be widespread as possible and we have a duty of care to each other to have at least one person within a small office or party or family that is trained in the delivery of CPR and resuscitation techniques.

Previously the guidelines stated that if persons untrained were unwilling to give breaths to give chest compressions only under the new guidelines this has changed to state ‘if you are not trained to, or are unwilling to give rescue breaths…’ This makes it clear that if you are not trained in CPR, chest compressions only is better than no CPR at all, though victims of drowning and children will have little or no oxygen in the blood at the point of cardiac arrest, so for these casualties rescue breaths are essential.

A cardiac arrest caused by a heart attack there will be residual oxygen in the blood for approximately 5 minutes at the most to sustain life and brain function which is why it is imperative to revive the victim within this golden 5 minute period or at least continue to perform effective CPR to maintain the pumping of the blood around the vital organs primarily the brain to avoid cerebral damage.

Studies on telephone CPR which was given via the phone to lay people who were untrained have shown how attempting to give rescue breaths when the layperson has not received prior training leads to considerable interruptions in chest compressions. Therefore chest compression only CPR is the preferred option if someone has NOT received training in CPR.

6) Agonal Gasps

Approximately 40% of cardiac arrest victims gasp initially in the first few minutes of cardiac arrest. These are called ‘agonal gasps’ and are often mistaken for breathing, so CPR is not started.

The new guidelines state ‘it should be emphasized during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest; they are an indication for starting CPR immediately and should not be confused with normal breathing.’

In short don’t confuse an Agonal Gasp with ‘normal breathing’

Effective CPR is going to save life and with the increase in community awareness of life saving techniques and the placement of AED Automated External Defibrillators in public places will invariably reduce the death rate and save more people.

Paediatric Guidelines - A note to avoid confusion

The paediatric guidelines for laypeople / first aiders remain unchanged.

T: Resuscitation Guidelines
D: In conjunction with the European Resuscitation Council and the Resuscitation Council UK new guidelines for trainers have been published on the 18th of October
K: Resuscitation Guidelines, Effective CPR, Compressions, CPR, AED, agonal gasp.