By: Lauren Middleton, CPR Coordinator, 2015-2016
Every five years, the American Heart Association (AHA) reviews and updates their protocols on cardiopulmonary resuscitation (CPR). The changes are based on international analysis of new resuscitation research from the past five years. The updates allow CPR providers to give the best care possible using the most recent science. The 2010 update had several pertinent changes. The compression rate was raised from approximately 100 compressions per minute to at least 100. The compression depth was also increased for adults from 1.5-2 inches to at least 2 inches. The major 2010 difference was the change in step sequence from Airway, Breathing, Chest Compressions to Chest compressions, Airway, Breathing.
The 2015 Update continues to emphasize the importance of these changes and make others according to new research. When a bystander finds an unresponsive person, the AHA recommends checking for pulse and breathing at the same time to reduce time before compressions. If CPR is required, the bystander should start by activating the emergency response system (call 911 and get an AED). The new Guidelines include using mobile devices to call for help instead of just shouting for help. This is especially important when there are no other bystanders. The CPR provider does not need to leave the victim to go get help if they can use their cell phone to call. Once 911 is contacted, the phone should be left on speaker-phone so that the dispatcher can give further instructions (performing CPR or identifying agonal gasps). The dispatcher will ask about the quality of the breathing. If the victim is unresponsive and not breathing or only gasping, CPR should be started. The dispatcher can also guide the rescuer through the steps of CPR. At the very least, chest compressions without breaths should be provided.
The rate of chest compressions now has an upper limit of 120 compressions per minute. In general, more compressions increase the chance of survival, but the new limit is based on preliminary data that suggest faster compressions result in an inadequate compression depth. An upper limit to adult compression depth has also been added in the 2015 Update. The depth of at least two inches is now from 2-2.4 inches or 5-6 centimeters. The purpose of the chest compressions is to push blood through the heart to deliver oxygen to the brain and body. Rescuer compressions are often too shallow rather than too deep. The upper limit is based on one small study that found an association between too deep compressions and increased injuries to the victim. The AHA emphasizes that in a 2-rescuer scenario, the person giving chest compressions should not lean on the chest between compressions or when the other rescuer is giving breaths.
The 2015 Update also reviewed and updated protocols for special situations including bystander-administered naloxone and ventilation with an advanced airway in place. If a rescuer has appropriate training, they can administer naloxone to a person with a known or suspected opioid addiction. If there is an advanced airway in place, the patient should be ventilated at a rate of one breath every six seconds. This is a change from one breath every 6-8 seconds. For more information, the 2015 Guidelines and Highlights are available online at: https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf
The full updated guidelines can be found at: