Clinical Competencies for AACS
Every five years content experts from the America Heart Association (AHA) meet and evaluate all of the research that has been done in emergency cardiac care (ECC). This is the basis of the basic life support (BLS) and advanced cardiac life support (ACLS) standards. This ensures that the national recommendations are based upon the best evidence available. In December 2005 the AHA published revisions to the BLS and ACLS standards. This content is intended to highlight the changes from the 2000 Guidelines around inpatient cardiac arrest. It is not meant to replace any AHA provider course.
NOTE: The AHA renewal period for both BLS and ACLS is two years. This time interval is not affected by the release of these new guidelines. For example, if your BLS card is "good" until May 2007, you do not have to attend a renewal course until that time. If you are interested in finding out more about the 2005 AHA Guidelines, you may attend a renewal class prior to that time. Please refer any questions to the
2005 GUIDELINES: The 2005 Guidelines place a renewed emphasis on providing adequate compressions. The motto is to "push hard and push fast." While the compression rate remains approximately 100 per minute, the ratio of compressions to ventilation is now 30 compressions to 2 breaths for everything except 2-rescuer infant and child CPR, which has been increased to 15 compressions to 2 breaths.
2000 Guidelines: Compression to ventilation ratios varied from 5:1in infant, child and two rescuer adult to 15:2 in one rescuer adult CPR.
WHY THE CHANGE? Most of the research showed that compressions were too slow, too shallow and interrupted too often. The new approach focuses on more continuous compressions, which will increase the amount of blood getting to the patient's heart and brain. Other things to remember are to minimize the number and length of duration (pulse checks should be every 2 minutes (about 5 cycles) and should last less than 10 seconds) and to try and let the chest totally recoil ("come to a normal position") between compressions. Both of these actions may also increase blood pressure.
Witnessed v. Unwitnessed Arrests
2005 GUIDELINES: It the arrest is unwitnessed and the exact time the patient has been down is unknown, perform 2 minutes of CPR prior to evaluating the cardiac rhythm with an AED. If the arrest was witnessed, attach the defibrillator as soon as possible and evaluate the cardiac rhythm for potential defibrillation.
2000 GUIDELINES: Attach the defibrillator and evaluate the rhythm as soon as the unit is available.
WHY THE CHANGE? Research suggests that patients who do not have a pulse for periods of longer than four minutes are less likely to respond to defibrillation. Two minutes of CPR appears to make the heart more likely to respond to defibrillation.
Number of Shocks
2005 GUIDELINES: One shock followed by immediate CPR for two minutes prior to pulse check or rhythm evaluation. Recommended energy levels for monophasic defibrillators (e.g. the LifePack 9Ps on most crash carts, or the LP10s on some units) should start at 360 Joules. Note that this energy level must be manually adjusted by the operator. Biphasic defibrillators should start at 200 Joules. Currently biphasic defibrillators are stocked on CICU, 3E, OR, MIPS and the Echo Lab.
2000 GUIDELINES: Up to three stacked shocks with rhythm evaluation between each defibrillation.
WHY THE CHANGE? Researchers who have examined the efficacy of defibrillation found that the majority of people, who will respond, will do so after one shock. Very few will respond to the second or third shock. Repeated rhythm evaluations can lead to long interruption in compressions. Additionally, if a patient does develop a pulse after being defibrillated, the majority will convert to a non-pefusing rhythm (e.g. pulseless electrical activity) for several minutes after their heart starts beating in an organized rhythm. They seem to benefit from the ongoing compressions.
Last modified: 6/05/2006 3:41 PM