Monday, October 18, 2010

2010 AHA CPR/ECC Guidelines

If you haven't already heard, today the AHA released the 2010 edition of their CPR/ECC Guidelines which include updates for laypersons, BLS, ACLS, PALS, and neonatal resuscitation. If you've been following resuscitation research at all for the last few years, there are not many surprises.

  1. Compressions trump ventilations in adult patients (C-A-B not A-B-C).
  2. Minimize interruptions in the "flow" of a resuscitation, that is, continuous compressions are to be minimally interrupted.
  3. ETCO2 is to be preferred over manual pulse checks: if you don't have a rise in ETCO2 to physiologic or near-physiologic levels, you probably do not have a perfusing rhythm.
  4. AEDs are indicated for all ages, including infants and neonates, provided there are pads available which fit without overlap (>3cm gap).
  5. Pharmacologic therapy has the same weight as TCP in certain bradyarrhythmias.
  6. Procainamide is now first-line or at least recommended on par with Amiodarone, Lidocaine is almost off the list.
  7. Atropine is no longer recommended during routine PEA/Asystole resuscitations.
  8. Studies into neonatal resuscitation have shown that deep suctioning is not required in vigorously born neonates with meconium staining.
  9. Routine use of naloxone in cardiac arrest secondary to opioid overdose is not recommended.
There were many other differences, including the addition of circular flowcharts documenting the new guidelines (linear flowcharts are still provided). I encourage everyone to read them.

Edit: here is a document (PDF) comparing the AHA 2005 CPR/ECC guidelines to the 2010 guidelines.

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