October 2010 Resuscitation Council Major Changes

The following changes in the BLS guidelines have been made to reflect the importance placed on chest compression, particularly good quality compressions, and to attempt to reduce the number and duration of pauses in chest compression:

1. When obtaining help, ask for an automated external defibrillator (AED), if one is available.

2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min

3. Give each rescue 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

So, it is still 30:2 but as expected we put most emphasis on chest compressions so we now do the breath quickly if doing them at all. Also call for and use a Defibrillator if available

CPR / Resuscitation changes explained

1. When obtaining help, ask for an automated external defibrillator (AED), if one is available.

The availability of defibrillators today in many workplaces and public areas as well as the overwhelming amount of evidence to show that defibrillators are essential in increasing a victim of cardiac arrest's life mean that we now should always ask for one to be brought to the scene of an incident.

2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min

To ensure we get good quality chest compressions they simply need to be HARDER and FASTER than previously advised. Forget all that nelly the elephant rubbish and concentrate on compressing the chest sufficiently to pump the blood around the body and maintain a shockable rhythm so that when the defibrillator arrives it has a much better chance of success.

3. Give each rescue breath over 1 second rather than 2 seconds

This again just underlines the importance of minimising interruptions to chest compressions. Interruptions in chest compressions are common and are associated with a reduced chance of survival.

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.

This line simply underlines that we should never stop CPR once it has started unless the above are present. I think this leaves no doubt in the rescuers mind what should be done.

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.

We welcome this particular line as we come across lots of first aiders who have been taught chest compression only CPR and have never been taught how to perform rescue breaths. Although this was and still is an option for rescuers who are unable or willing to perform rescue breaths it never was intended to be something that was taught as a normal.

"Chest compression combined with rescue breaths is the method of choice for CPR by trained lay rescuers and professionals and should be the basis for lay-rescuer education..........Those laypeople with a duty of care, such as first aid workers, lifeguards, and child minders, should be taught chest compression and ventilation"

"Compression-only CPR is another way to increase the number of compressions given and will, by definition, eliminate pauses. It is effective for a limited period only (probably less than 5 min) and is not recommended as the standard management of out-of-hospital cardiac arrest."

AED protocol changes

There are no major changes to the sequence of actions for AED users in Guidelines 2010. The ILCOR Consensus on Science and Treatment Recommendations makes the following recommendations which are relevant to the RC(UK) AED guidelines:

1. An AED can be used safely and effectively without previous training.

Therefore, the use of an AED should not be restricted to trained rescuers. However, training should be encouraged to help improve the time to shock delivery and correct pad placement.

2. Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led BLS and AED courses.

Such courses should be validated to ensure that they achieve equivalent outcomes to instructor led courses.

3. When using an AED minimise interruptions in chest compression. Do not stop to check the victim or discontinue cardiopulmonary resuscitation (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.

I have concerns about untrained persons using AEDs but they are supposed to be "Idiot proof"

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