Review of New :

2015 American Heart Association

Guidelines for CPR & ECC
BY:
ADILA LIYANA BINTI SUKRI
C 111 11 868

PRECEPTOR:
dR. ARIF PRASETYO

SUPERVISOR:
Dr. dr. ANDI SALAHUDDIN Sp.An
 Adult BLS and CPR Quality Overview
Seventy percent of out-of-hospital cardiac
arrests (OHCAs) 50%.
Early CPR, and rapid defibrillation.
Chain of Survival are unchanged from 2010.
More data are available showing that high-
quality CPR improves survival.
2015 Guidelines Update
Immediate Recognition and Activation of
the Emergency Response System
Recommendation Recommendation Comments
Emergency dispatchers determine if a patient is Class I, LOE C-LD updated
unresponsive with abnormal breathing after
acquiring information to determine the location of
the event
Unresponsive with abnormal or absent breathing Class IIa, LOE C-LD updated
assume that the patient is in cardiac arrest
Dispatchers should be educated to identify Class I, LOE C-LD updated
unresponsiveness with abnormal breathing and
agonal gasps across a range of clinical presentations
and descriptions
2015 Guidelines Update
Early CPR

Recommendation Recommendation Comments

Similar to the 2010 Guidelines, it may be reasonable Class IIb, LOE C-LD updated
for rescuers to initiate CPR with chest
compressions
2015 Guidelines Update
Untrained Lay Rescuer

Recommendation Recommendation Comments

Untrained lay rescuers should provide compression- Class I, LOE C-LD updated
only CPR, with or without dispatcher assistance
The rescuer should continue compression-only CPR Class I, LOE C-LD updated
until the arrival of an AED or rescuers with
additional training
2015 Guidelines Update
Trained Lay Rescuer

Recommendation Recommendation Comments

All lay rescuers should, at a minimum, provide chest Class I, LOE C-LD updated
compressions for victims of cardiac arrest
Should add rescue breaths in a ratio of Class I, LOE C-LD updated
30 compressions to 2 breaths if the trained lay
rescuer is able to perform rescue breaths
The rescuer should continue CPR until an AED Class I, LOE C-LD updated
arrives and is ready for use or EMS providers take
over care of the victim
2015 Guidelines Update
Healthcare Provider

Recommendation Recommendation Comments

Provide chest compressions and ventilation for all Class IIa, LOE C-LD updated
adult patients in cardiac arrest, from either a cardiac
or noncardiac cause
2015 Guidelines Update
Delayed Ventilation

Recommendation Recommendation Comments

For witnessed OHCA with a shockable rhythm, it Class Iib ,LOE C-LD NEW
may be reasonable for EMS systems with
priority-based, multitiered response to delay
positive-pressure ventilation by using a strategy
of up to 3 cycles of 200 continuous compressions
with passive oxygen insufflation and airway
adjuncts
2015 Guidelines Update
Recognition of Arrest

Recommendation Recommendation Comments

Dispatchers should instruct rescuers to provide CPR Class I, LOE C-LD updated
if the victim is unresponsive with no normal
breathing even when the victim demonstrates
occasional gasps
2015 Guidelines Update
Suspected Opioid-Related Life-Threatening Emergency

Recommendation Recommendation Comments

For a patient with known or suspected opioid Class IIa, LOE C-LD new
addiction who has a definite pulse but no normal
breathing or only gasping administer intramuscular
or intranasal naloxone
For patients in cardiac arrest, so naloxone Class IIb,LOE C-EO new
administration may be considered
after initiation of CPR if there is high suspicion for
opiate overdose
It is reasonable to provide opioid overdose Class IIa, LOE C-LD new
response education with or without naloxone
distribution to persons at risk for opioid overdose in
any setting
2015 Guidelines Update
Hand Position During Compressions

Recommendation Recommendation Comments

Consistent with the 2010 Guidelines, it is reasonable Class IIa, LOE C-LD updated
to position hands for chest compressions
on the lower half of the sternum in adults with
cardiac arrest
2015 Guidelines Update
Chest Compression Rate

Recommendation Recommendation Comments

Rate of 100/min to 120/min Class IIa, LOE C-LD updated
2015 Guidelines Update
Chest Compression Depth

Recommendation Recommendation Comments

A depth of at least 2 inches or 5 cm. Class I, LOE C-LD updated
Avoiding excessive chest compression depths
(greater than 2.4 inches or 6 cm.)
2015 Guidelines Update
Chest Wall Recoil

Recommendation Recommendation Comments

Avoid leaning on the chest between compressions Class IIa, LOE C-LD updated
to allow full chest wall recoil
2015 Guidelines Update
Minimizing Interruptions in Chest Compressions

Recommendation Recommendation Comments

In adult cardiac arrest pauses in chest compressions Class I, LOE C-LD updated
should be as short as possible
CPR without an advanced airway pause Class IIa, LOE C-LD updated
compressions for less than 10 seconds to deliver 2
breaths.
Goal of a chest compression fraction as high as Class IIb,LOE C-LD new
possible, with a target of at least 60% .
2015 Guidelines Update
Compression-to-Ventilation Ratio

Recommendation Recommendation Comments

Compression-to-ventilation Class IIa, LOE C-LD updated
ratio of 30:2 for adults in cardiac arrest .
2015 Guidelines Update
LaypersonCompression- Only CPR Versus Conventional CPR

Recommendation Recommendation Comments

Untrained lay rescuers to provide Class I, LOE B-R updated
compression-only CPR
Compression-only CPR is a reasonable alternative to Class IIa, LOE C-LD updated
conventional CPR in the adult cardiac arrest patient
Trained rescuers, ventilation may be considered in Class IIa,LOE C-LD updated
addition to chest compressions
2015 Guidelines Update
Open the Airway: Lay Rescuer

Recommendation Recommendation Comments

For victims with suspected spinal injury, rescuers Class III: Harm, updated
should initially use manual spinal motion restriction LOE C-LD
(eg, placing 1 hand on either side of the patients
head to hold it still)
rather than immobilization devices, because use of
immobilization devices by lay rescuers may be
harmful.
Spinal immobilization devices may interfere with
maintaining a patent airway.
2015 Guidelines Update
Bag-Mask Ventilation

Recommendation Recommendation Comments

As long as the patient does not have an advanced Class IIa, LOE C-LD updated
airway in place, the rescuers should deliver
cycles of 30 compressions and 2 breaths during
CPR. The rescuer delivers breaths during pauses
in compressions and delivers each breath over
approximately 1 second
2015 Guidelines Update
Ventilation With an Advanced Airway

Recommendation Recommendation Comments

1 breath every 6 seconds (10 breaths per Class IIb, LOE C-LD updated
minute) while continuous chest compressions are
being performed
2015 Guidelines Update
Passive Oxygen Versus Positive-Pressure Oxygen
During CPR

Recommendation Recommendation Comments

We do not recommend the routine use of passive Class IIb, LOE C-EO new
ventilation techniques during conventional CPR for
adults, because the usefulness/effectiveness of
these techniques is unknown.
However, in EMS systems that use bundles of care Class IIb, LOE C-LD new
involving continuous chest compressions, the use of
passive ventilation techniques may be considered
as part of that bundle.
2015 Guidelines Update
CPR Before Defibrillation

Recommendation Recommendation Comments

For witnessed adult cardiac arrest when an AED is Class IIa, LOE C-LD updated
immediately available, it is reasonable that
the defibrillator be used as soon as possible
For adults with unmonitored cardiac arrest or for Class IIa, LOE B-R) updated
whom an AED is not immediately available,
CPR be initiated while the defibrillator equipment is
being retrieved and applied
2015 Guidelines Update
Analysis of Rhythm During Compressions

Recommendation Recommendation Comments

There is insufficient evidence to recommend the Class IIb, LOE C-EO new
use of artifact-filtering algorithms for analysis of
ECG rhythm during CPR.
Their use may be considered as part of a research
program or if an EMS system has already
incorporated ECG artifact-filtering algorithms in its
resuscitation protocols
2015 Guidelines Update
Timing of Rhythm Check

Recommendation Recommendation Comments

It may be reasonable to immediately resume chest Class IIb, LOE C-LD updated
compressions after shock delivery for adults
in cardiac arrest in any setting
2015 Guidelines Update
Chest Compression Feedback

Recommendation Recommendation Comments

It may be reasonable to use audiovisual feedback Class IIb, LOE B-R updated
devices during CPR for real-time optimization of CPR
performance
Thank you