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DALLAS, Nov. 24 /PRNewswire/ -- New emergency care guidelines include dramatic changes to cardiopulmonary resuscitation (CPR) and emphasis on chest compressions, according to authors of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The guidelines were published online today in Circulation: Journal of the American Heart Association. They provide recommendations for how lay rescuers and emergency healthcare providers should resuscitate victims of cardiovascular emergencies. Topics include CPR, the use of automated external defibrillators (AEDs) and recommendations for advanced cardiovascular life support (ACLS) and pediatric advanced life support (PALS). The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of cardiac arrest patients. Studies show that effective chest compressions create more blood flow through the heart to the rest of the body, buying a few minutes until defibrillation can be attempted or the heart can pump blood on its own. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that rescuers "push hard and push fast" when giving chest compressions. "The 2005 guidelines take a back to basics approach to resuscitation," said Robert Hickey, M.D., chair of the American Heart Associations Emergency Cardiovascular Care programs. "Since the 2000 guidelines, research has strengthened our emphasis on effective CPR as a critically important step in helping save lives. CPR is easy to learn and do, and the association believes the new guidelines will contribute to more people doing CPR effectively." The most significant change to CPR is to the ratio of chest compressions to rescue breaths -- from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30-to-two ratio is the same for CPR that a single lay rescuer provides to adults, children and infants (excluding newborns). The change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions. The only exception to the new ratio is when two healthcare providers give CPR to a child or infant (except newborns), in which case they should provide 15 compressions for every two rescue breaths. Another guidelines change emphasizing the importance of CPR is the sequence of rhythm analysis and CPR when using AEDs. Previously, when AED pads were applied to the chest, the device analyzed the heart rhythm, delivered a shock if necessary, and analyzed the heart rhythm again to determine whether the shock successfully stopped the abnormal rhythm. The cycle of analysis, shock and re-analysis could be repeated three times before CPR was recommended, resulting in delays of 37 seconds or more. Now, after one shock, the new guidelines recommend that rescuers provide about two minutes of CPR, beginning with chest compressions, before activating the AED to re-analyze the heart rhythm and attempt another shock. Studies have shown that the first AED shock stops the abnormal cardiac arrest rhythm more than 85 percent of the time and that a brief period of chest compressions between shocks can deliver oxygen to the heart, increasing the likelihood of successful defibrillation. The guidelines also recommend that healthcare providers minimize interruptions to chest compressions by doing heart rhythm checks, inserting airway devices, and administering of drugs without delaying CPR. The new recommendations continue to encourage greater implementation of AED programs in public locations like airports, casinos, sports facilities and businesses. The 2005 guidelines reflect results of the Public Access Defibrillation trial, which reinforced the importance of planned and practiced response to cardiac emergencies by lay rescuers. The new guidelines recommend that 911 dispatchers be trained to provide CPR instructions by phone and help callers correctly identify cardiac arrest victims. Dispatchers may walk rescuers through compressions-only CPR for most adult victims of cardiac arrest; however, instructions to do compressions and rescue breaths will be given for infants and children or adult victims of asphyxia, caused by near-drowning or other non-cardiac causes. Dispatchers also should be trained to recognize the symptoms of heart attack and other Acute Coronary Syndromes, and advise such patients to chew an aspirin while awaiting EMS. To increase successful resuscitation, new guidelines advise EMS systems to evaluate their current protocols, shorten the response time for cardiac arrest patients, then document the impact of such changes on the number of lives saved. The guidelines are based on the Consensus on Science and Treatment Recommendations (CoSTR), a document developed by the International Liaison Committee on Resuscitation. This group includes the American Heart Association and leading international resuscitation councils. The review of resuscitation literature reflected in CoSTR is the largest ever published. It took more than 36 months and includes input from 380 international experts CoSTR serves as the scientific basis for many countries resuscitation treatment guidelines. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Comparison chart of key changes 2005 Recommendation 2000 Recommendation Explanation Basic Life Support Emphasized the When chest compressions Increased emphasis on first three links are interrupted, blood delivery of effective in the Chain of flow stops. Limiting chest compressions Survival: early access, interruptions to early CPR, and early chest compressions defibrillation. Stated will result in greater early CPR significantly survival. improved survival. Named early defibrillation In any given as the single greatest series (cycle) of determinant of survival chest compressions, for adult victims of earlier compressions cardiac arrest. are less effective than later ones. Therefore, fewer interruptions increase the percentage of effective chest compressions. Allowing the chest wall to fully "recoil" or return to its normal position between compressions results in better re-filling of blood in the heart, which allows more blood to be pumped to the rest of the body during the next compression. Single CPR A compression to A single ratio will compression-to- ventilation ratio of make learning the ventilation ratio: 15 to 2 was correct procedure for 30:2 for all recommended for adult responding to victims rescuers responding CPR; a ratio of 5 to 1 of all ages easier and alone to victims of for child and infant CPR. increase the likelihood any age, except that a rescuer will newborns. Three compressions remember the steps of for every one breath CPR during an CPR for newborns is should be given to emergency. the same as newborns, totaling 2000 guidelines 90 compressions and The new ratio also recommendation. 30 breaths per minute. helps reduce interruptions in chest compressions (see explanation above). AED programs should Key elements of Some AEDs do not be implemented in successful AED programs require a medical public locations were recommended, including prescription, so where theres a healthcare provider healthcare provider relatively high oversight, training of oversight of AED likelihood of likely rescuers, link programs is not witnessed cardiac to local EMS system mandatory. arrest (eg, airports, and process of casinos, sports continuous quality The Public Access facilities and improvement. Defibrillation trial businesses). reinforced the importance of planned and practiced response. Lay rescuer programs in airports and casinos and by police officers have reported survival rates as high as 49 percent to 74 percent when responding to sudden cardiac arrest caused by ventricular fibrillation. A single shock from Up to three shocks Repeated cycles of a defibrillator, in a series were rhythm analysis and followed by immediate recommended to treat shock result in delays CPR for two minutes, cardiac arrest with of up to 37 or more beginning with chest a "shockable" rhythm seconds before the compressions, should before returning to first post-shock chest be used to treat chest compressions; compressions are cardiac arrest caused the heart rhythm was delivered. Most by ventricular evaluated before and defibrillators fibrillation (VF - after each shock. eliminate VF more than the abnormal heart 85 percent of the time. rhythm responsible If the first shock for most cardiac fails, immediate CPR arrests). (before trying another shock) is likely to contribute to the success of a subsequent shock. Even when a shock eliminates VF, it may take several minutes for the heart to pump blood effectively, even if a normal heart rhythm returns. A brief period of chest compressions can deliver oxygen to the heart during this post- shock period, increasing the likelihood that the heart will begin to effectively pump blood on its own. After giving two After giving two rescuer Lay providers cannot rescue breaths, lay breaths, lay rescuers reliably detect the rescuers no longer were instructed to presence of circulation check for signs of check for signs of in a victim. Great circulation before circulation (normal harm can be done when beginning chest breathing, coughing rescuers dont do chest compressions. or movement). Lay compressions when rescuers gave rescue theyre needed. breathing without chest Relatively minimal harm compressions to victims can be done by with signs of circulation providing chest who were not breathing compressions when normally. they arent needed. Therefore, the new guidelines do not recommend that lay rescuers look for "signs of circulation" before delivering chest compressions. This eliminates the chance that lay rescuers might not recognize true cardiac arrest, and reduces delays to chest compressions. Eliminating instructions to look for signs of circulation and for delivering "rescue breathing without chest compressions" reduces the number of skills required for lay rescuers. This makes it more likely that the lay provider will learn and remember the steps of CPR. Dispatchers should be Dispatchers were not Early administration trained to recognize instructed to of aspirin has been the symptoms of Acute recognize ACS or associated with Coronary Syndromes recommend aspirin. decreased mortality (ACS), and advise rates in several patients with symptoms clinical trials. of ACS without history Many studies have of aspirin allergy demonstrated the or gastrointestinal safety of aspirin bleeding to chew administration. 161 mg - 325 mg of aspirin while awaiting the arrival of EMS providers. Advanced Cardiac Life Support Basic Life Support Heart rhythm analysis, Studies show that (BLS) skills are the delivery of shocks providing continuous priority in treating and selection of CPR outweighs the cardiac arrest. drug therapies resulted potential effects of Providers must in frequent drug therapies, so minimize interruptions interruptions to interruptions should to chest compressions. CPR. be minimized. New neurological No specific neurologic New research suggests tests and evaluations signs indicated the there are specific given 24 hours and potential for clinical signs, such 72 hours after successful resuscitation. as certain brain resuscitation can responses to stimuli, predict survival that correlate strongly to hospital discharge. with death or poor brain function following resuscitative efforts. More research is needed to predict potential for survival during resuscitation. Unconscious adult Mild hypothermia may In two randomized patients with be beneficial ... but clinical trials, return of spontaneous hypothermia should not induced hypothermia circulation after be induced actively (cooling within minutes out-of-hospital after resuscitation to hours after the cardiac arrest from cardiac arrest. return of spontaneous should be cooled (Position was updated circulation) resulted for 12 to 24 hours in a 2003 science in improved survival to 32 degrees C - statement from the and brain function in 34 degrees C when International Liaison adults who remained the initial rhythm Committee on comatose after initial was ventricular Resuscitation, resuscitation from fibrillation. which supported induced out of hospital VF Similar therapy may hypothermia following cardiac arrest. be beneficial for resuscitation.) patients with non-VF arrest out of hospital or for in-hospital arrest. Tissue plasminogen Administration of tPA National Institute of activator (tPA) is was recommended for Neurological Disorders recommended for carefully selected and Stroke (NINDS) carefully selected patients with acute results have been patients with acute ischemic stroke if they supported by subsequent ischemic stroke, but had no contraindications one year follow up, cautions that tPA must to fibrinolytic therapy reanalysis of the NINDS be administered in and if the drug can be data and a meta the setting of a administered within analysis. Additional clearly defined 3 hours of the onset trials supported the protocol and of stroke symptoms. NINDS results. institutional Note: Higher commitment. complications of hemorrhage following tPA was reported in one study when participating hospitals did not require strict adherence to NINDS protocols.

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