First Aid News from Safety 1st

Update to Resuscitation Guidelines October 2010

European Resuscitation Council and the Resuscitation Council (UK) jointly published the new Resuscitation Guidelines 2010.

Summary of the changes:

• 1 When obtaining help, ask for an Automated External Defibrillator (AED) if one is available.
• 2 Compress the chest to a depth of 5–6cm and at a rate of 100–120 per minute.
• 3 Give each breath over 1 second rather than 2 seconds.
• 4 Do not stop to check the casualty or discontinue CPR unless the casualty 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.
• 6 Teach about agonal gasps.

Details of the the changes:

1. AEDs are becoming more and more widespread in public places and in the emergency services. An AED should be viewed as a standard piece of first aid equipment and remains the single biggest factor in survival rates of sudden cardiac arrest.

2. Previous guidelines indicated a depth of 4 - 5 cm at a rate of 100 per minute. The changes reflect evidence that chest compressions are often undertaken at insufficient depth and at the wrong rate. If chest compressions are delivered outside the new guideline rates of 100 to 120 per minute, coronary perfusion drops significantly. If you go at the new upper limit of 120, that’s 2 beats per second.

3. This is to further highlight the importance of minimising interruptions in chest compressions, which commonly happen and is associated with a reduced chance of survival.

4. The new guidance advocates stopping only if you see signs of the victim regaining consciousness. This excludes convulsions or spasms that can happen normally during a cardiac arrest.

5. Those with a duty of care includes workplace first aiders, those who work with children, lifeguards etc. If you are not trained in CPR, chest compressions only is better than no CPR at all, though victims of drowning and children will have little or no oxygen in the blood at the point of cardiac arrest, so for these casualties rescue breaths are essential. Even with a cardiac arrest of cardiac origin (caused by a heart attack) the residual oxygen in the blood will last 5 minutes at the longest. Even with an open airway the air drawn in and out of the lungs by chest compressions alone is not sufficient to oxygenate the lungs because of the ‘dead air space’ in the airways. For this reason you should always train first aid students to give full CPR including rescue breaths.

6. Around 40% of cardiac arrest victims gasp initially in the first few minutes of cardiac arrest. These are called ‘agonal gasps’ and are often mistaken for breathing, so CPR is not started. The new guidelines say ‘it should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest; they are an indication for starting CPR immediately and should not be confused with normal breathing.’