Why: Blood flow is critical to keeping vital organs alive. Better chest compressions produce more blood flow. During chest recoil blood refills the heart. If the heart is not filled adequately before each compression blood flow is reduce. Half of chest compressions performed by professional rescuers are too shallow and frequently interrupted.
Why: Simplifies CPR information, making it easier to learn, remember, and perform better CPR. Ensures that all rescuers deliver longer series of uninterrupted compressions. The 15:2 ratio for 2-rescuer CPR for infants and children provides for additional ventilations they are likely to need.
Why : There is no evidence that lay rescuers can accurately check for signs of circulation. Checking for signs of circulation delays delivery of chest compressions.
Why : Adult victims of sudden cardiac arrest may gasp for the first minutes after collapse and rescuers should treat gasping as no breathing. Gasping does not occur as often in infants and children in cardiac arrest as it does in adults.
Why : Providers should give rescue breaths if victim is not breathing adequately and should not wait to give rescue breaths until adult respiratory arrest occurs. Children may demonstrate breathing patterns, such as rapid breathing or grunting, which are not adequate or normal. Hypoxic arrest in infants and children is common, ventilations and compressions are very important.
Why : The rescuer must be able to open the airway for the victim who does not respond. All methods of opening the airway can produce movement of an injured spine. The Jaw thrust may not be safer and is more difficult to perform than the head tilt-chin-lift.
Why : The jaw thrust is difficult to learn and perform, may not effectively open the airway and may cause spinal movement. Opening the airway is a priority when a trauma victim is unresponsive. Immobilization devises may interfere with effective CPR.
Why : The goal of each rescue breath should be to make the chest rise. Rescue breaths longer than 1 second can reduce blood return to the heart which decreases blood flow produced by next set of compressions. Lay rescuers should not try more than 2 times to give a rescue breath so as not to delay chest compressions.
Why : For best oxygenation of blood and elimination of carbon dioxide, ventilations should closely match perfusion. During CPR blood flow to lungs is about 25-33% of normal, less ventilation is needed. Hyperventilation is not necessary and can be harmful. Positive pressure in chest created by rescue breaths decreases venous return to heart which decreases blood flow produced by next set of compressions.
Why : The elimination of rescue breathing without chest compressions will reduce the number of CPR skills lay rescuers must learn, remember, and perform. Eliminates need to further assess victim after initial rescue breaths and reduces the time delay before delivering chest compressions.
Why : The wide range of acceptable breaths for the infant and child will allow the provider to tailor support to the patient.
Why: In studies rescuer fatigue, as demonstrated by inadequate chest compression rate or depth and inadequate chest recoil, developed in 1-2 minutes. Rescuers did report feeling fatigue for five minutes or longer.
Why : In infants and children, hypoxi c cardiac arrest is the most common type of arrest. Some infants and children may respond to that initial CPR.
Why : Change to hand placement for infants was made to simpl if y instructions. Rescuers and children come in all sizes and rescuer should use 1 or 2 hands as needed to compress the chest about 1/3 to 1/2 its depth.
Why : There is no single anatomic or physiologic characteristic that distinguishes a “child” victim from an “adult” victim. Healthcare providers will continue to use the cutoff of 8 years old for use of AED child pads or child attenuator system. “ Child” CPR guidelines and sequence (CPR first, 15:2 compressions for 2 rescuer CPR) should be used for victims 1 year to the onset of puberty.
Why : Bradycardia is a common terminal rhythm observed in infants and children. Healthcare provider should not wait for the development of pulseless arrest to begin chest compressions for the infant or child with poor perfusion who does not improve with support of oxygenation and ventilation.
Why : Rescuers and children come in all sizes and rescuer should use 1 or 2 hands as needed to compress the chest about 1/3 to 1/2 its depth.
Why : Evidence indicates that the 2 thumb-encircling technique produces higher coronary artery perfusion pressure. The 2 thumb-encircling technique more consistently results in appropriate depth or force of compression, and it may generate higher systolic and diastolic blood pressure.
Why : The goal is to simplify instruction and help the rescuer know when to act.
Why : The goal of these revisions is simplification. Studies show that chest compressions increase intrathoracic pressure as high or higher than abdominal thrusts. Blind finger sweeps may result in injury to victim’s mouth or throat and there is no evidence of effectiveness.
Why : The rhythm analysis for a 3-shock sequence can result in a delay of 29-37 seconds between the delivery of the first shock and the first post-shock chest compression. Modern biphasic defibrillators have a high first-shock efficacy of more than 85%. If the first shock fails, CPR likely has greater value than an immediate second shock. After VF is terminated, many victims have a nonperfusing rhythm for several minutes. Compressions help deliver oxygen to the heart increasing the likelihood it can effectively pump blood after the shock.
Why : Some AEDs have been shown to be very accurate in recognizing pediatric shockable rhythms, and some are equipped to deliver energy doses suitable for children.
Why : Studies show that 1 ½ - 3 minutes of EMS CPR before attempted defibrillation improves survival for victims of VF SCA if arrival time is more than 4-5 minutes . When VF is present for several minutes, the heart has used up most of the available oxygen and substrate needed to contract (pump) effectively. The amplitude of the VF waveform is typically low at this point and shock delivery may not eliminate VF. When a shock eliminates VF, it takes several minutes for a normal heart rhythm and blood flow to return. Compressions help deliver oxygen to the heart increasing the likelihood it can effectively pump blood after the shock.
Why : The three shock recommendation was based on monophasic defibrillator waveforms and repeated shocks were necessary to eliminate VF. Modern biphasic defibrillators have a higher first-shock success. Rhythm analysis after each shock is typically delayed by 37 seconds or longer, resulting in delays in compressions. If 1 st shock fails to eliminate VF, CPR with effective chest compressions is likely to provide blood flow to the myocardium and improve the likely success of a shock. Even when shock delivery is successful in eliminating VF, most victims demonstrate a nonperfusing rhythm and are in need of immediate CPR, especially chest compressions.
Why : The goal of this revision is simplify training and reduce number of different doses that providers need to learn, remember, and use. This recommendation is not intended to require reprogramming of AEDs that deliver doses recommended in 2000.
Why : The goal is to simplify attempted defibrillation and to support the use of device-specific doses proven effectiveness. Note that energies selected on a rectilinear biphasic defibrillator will differ from delivered energies.
Why : Evidence establishes the safety of biphasic waveforms and the ability of most AEDs to recognize shockable rhythms in infants and children. If available, use an AED that reduces the delivered energy dose through use of a special pad/cable system or other method.
Why : Although synchronized cardioversion is preferred for treatment of an organized ventricular rhythm, for some irregular rhythms, such as polymorphic VT, synchronization is not possible. Low energy levels should not be used for unsynchronized shocks because low-energy shocks have a high likelihood of provoking VF when given in an unsynchronized mode.
Why : Evidence shows that organized community CPR and AED programs improved survival to discharge for victims with witnessed VF. CPR and AED Programs in airports and casinos, and with police officers have survival rates are as high as 49-74%.
Why : Dispatcher CPR instruction increases likelihood of bystander CPR. Dispatchers must help bystanders distinguish between effective breathing and gasps. Victims of hypoxic arrest need rescue breaths and compressions.
Why : All EMS systems should have a process of ongoing quality improvement. Process should identify delays in system response and reduce them when feasible.
Why : Studies show that when EMS call-to-response intervals are 4-5 minutes or longer, a period of 1 ½ to 3 minutes of CPR before defibrillation was associated with improved survival.
