The American Heart Association (AHA) updates their CPR and Emergency Cardiovascular Care guidelines annually. Their commitment to a continuous evidence evaluation process ensures up-to-date recommendations on how to manage a sudden cardiac arrest.
Although it can be overwhelming at times, keeping tabs on these updates is essential to the effective management of an organization’s risk profile. In this piece, we take you through key guidelines and recommendations to help you keep abreast of the latest AHA CPR guidelines. These fall under five of the report’s nine areas:
1. Dispatcher-assisted CPR For Adults And Pediatric Patients
Dispatcher-assisted CPR (DA-CPR) is an important link between bystanders at the scene of an out-of-hospital cardiac arrest (OHCA) and EMS care. The AHA working group responsible for these updates reviewed a number of published studies examining the effect of DA-CPR on patient outcomes. These indicated a fivefold increase in the likelihood of CPR being administered when DA-CPR is made available, as well as an association between DA-CPR and improved patient outcomes for both adult and pediatric patients.
As a result, their latest recommendation is that emergency dispatch centers should offer CPR instructions, and that they ensure the dispatchers are well-trained to provide them. Their 2015 recommendation that bystanders to a suspected OHCA receive instructions from dispatch to provide chest compression-only CPR remains unchanged.
2. The Use Of Advanced Airways During CPR
The AHA’s 2019 update addressed the use of three possible airway management strategies during resuscitation: bag-mask ventilation, supraglottic airway placement and endotracheal intubation strategies.
They note that the choice of bag-mask ventilation versus advanced airway insertion is largely determined by a combination of the patient’s needs and the skills and experience of the lay responder. Their recommendations also assume that responders possess the initial training and skills to insert airways and verify their proper position while minimally interrupting chest compressions.
Further updates include:
- Both bag-mask ventilation and advanced airway strategies may be considered during CPR for adult cardiac arrest in any setting
- If an advanced airway is used, the supraglottic airway can be used for adults with OHCA in settings with low tracheal intubation success rate
- In settings with high tracheal intubation success rates, either supraglottic airway or endotracheal tubes can be used for adults with OHCA
- In-hospital expert providers may use either supraglottic airway or endotracheal tube procedures
- EMS systems that perform prehospital intubation should provide an ongoing quality improvement program to both minimize complications, and track their overall success rates with supraglottic airway and endotracheal tube placement
3. Extracorporeal CPR For Adults
Extracorporeal CPR (ECPR) is an emergency facility procedure that can only be performed by trained medical professionals. This specialist treatment essentially involves initiating a cardiopulmonary bypass in the person being resuscitated during cardiac arrest.
The AHA’s key recommendation on extracorporeal CPR (ECPR) for adult patients is that it may be considered for selected patients as a rescue therapy when traditional CPR has failed, and can be implemented quickly by skilled providers.
There are no recommendations for the routine use of ECPR.
4. Targeted Temperature Management
Updated recommendations regarding targeted temperature management (TTM) in cases of OHCA and IHCA were triggered by the publication of results from a new randomized controlled trial. This study explored the effects of TTM 32°C to 34°C versus TTM 36°C to 37.5°C for children who remained comatose after an in-hospital cardiac arrest (IHCA).
Updates regarding TTM include:
- Core temperature should be continuously measured during treatment
- TTM can reasonably be used for infants and children between 24 hours and 18 years of age who remain comatose after an OHCA or IHCA
The following recommendations remain unchanged since 2015:
- Continuous measurement of temperature during the first several days for infants and children remaining comatose after cardiac arrest
- There is insufficient evidence to recommend cooling over normothermia for infants remaining comatose after IHCA, though related treatment protocols for OHCA patients exist
The AHA makes no recommendations regarding treatment duration, citing insufficient evidence.
5. The Treatment Of Presyncope
Physical counterpressure maneuvers are simple and designed to reduce syncope and its associated consequences. They’re designed to elevate blood pressure through systematic muscle contraction in the upper and/or lower body.
The 2019 updated recommendations for presyncope treatment are predominantly based on evidence suggesting that people who are prone to vasovagal or orthostatic syncope may improve their quality of life by learning and using physical counterpressure maneuvers such as arm tensing, neck flexion, and leg crossing with muscle tensing and squatting.
Essential updates include:
- The priority for someone experiencing signs or symptoms of presyncope is to assume a safe position, such as sitting or lying down. Once they are safe, they may engage physical counterpressure maneuvers
- A first aid provider recognizing presyncope of suspected vasovagal or orthostatic origin may reasonably encourage someone to perform physical counterpressure maneuvers. If there’s no improvement after 1-2 minutes, or if symptoms worsen, they should call for additional help
- Lower-body physical counterpressure maneuvers are preferable to their upper-body and abdominal counterparts, provided there are no extenuating circumstances
- The use of physical counterpressure maneuvers are not suggested when symptoms of a heart attack or stroke accompany presyncope
Treat Appropriately With The Right Support
While it’s important to be up-to-date with the AHA’s guidelines, it’s equally vital to have the right life-saving equipment available when you and your team require it and that it is properly managed and maintained. Because an efficient AED program management process could mean the difference between life and death for someone in cardiac arrest, it’s essential that your AEDs are ready to go when needed and that your staff is properly trained in its use.
PlusTracTM AED Management provides you with the step-by-step guidance you need to assure that your staff has the training and properly maintained equipment to perform critical first aid care during a sudden cardiac event.
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