May 2011, Volume 41 Number 5 , p 40 - 44
IN 2010, THE AMERICAN Heart Association (AHA) released updated guidelines for basic life support (BLS) and advanced cardiovascular life support (ACLS). Several changes have been made to the guidelines as well as the standard algorithms to improve resuscitation practice. This article will provide an overview of the newest additions and deletions so you're up to date on the most recent advances in emergency cardiovascular care for adults. A future article will cover guideline changes in pediatric life support. To see the complete AHA guidelines, visit http://static.heart.org/eccguidelines/2010-guidelines-for-cpr.html .The fundamental aspects of BLS, which remain unchanged, include recognition of arrest, activation of an emergency response system (ERS), early CPR, and rapid defibrillation. But the sequence of BLS has changed from the familiar ABC (airway, breathing, circulation) to CAB (compressions, airway, breathing). This change was made because research showed that in the ABC sequence, chest compressions are often delayed while the responder opens the airway to give ventilations, retrieves a barrier device, or gathers and assembles ventilation equipment. When the sequence is CAB, chest compressions are started sooner and the delay in ventilation is minimized. Most victims of out-of-hospital cardiac arrest don't receive bystander CPR, and one reason may be the ABC sequence, which starts with procedures that rescuers find most difficult (opening the airway and delivering breaths). Starting with chest compressions may encourage more rescuers to begin CPR.1 The sequence now looks like this:Recognition. "Look, listen, and feel" has been removed from the BLS algorithm; instead, you'll need to determine unresponsiveness and absence of normal breathing, such as absent or gasping respirations. Once the patient is determined to be unresponsive, activate the ERS and get an automated external defibrillator (AED)/defibrillator or send a second rescuer (if available) to do this.Compressions.