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Welcome to the
American Heart Association
2010 Update for CPR.
Clinical staff – all levels
2010 AHA Update for CPR
1.0
5/24/2011
This module provides the audience with an overview of
the American Heart Association’s 2010 changes to
CPR procedures for healthcare professionals.
The module contains 45 slides and should take ~25
minutes to complete. 404-785-6767
Shannon Dunlap
Mark Guerrein
05/24/2011 2©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
None
Children’s Healthcare of Atlanta has developed this module to
present the updated CPR protocol from the American Heart
Association (AHA) to clinicians who perform CPR.
On April 1, 2011, we will begin utilizing this new protocol when CPR is
performed in our hospitals and neighborhood locations. You will be
thoroughly instructed in this protocol during your next CPR
recertification or your initial CPR certification course. Meanwhile,
there are some important points you must know so that you and all
those performing CPR are using the same protocol.
If you have any questions about any of these points you can ask your
educator or contact Shannon Dunlap.
Note: The new guidelines are highlighted in red throughout the CBT.
05/24/2011 3©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
At the completion of this module you will be able to
describe the American Heart Association’s 2010 revisions
to providing basic life support (including CPR) for:
•Adult victims
•Infant and child victims
•Victims with foreign body obstructions in their airways
05/24/2011 4©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
In late 2010, the American Heart Association or AHA
modified its recommendations on Cardio Pulmonary
Resuscitation (CPR) procedures to improve survival
rates of adult and pediatric victims.
These recommendations were based upon empirical
studies that indicated improved survival. They include:
•Changes to the “Chain of Survival”
•Changes to the CPR sequence
In this lesson you will be presented with an overview of
these changes.
Lesson 1: CPR Overview
05/24/2011 5©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
CPR Overview
• Immediate recognition of cardiac
arrest and activation of the
emergency response system
• Early CPR emphasizing chest
compressions
• Rapid defibrillation
• Effective advanced life support
• Integrated post-cardiac care
Successful resuscitation following cardiac arrest requires several key actions
also know as the Chain of Survival. These are:
05/24/2011 6©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Change in Sequence
The new AHA guidelines recommend a
fundamental change in CPR sequence
from A-B-C to C-A-B
C-A-B
•Compressions: Push hard and fast on
the center of the victim’s chest.
•Airway: Tilt the victim’s head back and lift
the chin to open the airway.
•Breathing: Give mouth-to-mouth or
bag/mask rescue breathing.
05/24/2011 7©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Change in Sequence continued
The new AHA guidelines have also eliminated “Look, Listen, and Feel” from
the CPR sequence because performing it is inconsistent and time consuming.
05/24/2011 8©2011 Children’s Healthcare of Atlanta Inc.
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Cardiac Arrest
• Cardiac arrest in adults is usually
sudden, and the primary cause is
cardiac related. Therefore
circulation produced by chest
compressions is crucial.
• Cardiac arrest in children is
mostly asphyxial which requires
both compressions and
ventilations.
• Rescue breathing may be more
important for children than adults
in cardiac arrest.
05/24/2011 9©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Lesson 1: CPR Overview
In this lesson you learned about general changes to
CPR guidelines that the AHA has recommended:
•Changes to the “Chain of Survival”
•Changes to the CPR sequence from A-B-C to C-A-B
In the next lesson you will be presented the specific
changes to the AHA CPR guidelines for adults.
05/24/2011 10©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Lesson 2: Adult Basic Life
Support for Healthcare
Providers
In this lesson you will learn about changes to the CPR
procedures for adults that are provided by our
caregivers here at Children’s.
These include revisions to:
•Chest compressions
•Pulse checks
•Rescue breaths
You will also learn about revisions on using an
Automated External Defibrillator (AED) in conjunction
with CPR.
05/24/2011 11©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Adults / Adolescents Basic Life Support (BLS) for
Healthcare Providers
• The rescuer recognizes that the
patient is unresponsive – no
breathing or no normal breathing.
• Activate the emergency response
system and get AED/defibrillator –
if second rescuer is available send
her or him to do this.
• Check the pulse – if definite pulse
within 10 seconds give 1 breath
every 5 to 6 seconds and re-check
carotid pulse every 2 minutes.
05/24/2011 12©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Adult BLS for Healthcare Providers
• If there is no pulse, begin CPR starting with
30 compressions. Then open the airway and
give 2 breaths.
• When the AED/defibrillator arrives, check
rhythm.
• If rhythm is shockable, give 1 shock and
resume CPR immediately for 2 minutes.
• If rhythm is not shockable, resume CPR for 2
minutes; check rhythm every 2 minutes and
continue until advanced life support providers
take over or the patient starts to move.
• The AED will automatically prompt you to
perform the above actions.
05/24/2011 13©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Chest Compressions in AdultsRescuers should focus on delivery of high qualityCPR – Push Hard and Push Fast
• Provide chest compressions at an adequate rate (at least 100/min)
• Provide Chest compressions to adequate depth
o Adults: Compression depth of at least 2 inches (5cm)
o Allow complete chest recoil after each compression
• Minimize interruptions in compressions
• Avoid excessive ventilations
• If multiple rescuers are available, they should rotate the task of compressions
every 2 minutes
05/24/2011 14©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Pulse Checks
• Studies have shown that healthcare
providers and lay rescuers have
difficulty detecting pulses.
• To avoid delay in CPR, healthcare
providers should take no more than 10
seconds to check for a pulse.
• If a pulse is not detected within 5-10
seconds then compressions should be
started.
05/24/2011 15©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Rescue Breaths
• The 2010 AHA Guidelines recommend
the initiation of compressions before
ventilations.
• Once compressions have been started,
a trained rescuer should deliver rescue
breaths by mouth-to-mouth or
bag/mask.
05/24/2011 16©2011 Children’s Healthcare of Atlanta Inc.
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Rescue Breaths
• Rescue breaths should be
delivered over 1 second.
• Give sufficient tidal volume to
produce visible chest rise.
• Use compression to ventilation
ratio of 30 compressions to 2
ventilations.
• If there is a pulse give 1 breath
every 5-6 seconds.
05/24/2011 17©2011 Children’s Healthcare of Atlanta Inc.
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AED/Defibrillation
Defibrillation sequence
• Turn on the AED.
• Follow the AED prompts.
• Resume chest compressions
immediately after the shock;
minimize interruptions.
Pad placement
• The 4 pad positions are
anterolateral, anteroposterior,
anterior-left infrascapular, and
anterior-right infrascapular. All of
these positions are equally
effective.
05/24/2011 18©2011 Children’s Healthcare of Atlanta Inc.
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Adult BLS for Healthcare Providers
The following slide displays a flow chart of the steps to follow when providing
Adult BLS.
05/24/2011 19©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Victim is unresponsive. No breathing or no normal breathing (i.e., only gasping).
Activate the emergency response
system and get AED/defibrillator.
Check pulse:
DEFINITE pulse within 10 secs.?
Begin cycles of 30 compressions
and 2 breaths.Give 1 breath every 5 to 6 secs.
Re-check pulse every 2 mins.
AED/defibrillator arrives.
Shockable rhythm?
Shockable rhythm:
Give 1 shock and resume
CPR for 2 mins.
No shockable rhythm: Resume
CPR immediately for 2 mins. Check
rhythm every 2 mins. Continue until
ALS providers take over or victim
starts to move.
2
3
3a 4
5
6
7 8
1
Pulse No Pulse
No
High Quality CPR•Rate at least 100/minute
•Compression depth at least 2
inches (5cm)
•Allow complete chest recoil after
each compression.
•Minimize interruptions in chest
compressions.
•Avoid excessive ventilations.
** Indicates a
change to
AHA protocol
YES
Adult / Adolescent
BLS for
Healthcare Providers
Lesson 2: Adult Basic Life
Support for Healthcare
Providers
In this lesson you learned about revisions to CPR
procedures for adults including:
•Chest compressions
•Pulse checks
•Rescue breaths
You also learned about revisions on using an Automated
external defibrillator (AED) in conjunction with CPR.
In the next lesson information about BLS for children
and infants is presented.
05/24/2011 21©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Lesson 3: Child and
Infant CPR
This lesson presents information about revisions to the
CPR procedures for infants and children.
These include:
•The differences between CPR for infants and children
•Inadequate breathing issues
•Poor Perfusion
You will also learn about revisions on using an
Automated External Defibrillator (AED) in conjunction
with CPR for children and infants.
05/24/2011 22©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Child and Infant CPR
• Infant BLS guidelines apply to
infants less than approximately 1
year of age.
• Child BLS guidelines apply to
children approximately 1 year of
age until puberty.
• For teaching purposes, puberty is
defined as breast development in
females and presence of axillary
hair in males.
05/24/2011 23©2011 Children’s Healthcare of Atlanta Inc.
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Child and Infant CPRThe AHA recommends that the sequence of CPR for adults and infants/children be the same
Rationale for making the changes in
CPR sequence to C-A-B in infants
and children:
•The majority of victims who require
CPR are adults. They have a better
outcome if compressions are started
as early as possible.
•Beginning CPR with compressions
rather than ventilations leads to a
shorter delay to the first compression.
• All rescuers should be able to start
chest compressions almost
immediately. Whereas positioning
the head and making sure there is
a seal for mouth-to–mouth or bag-
mask resuscitation takes time and
delays the initiation of chest
compressions
• This also offers the advantage of
consistency in education whether
the victims are adult, children or
infants.
05/24/2011 24©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Pediatric Chain of Survival
• Make sure the area is safe for you
and the infant/child
• Assess the need for CPR and
start compressions – lone
rescuers should give about 5
cycles of compressions and
ventilations before leaving the
child to activate the emergency
response
• Activate emergency response
system and get the AED
• Effective advanced life support
• Integrated post-cardiac care
05/24/2011 25©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Chest Compressions in Infants and Children
Rescuers should focus on delivery of high quality CPR –
Push Hard and Push Fast.
•Provide chest compressions to adequate rate (at least 100/minute)
•Provide chest compressions of adequate depth
– Infants and children: a depth of at least one third the anterior-posterior
(AP) diameter of the chest or about 1 ½ inches (4cm) in infants and about
2 inches (5cm) in children
•Allow compete chest recoil after each compression
•Minimize interruptions in compressions
•Avoid excessive ventilation
If multiple rescuers are available they should rotate the task of compressions
every 2 minutes.
05/24/2011 26©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Pediatric BLS for Healthcare Providers in Infants
and Children
• If second rescuer is available send him or her to
activate the emergency response and obtain
AED/defibrillator. – AEDs have now been
approved for use with infants.
• Check pulse – if definite pulse within 10
seconds give 1 breath every 3 seconds.
• Add compressions if pulse remains less than
60/min with poor perfusion despite adequate
oxygenation and ventilation.
• Recheck pulse every 2 minutes.
05/24/2011 27©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Pediatric BLS for Healthcare Providers in Infants
and Children• If no pulse is detected, begin cycles of 30
compressions and 2 breaths for one rescuer. For
2 rescuers begin cycles of 15 compressions and 2
breaths.
• If lone rescuer, after about 2 minutes, activate the
emergency response system if not already done.
Use an AED as soon as available.
• If rhythm is shockable, give 1 shock and resume
CPR immediately for 2 minutes.
• If rhythm is not shockable, resume CPR
immediately for 2 minutes. Check rhythm every 2
minutes. Continue until Advanced Life Support
providers take over or victim starts to move.
05/24/2011 28©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Pediatric BLS for Healthcare Providers
The following slide displays a flow chart of the steps to follow when providing
pediatric BLS.
05/24/2011 29©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Victim is unresponsive. Not breathing or gasping. Send someone to activate
The emergency response system and get an AED/defibrillator.
One rescuer:
For SUDDEN COLLAPSE activate the
emergency response system and get
AED/defibrillator
Check pulse:
DEFINITE pulse within 10 secs.?
One rescuer: Begin cycles of 30
compressions and 2 breaths
Two rescuers: Begin cycles of 15
compressions and 2 breaths
Give 1 breath every 3 secs. Add
compressions if pulse remains
< 60/min with poor perfusion despite
adequate oxygenation and ventilation
RE-check pulse every 2 mins
After about 2 mins, activate emergency
response system and get AED (if not already
done). Use AED ASAP to check rhythm.
Shockable rhythm?
Shockable rhythm:
Give 1 shock and resume
CPR for 2 mins.
No shockable rhythm: Resume
CPR immediately for 2 mins. Check
rhythm every 2 mins. Continue until
ALS providers take over or victim
starts to move.
2
3
3a 4
5
6
7 8
1
Pulse No Pulse
No
High Quality CPR•Rate at least 100/minute
•Compression depth at
least 1/3 anterior-posterior
diameter of chest, about 1
½ inches (4cm) in infants
and 2 inches (5cm) in
children
•Allow complete chest recoil
after each compression.
•Minimize interruptions in
chest compressions.
•Avoid excessive ventilations.
*
* Indicates a
change to AHA
protocol
YES
Pediatric BLS for
Healthcare Providers
TWO rescuers:
For SUDDEN COLLAPSE send someone
to activate the emergency response
system and get AED/defibrillator
2
Chest Compressions for Healthcare Provider
of Infants• For infants, the single rescuer should
use the 2-finger chest compression
technique.
• The 2-thumb encircling hands
technique is recommended when CPR
is provided by 2 rescuers.
• To do this, encircle the infant’s chest
with both hands. Spread your fingers
around the thorax, and place your
thumbs together over the lower third of
the sternum. Forcefully compress the
sternum with your thumbs.
05/24/2011 31©2011 Children’s Healthcare of Atlanta Inc.
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Inadequate Breathing with Pulse
If there is a palpable pulse > 60 per
minute but there is inadequate
breathing:
Give rescue breaths at a rate of about
12-20 breaths per minute – 1 breath
every 3-5 seconds until spontaneous
breathing resumes.
05/24/2011 32©2011 Children’s Healthcare of Atlanta Inc.
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Bradycardia with Poor Perfusion
If the pulse is less than 60 beats per minute and there are signs of poor perfusion
( i.e., pallor, mottling, cyanosis) begin compressions.
05/24/2011 33©2011 Children’s Healthcare of Atlanta Inc.
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AED/Defibrillators in Children and Infants
• If a manual defibrillator is unavailable
then an AED that has a pediatric
dose attenuator (pediatric pads) is
preferred for infants.
• An AED with a pediatric dose
attenuator is also preferred for
children under 8 years of age.
• If neither is available an AED without
a dose attenuator may be used.
• In infants, manual defibrillators are
preferred. If a manual defibrillator is
not available then one with a
pediatric dose attenuator (pediatric
pads) is preferred.
• AED’s that do not have
pediatric dose attenuators have
been used in infants with no
clear adverse effects.
05/24/2011 34©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
BLS for Adults vs. Children
In this lesson we discussed Basic Life Support (BLS) for children and Infants.
In the previous lesson Adult BLS was presented. It may be helpful to compare
the differences of these groups. The next slide displays a table taken from the
AHA 2010 Guidelines summarizing these differences.
05/24/2011 35©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Recommendations
Component Adults Children Infants
Recognition
Unresponsive (for all ages)
No breathing or no normal
breathing (i.e., only gasping)No breathing or only gasping
No pulse palpated within 10 seconds for all ages (HCP only)
CPR Sequence C-A-B
Compression rate At least 100/min
Compression depth At least 2 inches (5cm)At least ½ AP diameter
About 2 inches (5cm)
At least ½ AP diameter
About 1½ inches (4cm)
Chest wall recoilAllow complete recoil between compressions
HCPs rotate compressions every 2 minutes
Compression
interruptions
Minimize interruptions in chest compressions
Attempt to limit interruptions to < 10 seconds
Airway Head tilt-chin lift (HCP suspected trauma: jaw thrust)
Compression-to-
ventilation ratios
(until advanced
airway placed)
30:2
1 or 2 rescuers
30:2
Single rescuer
15:2
2 HCP rescuers
Ventilations: when
rescuer untrained or
trained and not
proficient
Compressions only
Ventilations with
advanced airway
(HCP)
1 breath every 6-8 seconds (8-10 breaths/min)
Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
Defibrillation
Attach and use AED as soon as possible. Minimize interruptions in chest compressions
before and after shock;
resume CPR beginning with compressions immediately after each shock.Source: Highlights of the 2010
AHA Guidelines for CPR & ECC
Summary of Key BLS Components for Adults, Children, and Infants**Excluding the newly born, in
whom the etiology of an arrest is
nearly always asphyxiate.
Lesson 3: Child and
Infant CPR
In this lesson you learned about.
•The differences between CPR for infants and children
versus adults
•Inadequate breathing issues
•Poor perfusion
You also learned about using an Automated External
Defibrillator (AED) in conjunction with CPR for children
and infants.
05/24/2011 37©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Lesson 4: Foreign Body
Obstruction (Choking)
This final lesson will present information about foreign
body obstructions in victims’ airways, including:
• Relief for responsive and unresponsive victims
•Recognizing and responding appropriately to mild and
severe obstructions
You will also learn about Hands-only CPR.
05/24/2011 38©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Foreign Body Airway Obstruction (Choking)
• Greater than 90% of childhood
deaths from foreign body
aspiration occur in children under
5 years old.
• Foreign body obstruction can be
either mild or severe.
• When it is mild, the adult and children
can cough and make some sounds.
• When it is severe, the adult or child
cannot cough or make any sound.
05/24/2011 39©2011 Children’s Healthcare of Atlanta Inc.
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Relief of Foreign Body Obstruction
• If the foreign body obstruction is
mild, do not interfere. Allow the
victim to clear airway by coughing
while you observe for signs of
severe foreign body obstruction.
• If the foreign body obstruction is
severe you must act to relieve the
obstruction.
• For adults and children, perform
abdominal thrusts until the object
is expelled or the victim becomes
unresponsive.
• For infant, deliver repeated cycles
of 5 back blows followed by 5
chest compressions until the
object is expelled or the victim
becomes unresponsive.
05/24/2011 40©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Relief of Foreign Body Obstruction (Unresponsive)
If the victim becomes unresponsive:
•Start CPR with chest compressions –
do not perform a pulse check.
•After 30 chest compressions open
the airway.
•If you see a foreign body, remove it
but do not perform blind finger
sweeps because they may push the
objects further into the pharynx.
• Attempt to give 2 breaths and
continue with cycles of chest
compressions and ventilations
until the object is expelled. Look
for the object after each round of
compressions and sweep if seen.
• After 2 minutes, if no one has
done so, activate the emergency
response system.
05/24/2011 41©2011 Children’s Healthcare of Atlanta Inc.
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Hands-only CPRBecause we are in a healthcare setting, this CBT has focused primarily on CPR
for Healthcare Providers. Hands-only CPR is for layperson cardiac arrest
rescue in the community or out of the hospital when unable to provide breaths
(no mask/barrier) because:
• Lay rescuers are more likely to provide CPR if they do
not have to give ventilations.
• It is easier for emergency response personnel to
instruct lay rescuers how to perform chest
compressions when they are untrained.
• Survival rates from cardiac arrest are similar for
Hands-only CPR and CPR using both compressions
and ventilations.
• If the lay rescuer is trained, it is still recommended
that the rescuer perform both compressions and
ventilations.
05/24/2011 42©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
Lesson 4: Foreign Body
Obstruction (Choking)
This lesson presented information about foreign body
obstructions in victims’ airways, including:
• Relief for responsive and unresponsive victims
•Recognizing and responding appropriately to mild and
severe obstructions
You also learned about Hands-only CPR used by lay-
people.
05/24/2011 43©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.
You have completed this module. In it you learned about
the changes to the AHA’s new recommendations for
providing CPR. These changes impact providing basic
life support for:
•Adult victims
•Infant and child victims
•Victims with foreign body obstructions in their airways
05/24/2011 44©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.
References
2010 American Heart Association Guidelines for CPR and ECC, Supplement to Circulation November 2,2010, Volume 122, Issue 18, Supplement 3.
www.heart.org
05/24/2011 45©2011 Children’s Healthcare of Atlanta Inc.
All Rights Reserved.