2015 New CPR Guidelines
BLS for Healthcare Provider
The official name of the BLS for Healthcare Provider has changed. The new name of this course is BLS Provider. Sometimes we have students or supervisors ask us about this new name change. The name change happened around March 2016. Also, the American Heart Association has a new card and book for this course:
Q: Why does the BLS Course name no longer include “for Healthcare Providers” or “for Prehospital Providers”?
A: The audience-specific identifiers have been removed because the new BLS Course is designed for healthcare providers caring for patients both in and out of a hospital/in-facility setting. For example, the course DVD includes tracks for both prehospital and in-facility healthcare providers. Instructors may choose a track depending on the type of provider they are teaching or can alternate between tracks to meet the needs of both types of providers.
The American Heart Association announced its newest CPR recommendations on October 16th, 2015. The new CPR guidelines are based on the latest scientific data from the previous 5 years. The new update has placed limits on how fast and deep chest compressions should be performed.
The guidelines are updated every five years. The 2010 recommendations led to a major shift in how CPR is taught, by focusing more on chest compressions to keep blood moving to prevent brain damage, rather than delivering rescue breaths.
The new guidelines do not have any major changes, but here are some of the basics:
- No more than 120 compressions per minute with a minimum of 100.
- Chest compressions for adults should be no more than 2.4 inches and at least 2 inches.
- 911 Operators should be trained to help bystanders check for breathing & recognize cardiac arrest.
If you are currently certified in CPR, you do not need to retake your training course. However, when your CPR card expires, you will be trained with the new guidelines. The American Heart Association is currently working on developing new instructor materials, new books, and new DVDs and they will be released when finished (early 2016).
When do you start teaching the new guidelines?
We cannot start teaching the new guidelines until the American Heart Association produces the new material. After guidelines are announced, the American Heart Association must print out new books, develop new instructor material, produce new DVDs, and design new instructor training. This usually takes 3-4 months. However, until we have the new material we teach the current guidelines. The current guidelines will be acceptable until we have the new material.
Do I need to renew my card after the new guidelines are released?
No. This just means after your card expires, you would attend a renewal class with the new standards.
Read more about the new CPR guidelines here.
Register for a CPR Class in the Bay Area here.
ACLS 2015 Changes
- The recommended chest compression rate is 100-120 per minute which is updated from the at least 100/min.
- The recommended chest compression depth is 5-6cm or just over 2 inches, but not more than 6cm as too deep can be harmful.
- Use Audiovisual devices such as metronomes and compression depth analyzers which can be used to optimize CPR quality.
- The routine use of impedence threshold devices (ITDs) alone or mechanical chest compression devices alone are not recommended, however in out of hospital situations where manual compressions are difficult due to physical space limitations, mechanical devices may be useful.
- A recent RCT suggests that the use of the ITD plus active compression decompression CPR is associated with improved neurological intact survival for patients with out of hospital cardiac arrest.
- ECMO or ECPR may be considered for selected patients with refractory cardiac arrest where a reversible cause of cardiac arrest is suspected.
- Vasopressin has been removed from the algorithm altogether, and an emphasis on EARLY administration of epinephrine is stressed.
- Ultrasound has been added as an additional method for helping to confirm ROSC and for confirming ETT placement.
- Use maximum inspired oxygen during CPR and then after ROSC, titrate oxygen to an oxygen saturation of 94% rather than continuing maximum oxygen delivery.
- A low end tidal CO2 in intubated patients after 20 minutes of CPR is associated with a very low likelihood of survival, and this factor should be used in combination with other factors to help determine when to terminate resuscitation.
- The routine use of lidocaine after ROSC is not recommended, however the initiation or continuation of lidocaine may be considered immediately after ROSC from ventricular fibrillation or pulseless ventricular tachycardia.
- Emergency PCI is recommended for all patients with STEMI AND for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected.
- Do Targeted Temperature Management – recommendations have been updated with new evidence suggesting that a range of temperatures between 32 and 36 may be acceptable to target in the post cardiac arrest period, and an emphasis on fever prevention and treatment is stressed.
2015 PALS Changes
|HCP’s must call for nearby help upon finding the victim unresponsive, which is updated from calling for help after determining if the patients breathing is absent or not normal.
Trained rescuers are encouraged to simultaneously perform some steps (i.e., checking for breathing and a pulse at the same time) in an effort to reduce the time to first compression.
Push at a rate of 100 to 120 compressions per minute for infants and children.
|Use Audiovisual devices such as metronomes and compression and depth analyzers which can be used to optimize CPR quality. CPR Metronome is one of the top rated free apps available for Android and Apple devices. (Safety Training Seminars has installed CPR Metronone Devices in all of our classrooms.)
It may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (ie, during CPR with an advanced airway).
For children in shock, an initial fluid bolus of 20 mL/kg is reasonable. However, for children with febrile illness in settings with limited access to critical care resources (ie, mechanical ventilation and inotropic support), administration of bolus IV fluids should be undertaken with extreme caution, as it may be harmful. Individualized treatment and frequent clinical reassessment are emphasized.
There is no evidence to support the routine use of atropine as a premedication to prevent bradycardia in emergency pediatric intubations. It may be considered in situations where there is an increased risk of bradycardia.
There is no evidence to support a minimum dose of atropine when used as a premedication for emergency intubation.
Amiodarone or lidocaine is equally acceptable for the treatment of shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).
For children who are comatose in the first several days after cardiac arrest (in-hospital or out-of- hospital), temperature should be monitored continuously and fever should be treated aggressively.
For comatose children resuscitated from OHCA it is reasonable for caretakers to maintain either 5 days of normothermia (36 -37.5 degrees celcius or 2 days of initial continuous hypothermia (32-34 degrees celcius) followed by 3 days of normothermia.
For children remaining comatose after IHCA, there are insufficient data to recommend hypothermia over normothermia.