AMERICAN HEART
ASSOCIATION
CHANGES IN THE 2010
GUIDELINES AFFECTING
ALL RESCUERS
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Health Care Provider*
 “PUSH HARD AND PUSH FAST”
 At least 100 COMPRESSIONS / MINUTE*
 Allow the chest to recoil -- equal compression and relaxation times
 <10 seconds for pulse checks or rescue breaths
 Compression Depth*
 Adults 2”
 Child/Infant 1/3 depth of chest
 Avoid excessive ventilations
1.5" infant
2" child
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
 A-B-C changed to C-A-B*
 Critical element is chest compressions
 Delay in A-B
 Avoidance of A & B
 Early defib
 If alone--call and retrieve AED
 Exception asphyxial arrest
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
• Cricoid pressure not recommended
• Advanced airway = 1 every 6-8 seconds
• Adult: 1 every 5-6
Peds: 1 every 3
• With advanced airway- no pause
Dispatcher Identification
• SCA = seizure & agonal gasps
• Trained to ID – ask if breathing is
normal
• Only gasping???
• Provide CPR instructions
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
AHA ECC Adult Chain of Survival - New
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
• Lay Rescuer – Hands-only CPR (untrained vs trained)
– Easier
– Guided by dispatchers
– SR are same
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Simplified Universal
BLS algorithm
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Electrical Therapies
• Shock first vs CPR first
• No precordial thump
• CPR devices – no data for
• AED in hospital (goal to shock =< 3 mins)
• Use in infants (with or without attenuator)
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
ACLS
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Simplified algorithm
Optimized CPR quality with monitoring
Waveform capnography (>12 mmHg)
Atropine deleted (PEA/Asystole)
Chronotropic drugs for brady, then pacing
Adenosine safe for monomorphic wide tachs
Post-cardiac arrest
AMERICAN HEART ASSOCIATION
CAPNOGRAPHY
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Post-Cardiac Arrest – ROSC
• Therapeutic Hypothermia
– Remain comatose
– 32-34 degree C (all ages) (89.6-93.2 F)
– 12-24 hours
• PCI
• O2 sat ≥94% & PETCO 35-40
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Special Resuscitation Situations
• Asthma
• Hypothermia
• Anaphylaxis
• Avalanche
• Pregnancy
• Drowning
• Morbid obesity
• PE
• Electrolyte imbalance
• Toxins
• Electric shock/lightening
• PCI
• Cardiac tamponade
• Cardiac surgery
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Acute Coronary Syndromes
• Out of hospital 12-lead
• Triage to PCI
• Oxygen – > 94 % is the goal (capno)
• Morphine – use with caution in UA/non-STEMI
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Stroke
• Stroke-prepared hospitals
• Triage to stroke centers
• TPA up to 4.5 hours
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Learning to Mastery
• New CPR Prompts devices
• Online training: http://www.onlineaha.org/
• Instructor network
http://ahainstructornetwork.americanheart.org/AHAECC/ecc.jsp?pid=ahaecc.signin&_requestid=133687