NEW YORK NURSE: December 2010
by Denise Côté-Arsenault, Ph.D. RNC, FNAP
There has been a good deal of talk in the news lately regarding the American Heart Association’s (AHA) revised guidelines (2005) for bystanders administering Cardiopulmonary Resucitation (CPR) outside of hospitals. For nurses, the rules for CPR and Basic Life Support (BLS) have changed numerous times over the past 30 years due to the ongoing accumulation of research. One concern has been that survival rates have not improved for out-of-hospital resuscitations, with survival rates at less than 15 percent. And, in-hospital resuscitations do not fare much better. Therefore, the AHA continues to revise and simplify CPR guidelines.
The latest round of revisions is revolutionary: eliminate the breaths in CPR and focus solely on giving 100 compressions per minute. This approach will eliminate the public’s concern about giving mouth-to-mouth resuscitation, save precious minutes, and avoid the interruption of chest compressions that is predictive of reduced survival rates. CPR with mouth-to-mouth has been found to be no more effective than chest compression only (Hallstrom, Cobb, Johnson & Copass, 2000). There is also a decreased emphasis on checking for a pulse, according to Pepe et al. (2001) because it wastes time and the public is often inaccurate in their assessments (Eberle, B., et al., 1996). The current rule is to “evaluate for signs of circulation” such as normal breathing, coughing or movement (AHA, 2005).
Was there a single study that provided the breakthrough evidence? No, not at all. Decades of research was reviewed repeatedly by a variety of multi-disciplinary groups. The most significant guideline review was done by the Ventilation Working Group of the Basic Life Support and Pediatric Life Support Subcommittees of the American Heart Association (Becker et al., 1997). The recommendations from 1997 have primarily remained intact as implementation has been enacted.
The Guidelines 2000 Conference was an international effort seeking consensus based on sound science and evidence (Cummins & Hazinski, 2000). The focus of the conference was resuscitation of all types, including in-hospital. Experts from around the globe evaluated the same science and evidence to determine best practice guidelines – an impressive undertaking. The findings from this conference, and the AHA guidelines over the past decade, have many implications for CPR by professionals, as well as by bystanders. Current practice must be adjusted to incorporate the many recommendations. Change takes time, but efforts must continue to bring the best practice guidelines to the bedside and the roadside. Nurses remain on the front lines in these efforts.
American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (2005). Circulation 112, IV1-IV203.
Becker, L.B., Berg, R.A., Pepe, P.E., Idris, A.H., Aufderheide, T.P., Barnes, T.A., et al. (1997). A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation: A statement for the healthcare professionals from the Ventilation Working Group of the Basic Life Support and Pediatric Life Support Subcommittees of the American Heart Association. Circulation. 96, 2102-211.
Eberle, B., Dick, W.F., Schneider, T., et al. Checking the carotid pulse: Diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation, 33, 107-116,
Hallstrom, A., Cobb, L., Johnson, E., & Copass, M. (2000). Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. The New England Journal of Medicine, 342 (21), 1546-1553.
Pepe, P.E., Gay, M., Cobb, L.A., Handley, A.J., Zaritsky, A., Hallstrom, A., et al., (2001). Action sequence for layperson cardiopulmonary resuscitation. Annals of Emergency Medicine, 37:4, S17-S25.