2010 Resuscitation Guidelines

On October 18th the European Resuscitation Council and the Resuscitation Council (UK) jointly published the new Resuscitation Guidelines 2010

There are no major changes to the 2005 guidelines, although there are some subtle, yet very important amendments that reflect the latest scientific evidence available on resuscitation. 

Here is a summary of the changes to the Basic Life Support Guidelines: 

1. When obtaining help, ask for an Automated External Defibrillator (AED) if one is available.   

AEDs are becoming more and more widespread in public places and in the emergency services.  An AED should be viewed as a standard piece of first aid equipment and remains the single biggest factor in survival rates of sudden cardiac arrest.  In the UK approximately 30,000 people sustain cardiac arrest outside of hospital each year.  The chances of survival decline at a rate of about 10% with every 1 minute delay in providing a defibrillation shock.

The new guidelines say that ‘training in the use of an AED is desirable but not essential’.  Attempting to use an AED without prior training is likely to result in a better outcome than CPR alone (and the machines are very safe), although chances of survival can be increased significantly if training is provided, as this is likely to reduce interruptions in chest compressions and reduce the time taken to deliver the first shock. 

2. Compress the chest to a depth of 5–6cm and at a rate of 100–120 per minute. 

Previous guidelines indicated a depth of 4-5cm at a rate of 100 per minute. The changes reflect evidence that chest compressions, both inside and outside hospital are often undertaken at insufficient depth and at the wrong rate, both of which are associated with reduced survival rates.  In theory, ‘pressing harder’ will improve on the actual depth achieved. 

Interestingly, studies have shown that untrained lay-people generally deliver chest compressions too slow, whereas medical professionals tend to deliver compressions too fast.  If chest compressions are delivered outside the new guideline rates of 100 to 120 per minute, coronary perfusion drops significantly.  When was the last time you checked your perception of 100 per minute? If you go at the new upper limit of 120, that’s 2 beats per second. Practice it! 

3. Give each breath over 1 second rather than 2 seconds. 

This is not actually a change, as the 2005 guidelines also indicated ‘take about 1 second to make the chest rise’, though the Resus Council (UK) have indicated this as one of the changes.  It is likely that this is to further highlight the importance of minimising interruptions in chest compressions, which commonly happen and are associated with a reduced chance of survival. 

4. Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking or moving purposefully AND starts to breathe normally. 

The 2005 guidelines indicated stopping if ‘normal breathing’ resumed – which often resulted in rescuers interrupting chest compressions to confirm.  The new guidance advocates stopping only if you see signs of the victim regaining consciousness.  

5. CPR including 'mouth-to-mouth' ventilation is the gold standard for those with a duty of care.  For laypeople the emphasis is on chest compressions. 

This is a welcome clarification that teaching rescue breaths is necessary.  ‘Those with a duty of care’ includes workplace first aiders, those who work with children, lifeguards etc. 

There is a subtle but significant change in the guidance on when to give CHEST COMPRESSIONS ONLY: 

  • The 2005 Guidelines said to give compressions only CPR ‘if you are unwilling or unable to give rescue breaths…’
  • In the new 2010 guidelines this has changed to ‘if you are not trained to, or are unwilling to give rescue breaths…’ 
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This makes it clear that if you are not trained in CPR, chest compressions only is better than no CPR at all, though victims of drowning and children will have little or no oxygen in the blood at the point of cardiac arrest, so for these casualties rescue breaths are essential.  Even with a cardiac arrest of cardiac origin (caused by a heart attack) the residual oxygen in the blood will last 5 minutes at the longest.  

Even with an open airway (the patency of which can only really be tested by giving a rescue breath!) the air drawn in and out of the lungs by chest compressions alone is not sufficient to oxygenate the lungs because of the ‘dead air space’ in the airways. 

For this reason we always train first aid students to give full CPR including rescue breaths, and can only certify competence in CPR for First Aid at Work or Emergency First Aid at Work courses if the delegate has demonstrated effective rescue breaths. 

We also recommend the inclusion of a Pocket Mask in a First Aid kit for the workplace.  We don't sell First Aid supplies so have no commercial interest in recommending them.  Pocket masks are easier to use and more effective than disposable face-shields.  Their physical size distances the rescuer from the casualty's mouth by about 2" make the process of mouth-to-mouth ventilation more sanitary and psychologically easier to undertake.

6.  Agonal Breathing.

Around 40% of cardiac arrest victims gasp initially in the first few minutes of cardiac arrest. These are called ‘agonal gasps’ and are often mistaken for breathing, so CPR is not started.  The new guidelines say ‘it should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest; they are an indication for starting CPR immediately and should not be confused with normal breathing.’ 

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