2015 AHA GUIDELINE

FOR
CPR &
ECC
CPR 2015

CONTENTS
▸ Introduction
▸ Evidence Review and Development Process
▸ Parts of Guideline
▸ Knowledge Gaps
▸ Significant New and Updated Recommendations
▸ New Development
INTRODUCTION

WHY LEARN CPR??

▸ Each year, more than 350,000
OHCA occur in the US.

▸ Survival depends on immediately

getting CPR from someone
nearby

▸ 70% of OHCA happen in homes

▸ Only 46% of people who
experience an OHCA get the
immediate help that they need
before professional help arrives.
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CIETY FOR RECOVERY OF DROWNED PE

1700’S -1800’S
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PETER SAFAR

1950’S

ABC OF RESUSCITATION

FRIEDRICH MAASS
1891
HEST COMPRESSION IN HUMAN
JAMES ELAM

1950’S

RESCUE BREATH
INTRODUCTION

CPR
▸ 1960 : Cardiopulmonary resuscitation (CPR) was developed
▸ 1979 Advanced Cardiovascular Life Support (ACLS) is
developed

▸ 1983 CPR and ECC Guidelines for pediatric and neonatal

patients.

▸ 1992 International Liaison Committee on Resuscitation

(ILCOR) founded
INTRODUCTION

CPR GUIDELINE
▸ Ad Hoc Committee on CPR (NAS-NRC) : 1966
▸ AHA CPR & ECC GUIDELINE :
▸ 1974, 1980, 1986, 1992, 2000, 2005, 2010, 2015
CPR 2015

PARTS OF THE GUIDELINE

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HIGHLIGHT
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EVIDENCE BASE MEDICINE

▸ Based on an international evidence process involved 250 reviewer from
39 countries.

▸ Systematic review International Liaison Committee on Resuscitation

(ILCOR)

▸ AHA Classification System for Classes of Recommendation and Level of

Evidence

▸ Class I (strong), Class IIa (moderate), Class IIb (weak), Class III (no
benefit-moderate), Class III (Harm - strong)

▸ Level A, Level B-R (randomized), Level B-NR (nonrandomized), Level

C-LD (limited data), Level C-EO (expert opinion)
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CPR 2015

ETHICAL ISSUES
▸ The use of extracorporeal CPR (ECPR) for cardiac arrest
▸ Intra-arrest prognostic factors
▸ Review of evidence about prognostic scores for preterm
infants

▸ Prognostication for children and adults after cardiac arrest

▸ Function of transplanted organs recovered after cardiac
arrest
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SYSTEM OF CARE AND CONTINUOUS

QUALITY IMPROVEMENT
▸ A universal taxonomy of systems of care : SPSO
▸ Separation of the AHA adult Chain of Survival into 2 chains:
one for in-hospital and one for out-of-hospital systems of
care

▸ Review of best evidence on how these cardiac arrest

systems of care are reviewed, with a focus on cardiac arrest,
STEMI, and stroke
SPSO
CHAINS OF SURVIVAL
SOCMED

USE OF SOCIAL MEDIA TO SUMMON

RESCUERS
▸ 2015 (NEW) : incorporate social media technologies that
summon rescuers who are in close proximity to a victim of
suspected OHCA and are willing and able to perform CPR.

GO - JEK
GO - CPR
TEAM RESUSCITATION

EWSS, RRT, METS

▸ 2015 (Updated) : effective in reducing the incident of cardiac
arrest, particularly in general ward (adult and children)
▸ 2010 (Old) : conflicting evidence exist, evaluation of outcome
▸ WHY :
▸ established to provide early intervention for patients with
clinical deterioration, prevention IHCA
▸ composed : physician, nurses, and respiratory therapist
UNCHANGED/REAFFIRMATION
▸ Continuous Quality Improvement for Resuscitation
▸ resuscitation system should establish ongoing
assessment and improvement of system of care

▸ Regionalization of Care
▸ regionalized approach to OHCA resuscitation include the
use of cardiac resuscitation centers.
ADULT BLS AND CPR QUALITY : LAY
RESCUER CPR, HCP, AND BOTH
▸ Community Lay Rescuer AED Programs
▸ Dispatcher Identification of Agonal Gasps
▸ Emphasis on Chest Compressions : Hands-Only CPR (ULR). Add rescue breath 30:2
(TLR)

▸ Chest Compression Rate : 100 - 120/min*

▸ Chest Compression Depth : 5 - 6 cm*
▸ Chest Recoil : avoid leaning on the chest between compressions
▸ Minimizing Interruptions in Chest Compressions : chest compression fraction at lest
60%

▸ Bystander Naloxone in Opioid-Associated Life-Threatening Emergencies*

BOTH

▸ Chest Compression Rate

▸ 2015 (Updated): In adult victims of cardiac arrest, it is

reasonable for rescuers to perform chest compressions at a
rate of 100 to 120/min (Class IIa, LOE C-LD).

▸ 2010 (Old): It is reasonable for lay rescuers and HCPs to

perform chest compressions at a rate of at least 100/min.
BOTH

▸ Chest Compression Depth

▸ 2015 (Updated): During manual CPR, rescuers should

perform chest compressions to a depth of at least 2 inches
(5 cm) for an average adult, while avoiding excessive chest
compression depths (greater than 2.4 inches [6 cm]) (Class
I, LOE C-LD).

▸ 2010 (Old): The adult sternum should be depressed at least

2 inches (5 cm).
BOTH

▸ Chest Recoil

▸ 2015 (Updated): It is reasonable for rescuers to avoid

leaning on the chest between compressions, to allow full
chest wall recoil for adults in cardiac arrest.

▸ 2010 (Old): Rescuers should allow complete recoil of the

chest after each compression, to allow the heart to fill
completely before the next compression.
BOTH

▸ Minimizing Interruptions in Chest Compressions

▸ 2015 (Reaffirmation of 2010): Rescuers should attempt to

minimize the frequency and duration of interruptions in
compressions to maximize the number of compressions
delivered per minute.

▸ 2015 (New): For adults in cardiac arrest who receive CPR

without an advanced airway, it may be reasonable to
perform CPR with the goal of a chest compression fraction
as high as possible, with a target of at least 60%.
BOTH

▸ Bystander Naloxone in Opioid-Associated Life-Threatening

Emergencies

▸ 2015 (New): For patients with known or suspected opioid

addiction who are unresponsive with no normal breathing but
a pulse, it is reasonable for appropriately trained lay
rescuers and BLS providers, in addition to providing
standard BLS care, to administer intramuscular (IM) or
intranasal (IN) naloxone. Opioid overdose response
education with or without naloxone distribution to persons at
risk for opioid overdose in any setting may be considered.
ADULT BLS AND CPR QUALITY : LAY
RESCUER CPR, HCP, AND BOTH
▸ Immediate Recognition and Activation of Emergency Response
System

▸ Shock First vs CPR First*

▸ Comparison of Key Elements of Adult, Child, and Infant BLS
▸ Chest Compression Feedback
▸ Delayed Ventilation*
▸ Ventilation During CPR With an Advanced Airway
▸ Team Resuscitation: Basic Principles
HCP

▸ Immediate Recognition and Activation of Emergency

Response System

▸ 2015 (Updated): HCPs must call for nearby help upon finding the
victim unresponsive, but it would be practical for an HCP to
continue to assess the breathing and pulse simultaneously before
fully activating the emergency response system (or calling for
backup).

▸ 2010 (Old): The HCP should check for response while looking at
the patient to determine if breathing is absent or not normal.
HCP

▸ Shock First vs CPR First

▸ 2015 (Updated): For witnessed adult cardiac arrest when an AED is

immediately available, it is reasonable that the defibrillator be used as soon as
possible. For adults with unmonitored cardiac arrest or for whom an AED is not
immediately available, it is reasonable that CPR be initiated while the
defibrillator equipment is being retrieved and applied and that defibrillation, if
indicated, be attempted as soon as the device is ready for use.

▸ 2010 (Old): When any rescuer witnesses an out-of-hospital arrest and an AED
is immediately available on-site, the rescuer should start CPR with chest
compressions and use the AED as soon as possible. HCPs who treat cardiac
arrest in hospitals and other facilities with on-site AEDs or defibrillators should
provide immediate CPR and should use the AED/defibrillator as soon as it is
available.
HCP

▸ Chest Compression Feedback

▸ 2015 (Updated): It may be reasonable to use audiovisual

feedback devices during CPR for real-time optimization of CPR
performance.

▸ 2010 (Old): New CPR prompt and feedback devices may be

useful for training rescuers and as part of an overall strategy to
improve the quality of CPR in actual resuscitations. Training for
the complex combination of skills required to perform adequate
chest compressions should focus on demonstrating mastery.
HCP

▸ Delayed Ventilation

▸ 2015 (New): For witnessed OHCA with a shockable rhythm,

it may be reasonable for EMS systems with priority- based,
multitiered response to delay positive-pressure ventilation
(PPV) by using a strategy of up to 3 cycles of 200
continuous compressions with passive oxygen insufflation
and airway adjuncts.
HCP

▸ Ventilation During CPR With an Advanced Airway

▸ 2015 (Updated): 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).

▸ 2010 (Old): When an advanced airway (ie, endotracheal tube, Combitube, or

laryngeal mask airway) is in place during 2-person CPR, give 1 breath every
6 to 8 seconds without attempting to synchronize breaths between
compressions (this will result in delivery of 8 to 10 breaths per minute).
TEAM RESUSCITATION: BASIC PRINCIPLES
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ALTERNATIVE TECHNIQUES AND

ANCILLARY DEVICES FOR CPR
▸ Impedance Threshold Devices (ITD)
▸ Mechanical Chest Compression Devices
▸ Extracorporeal CPR (ECPR) and Invasive Perfusion Devices
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CPR BLS 2005-2010-2015

2005 2010 2015

Sequence A-B-C C-A-B C-A-B

Look-Listen-Feel (+) (-) (-)

Compression rate approximately 100/min at least 100/min rate 100 - 120/min

Depth 1,5 - 2 inch (4 - 5 cm) at least 2 inch (5 cm) 2 - 2,4 inch (5 - 6 cm)
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THANK YOU

▸ Contact :
▸ I Made Agus Kresna Sucandra
▸ kresnasucandra@yahoo.com