Page 508 - fbkCardioDiabetes_2017

484 Newer Guidelines on Cardiac Arrest in Nutshell

rescuers to perform chest compressions at a rate of ported an association between excessive compres-
100 to 120/min. sion depth and injuries that were not life-threatening.
Most monitoring via CPR feedback devices suggests
2010 (Old): that compressions are more often too shallow than
they are too deep.
: It is reasonable for lay rescuers and HCPs toperform
chest compressions at a rate of at least 100/min.
A TABLE 1BLE1 BLS Dos and Don’ts of Adult
Why High-Quality CPR
Why: There is substantial epidemiologic data demon- Rescuers Should Rescuers Should Not
strating the large burden of disease from lethal opi- Perform chest com- Compress at a rate slow-
oid overdoses, as well as some documented success pressions at a rate of er than 100/min or faster
in targeted national strategies for bystander-admin- 100-120/min than 120/min
istered naloxone for people at risk. In 2014, the nal-
oxone autoinjector was approved by the US Food Compress to a depth of Compress to a depth of
and Drug Administration for use by lay rescuers at least 2 inches (5 cm) less than 2 inches (5cm)
and HCPs.7 The resuscitation training network has RESCUERS SHOULD or greater than 2.4 inches
requested information about the best way to incor- NOT (6 cm)
porate
such a device into the adult BLS guidelines and train- Allow full recoil after Lean on the chest be-
ing. This recommendation incorporates the newly ap- each compression tween compressions
proved treatment.
Minimize pauses in Interrupt compressions
Chest Compression Depth compressions for greater than 10 sec-
onds
2015 (Updated): Ventilate adequately (2 Provide excessive venti-
During manual CPR, rescuers should perform chest breaths after 30 com- lation
compressions to a depth of at least 2 inches(5 cm) pressions, each breath (i.e., too many breaths or
for an average adult, while avoiding excessive chest- delivered over 1 second, breaths with excessive
compression depths (greater than 2.4 inches [6 cm]). each causing chest force)
rise)
2010 (Old):
d): The adult sternum should be depressed at least 2015 (Updated):
2 inches (5 cm). It is reasonable for rescuers to avoid leaningon the
chest between compressions, to allow full chest wall-
Why recoil for adults in cardiac arrest.
Compressions create blood flow primarily by increas- 2010 (Old):
ing intrathoracic pressure and directly compressing
the heart, which in turn results in critical blood flow Rescuers should allow complete recoil of the chest
and oxygen delivery to the heart and brain. Rescu- after each compression, to allow the heart to fillcom-
ers often do not compress the chest deeply enough pletely before the next compression.
despite the recommendation to “push hard.” While
a compression depth of at least 2 inches (5 cm) is Why
recommended, the 2015 Guidelines Update incorpo- Full chest wall recoil occurs when the sternum re-
rates new evidence about the potential for an up- turns to its natural or neutral position during the
per threshold of compression depth (greater than decompression phase of CPR. Chest wall recoil cre-
2.4 inches [6 cm]), beyond which complications may ates a relative negative intrathoracic pressure that
occur. Compression depth may be difficult to judge promotes venous return and cardiopulmonary blood
without use of feedback devices, and identification flow. Leaning on the chest wall between compres-
of upper limits of compression depth may be chal- sions precludes full chest wall recoil. Incomplete re-
lenging. It is important for rescuers to know that the coil raises intrathoracic pressure and reduces venous
recommendation about the upper limit of compres- return, coronary perfusion pressure, and myocardial
sion depth is based on 1 very small study that re- blood flow and can influence resuscitation outcomes.

GCDC 2017