RESUSCITATION GUIDELINES UPDATE: ADULT BASIC LIFE SUPPORT

*Salam A.M., **Al Musleh A.W. and *Gehani A.A.
Departments of *Cardiology & Cardiovascular Surgery and**Accident & Emergency
Hamad Medical Corporation, Doha, Qatar

Introduction:

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care was the world’s first international conference to produce evidence-based international resuscitation guidelines(1, 2).

Herein, we summarize the changes in these guidelines as it applies to Adult Basic Life Support (BLS). This interpretation is basically similar to that of the European Resuscitation Council (ERC)(3). The changes have been incorporated into the curriculum of our Advanced Life Support (ALS) provider courses and the new 2001 ERC ALS manual(4).

Basic Life Support:

The fundamentals of basic life support (BLS) have remained unchanged. Mouth-to-mouth ventilation oxygenates the blood, and chest compressions cause forward blood flow with changes in intrathoracic pressure. It must be stressed that BLS is a holding measure to buy time until a defibrillator and advanced life support measures are available. When cardiopulmonary resuscitation is started within four minutes after collapse, the likelihood of survival to hospital discharge doubles(5).

BLS Technique:

The mouth is opened by tilting the patient’s head backward and lifting the chin. (if neck trauma is suspected, the airway should be opened by thrusting the jaw forward.) The rescuer looks, listens, and feels for respirations. If the respirations are agonal or absent, two mouth-to-mouth ventilations are performed (each breath delivered over two seconds). Health care professionals should then feel for a carotid pulse for 10 seconds. If there is no pulse, 15 chest compressions are administered. Lay rescuers should initiate chest compressions if the patient is not breathing, coughing, or moving after the initial two breaths. When cardiopulmonary resuscitation is performed by two persons, the sequence is similar, and the ratio of compressions to breaths remains 15:2.

New changes:

Some of the changes are minor (e.g. duration of rescue breaths increased from 1.5–2 to 2s) or have been made to achieve international uniformity (e.g. checking mouth for obstructing foreign body earlier in the sequence). There have also been some modifications in the wording to aid clearer understanding; an example is the introduction of the term ‘normal breathing’ in an attempt to distinguish this from agonal respiration.

The major changes in technique are:

(a) Lay rescuers will no longer be taught or expected to perform a pulse check to determine cardiac arrest, although this will remain for healthcare providers; (b) Mouth-to-mouth ventilation volume for adults, when supplemental oxygen is not available, is increased to 700–1000 ml per breath; (c) Compression: ventilation ratio for two-rescuer CPR will be 15:2 when the airway is not protected; (d) Back slaps and abdominal thrusts will only be recommended for choking in the conscious adult; chest compressions will be used for unconscious victims.

New Methods & Developments:

Recommendations to improve cardiopulmonary resuscitation range from the use of mechanical vests to devices that actively compress and decompress the chest (active compression–decompression resuscitation)(6,7).

Randomized studies have shown equivocal benefit, and these new techniques have yet to receive widespread acceptance. Another technique, known as interposed abdominal compression cardiopulmonary resuscitation, which requires three rescuers, alternates chest compression with abdominal compression(8, 9) this technique appears to be equivalent or superior to standard cardiopulmonary resuscitation and is recommended as an alternative for professional rescuers.

References:

1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR). Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Resuscitation 2000; 46: 1-447.

2. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR). Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Circulation 2000; 102 (Suppl. I): I-1 -I-384.

3. Handley AJ, Monsieurs KG, Bossaert LL. European Resuscitation Council Guidelines 2000 for Adult Basic Life Support. Resuscitation 2001; 48: 199-205.

4. The European Resuscitation Council Advanced Life Support Manual. Published 2001. Obtainable from the European Resuscitation Council, University of Antwerp, P0 Box 113, B-2610 Antwerp, (Wilrijk), Belgium. (In Qatar from the CPR secretary Tel: +974 439 2132).

5. Cummins RO, Eisenberg MS. Prehospital cardiopulmonary resuscitation: is it effective? JAMA 1985; 253: 2408-2412.

6. Plaisance P, Lurie KG, Vicaut E, et al. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. N Engl J Med 1999; 341: 569-575.

7. Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P. Increased frequency of thorax injuries with ACD-CPR. Resuscitation 1999; 41: 33-38.

8. Babbs CF, Sack JB, Kern KB. Interposed abdominal compression as an adjunct to cardiopulmonary resuscitation. Am Heart J 1994;127:412-421.

9. Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circulation 1992; 86: 1692-1700.