Adult Basic Life Support and Cardiopulmonary Resuscitation Quality.

Key issues and major changes in the 2015 Guidelines Update recommendations for adult CPR by lay rescuers include the following: The crucial links in the out-of-hospital adult Chain of Survival are unchanged from 2010, ...

Key issues and major changes in the 2015 Guidelines Update recommendations for adult CPR by lay rescuers include the following: The crucial links in the out-of-hospital adult Chain of Survival are unchanged from 2010, with continued emphasis on the simplified universal Adult Basic Life Support (BLS) Algorithm. The Adult BLS Algorithm has been modified to reflect the fact that rescuers can activate an emergency response (ie, through use of a mobile telephone) without leaving the victim’s side. It is recommended that communities with people at risk for cardiac arrest implement PAD programs. Recommendations have been strengthened to encourage immediate recognition of unresponsiveness, activation of the emergency response system, and initiation of CPR if the lay rescuer finds an unresponsive victim is not breathing or not breathing normally (eg, gasping). Emphasis has been increased about the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (ie, dispatch-guided CPR). The recommended sequence for a single rescuer has been confirmed: the single rescuer is to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) to reduce delay to first compression. The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths. There is continued emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation. The recommended chest compression rate is 100 to 120/min (updated from at least 100/min). The clarified recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). Bystander-administered naloxone may be considered for suspected life-threatening opioid-associated emergencies. These changes are designed to simplify lay rescuer training and to emphasize the need for early chest compressions for victims of sudden cardiac arrest. More information about these changes appears below. In the following topics, changes or points of emphasis that are similar for lay rescuers and HCPs are noted with an asterisk (*). Community Lay Rescuer AED Programs 2015 (Updated): It is recommended that PAD programs for patients with OHCA be implemented in public locations where there is a relatively high likelihood of witnessed cardiac arrest (eg, airports, casinos, sports facilities). 2010 (Old): CPR and the use of automated external defibrillators (AEDs) by public safety first responders were recommended to increase survival rates for out-of-hospital sudden cardiac arrest. The 2010 Guidelines recommended the establishment of AED programs in public locations where there is a relatively high likelihood of witnessed cardiac arrest (eg, airports, casinos, sports facilities). Why: There is clear and consistent evidence of improved survival from cardiac arrest when a bystander Key Words: cardiac arrest cardiopulmonary resuscitation defibrillation emergency Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality 1 performs CPR and rapidly uses an AED. Thus, immediate access to a defibrillator is a primary component of the system of care. The implementation of a PAD program requires 4 essential components: (1) a planned and practiced response, which ideally includes identification of locations and neighborhoods where there is high risk of cardiac arrest, placement of AEDs in those areas and ensuring that bystanders are aware of the location of the AEDs, and, typically, oversight by an HCP; (2) training of anticipated rescuers in CPR and use of the AED; (3) an integrated link with the local EMS system; and (4) a program of ongoing quality improvement.