Channeling my inner Steve Martin I’m excited to report that the new American Heart Association (AHA) guidelines for CPR and Emergency Cardiovascular Care have been released.
You can download the entire document as published in Circulation, the official Journal of the AHA here. It’s a long document and you will be able to order your dead tree version from the AHA on November 3. As always I recommend you buy your books from my good friend Lou Jordan at EMSBooks.com.
The change making the biggest splash in the lay media is moving from Airway, Breathing, Circulation, to Circulation, Airway, Breathing. CAB has been used in some European EMS systems for several years, but the AHA decided that the matter needed more study and so did not make this change in 2005.
Briefly, for trained rescuers, not lay people, the sequence is determine if the person appears to be not breathing (no more pulse check), start rapid and fast chest compressions, then attend to the airway and breathing. As with the 2005 changes, the AHA still emphasizes early defibrillation whenever possible.
For the lay rescuer, the emphasis is on compression only CPR.
Therapeutic Hypothermia is now recommended for patients who have Return of Spontaneous Circulation (ROSC).
Atropine is out for Asystole or Pulseless Electrical Activity (PEA). It is however, still recommended for symptomatic bradycardia.
Amiodarone is recommended as the first line anti arrhythmic for VF/VT, but Lidocaine is acceptable if Amiodarone isn’t available. Lidocaine is also recommended for post ROSC administration in patients who were shocked out of VF/VT.
Adenosine is recommended as a safe and potentially effective therapy in the initial management of stable undifferentiated regular monomorphic wide-complex tachycardia.
The precordial thump is back, for some situations. Someday I’ll have to tell you all the story of how I invented the post cordial thump.
There is a joint AHA/American Red Cross first aid section.
A couple of cautionary notes. First, don’t change what you do until your system protocols change. Second, this post is based on a quick read of the Executive Summary and a couple of sections of the rest of the guidelines.
The entire document is 300+ pages long, so there is a lot of material to go through. There are significant changes to cardiac arrest and STEMI/ACS treatment, as well as others. It will take time for the changes to get out to every EMS system and for treatment protocols to be changed. Not to mention training both ALS and BLS providers to the new standards.
It is likely to be sometime next spring before all of the changes and new standards are in place and systems have trained all of their personnel.
I’m sure other EMS bloggers will be posting about the changes in the coming days and weeks and I look forward to some lively discussions. Expect Rouge Medic to have 3,000+ pages of commentary on the 300+ pages of the new guidelines. He wouldn’t be Rogue Medic if he didn’t!