Highlights of the 2010 AHA

Guidelines for CPR

Ali Haedar
American Heart Association (AHA)
Instructor for BLS & ACLS | Lecturer |
Emergency Medicine Specialist

Department of Emergency Medicine

Saiful Anwar General Hospital
Faculty of Medicine Universitas
Brawijaya, Indonesia

Background

Major Issues Affecting All Rescuers

Studies published before and since 2005 have demonstrated that:
1) The quality of chest compressions continues to require

improvement, although implementation of the 2005 AHA

Guidelines for CPR and ECC has been associated with better
CPR quality and greater survival
2) There is considerable variation in survival from out-of-hospital
cardiac arrest across emergency medical services (EMS)
systems
3) Most victims of out-of-hospital sudden cardiac arrest do not

receive any bystander CPR.

The changes recommended in the 2010 AHA Guidelines attempt to make
recommendations to improve outcome from cardiac arrest.

AHA protocol has been changed!

Continued Emphasis on High-Quality CPR

The 2010 AHA Guidelines for CPR and ECC once
again emphasize the need for high-quality CPR
1. A compression rate of at least 100/min (a change
from approximately 100/min)
2. A compression depth of at least 2 inches (5 cm) in
adults and a compression depth of at least one
third of the anteriorposterior diameter of the chest
in infants and children
3. Allowing for complete chest recoil after each
compression
4. Minimizing interruptions in chest compressions
5. Avoiding excessive ventilation (about 8 to 10
breaths per minute)

Keys change for 2010

A Change From A-B-C to C-A-B

Why?
The highest survival rates from cardiac arrest are

reported among patients who have VF or pulseless VT.

In these patients, the critical initial elements are chest

compressions & early defibrillation.

In the A-B-C sequence, chest compressions are often

delayed while the responder opens the airway to give

mouth-to-mouth breaths.
By changing the sequence to C-A-B, chest compressions

will be initiated sooner.

AHA ECC Adult Chain of Survival

Two new parts in the 2010 AHA Guidelines for CPR and ECC are PostCardiac Arrest Care and
Education, Implementation, and Teams.

Lay Rescuer Adult CPR

Immediate activation of the EMS based on signs

of unresponsiveness,
Initiation of CPR if the victim is unresponsive with
no breathing or no normal breathing (ie, victim is
only gasping).
Look, listen, and feel for breathing has been
removed from the algorithm.
There has been a change in the recommended
sequence for the lone rescuer to initiate chest
compressions before giving rescue breaths (C-AB rather than A-B-C).
The lone rescuer should begin CPR with 30
compressions rather than 2 ventilations to reduce
delay to first compression.
Compression rate should be at least 100/min
(rather than approximately 100/min).
Compression depth for adults has been changed
from the range of 1 to 2 inches to at least 2
inches (5 cm).

Emphasis on Chest Compressions

2010 (New):

2005 (Old)

Not trained bystander: should provide

The 2005 AHA Guidelines for CPR and

Hands-Only (compression-only) CPR

ECC did not provide different

with an emphasis to push hard and fast.

recommendations for trained Vs untrained

rescuers but did recommend that

Trained bystander: should, at a minimum,

dispatchers provide compression-only CPR

provide chest compressions for victims of

instructions to untrained bystanders. The

cardiac arrest. In addition, if the trained lay

2005 AHA Guidelines for CPR and ECC did

rescuer is able to perform rescue breaths,

note that if the rescuer was unwilling or

compressions & breaths should be

unable to provide ventilations, the rescuer

provided in a ratio of 30 compressions to 2

should provide chest compressions only.

breaths.

Healthcare Provider BLS

Cardiac arrest victims may present with agonal gasps that

may confuse potential rescuers, do immediate activation of

EMS.
If a pulse is not definitely felt within 10 seconds, should begin
CPR & use the AED.
Look, listen, and feel for breathing has been removed from
the algorithm.
Use of cricoid pressure during ventilations is generally not
recommended.
Rescuers should initiate chest compressions before giving
rescue breaths (C-A-B rather than A-B-C).
Compression rate is modified to at least 100/min from
approximately 100/min.

ELECTRICAL THERAPIES
AED Use in Children Now Includes Infants
2010 (New):
For attempted defibrillation of children 1-8
yo with an AED, the rescuer should use a
pediatric dose-attenuator system if is
available. If the rescuer provides CPR to a
child in cardiac arrest & does not have an
AED with a pediatric dose-attenuator
system, the rescuer should use a standard
AED.
For infants (<1 yo), a manual defibrillator is
preferred. If a manual defibrillator is not
available, an AED with pediatric dose
attenuation is desirable. If neither is
available, an AED without a dose
attenuator may be used.

2005 (Old):
For children 1-8 yo, the rescuer
should use a pediatric doseattenuator system if one is
available. If the rescuer provides
CPR to a child in cardiac arrest
& does not have an AED with a
pediatric attenuator system, the
rescuer should use a standard
AED.
There are insufficient data to
make a recommendation for or
against the use of AEDs for
infants <1 year of age.

Summary of Key BLS Components for Adults,

Children, and Infants

We have trained CPR for hundreds of

lay persons since 2012

Thank you!