The algorithms and guidelines of the American Heart Association
(AHA) and International Liaison Committee on Cardiac Resuscitation
(ILCOR) have been updated. The latest guidelines promote the use
of automatic external defibrillator (AEDs) by emergency medical
services (EMS), police, and the general public. The establishment
of public access defibrillator (PAD) programs and continued development
of EMS protocols make it necessary for receiving physicians in emergency
departments to be knowledgeable in the current recommendations of
the AHA regarding the use of the prehospital AEDs. These recommendations
can be found in the most current Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care 2005.*
According to the latest AHA guidelines, if a person experiences
witnessed sudden cardiac death (cardiac arrest) and a defibrillator
or an AED is available, defibrillation should be performed as soon
as possible. However, if a person is “found down” and
may have been unresponsive for several minutes, ∼ 5 cycles (∼ 2
min) of CPR should be performed before initiation of defibrillation.
People who experience cardiac arrest and receive immediate defibrillation
are more likely to be successfully defibrillated after the first
shock. For every minute of circulatory arrest there is an ∼ 10% decrease
in the likelihood of successful resuscitation. Patients who are
subject to delays in receiving resuscitation do not fare as well,
unless there has been a brief period of CPR before defibrillation.
Many communities, organizations, and EMS systems participate
in PAD programs. These programs facilitate
early recognition and management by the use of AEDs, and
some hospitals have AEDs available, so that a patient who “arrests” can
be defibrillated before the arrival of the code team.
Many patients who experience sudden cardiac death due to ventricular
fibrillation (VF) or pulseless ventricular tachycardia (VT) can
be defibrillated before they arrive at the hospital. That the rescuer
does not have to interpret the cardiac rhythm may increase the chance
of survival by markedly decreasing time to “first shock.” New
guidelines for resuscitation stress timely defibrillation and early,
consistent chest compressions with minimal interruption.
Children often experience VF after respiratory arrest. It is
reasonable that CPR be performed (5 cycles/2 min) before
defibrillation is attempted, unless the child suddenly collapses.
In that case, the AED should be applied as soon as it is available.
American Heart Association Guidelines for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care. Circulation 2005;112(24
suppl). Available online at: http://circ.ahajournals.org/content/vol112/24_suppl (accessed
CPR Basics: ABCs (Airway, Breathing, Circulation)
Universal precautions dictate that protective eye wear, gloves,
and when necessary, water-impervious gowns and footwear be used.
All patients must have a patent airway, be breathing, and have signs of spontaneous circulation. Figure
21–1 shows the basic life support (BLS) algorithm.
The new guidelines differentiate resuscitation by nonprofessional
rescuers from resuscitation by health care providers.