Every five years the American Heart Association does a major overhaul on their Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) guidelines. During these updates they share the latest science and discovery and make changes to the way we teach CPR classes. The latest update now includes new content such as team dynamics and administration of Naloxone.

The 2015 Guidelines Update for Healthcare providers adds a new perspective on systems of care, differentiating how providers handle in hospital cardiac arrests (IHCAs) from out-of-hospital cardiac arrests (OHCAs). The AHA now provides a different chain of survival dependent on where the cardiac arrest takes place. The BLS provider class now has two curriculums; one focused on pre-hospital care providers such as firefighters, EMTs, paramedics and off duty providers and in-hospital teams made up of physicians, nurses, respiratory therapists and code teams.

Other key changes to the curriculum include emphasis on chest compressions, chest compression rate and depth. Below are the new guidelines taken from the HIGHLIGHTS of the 2015 American Heart Association Guidelines Update for CPR and ECC.

Emphasis on Chest Compressions

Untrained lay rescuers should provide compression-only (Hands-Only) CPR, with or without dispatcher guidance, for adult victims of cardiac arrest. The rescuer should continue compression-only CPR until the arrival of an AED or rescuers with additional training. All lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest. In addition, if the trained lay rescuer is able to perform rescue breaths, he or she should add rescue breaths in a ratio of 30 compressions to 2 breaths. The rescuer should continue CPR until an AED arrives and is ready for use, EMS providers take over care of the victim, or the victim starts to move.

Chest Compression Rate

In adult victims of cardiac arrest, it isreasonable for rescuers to perform chest compressions at a rate of 100 to 120/min. The number of chest compressions delivered per minute during CPR is an important determinant of return of spontaneous circulation (ROSC) and survival with good neurologic function. The actual number of chest compressions delivered per minute is determined by the rate of chest compressions and the number and duration of interruptions in

Chest Compression Depth

During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]). Compressions create blood flow primarily by increasing intrathoracic pressure and directly compressing the heart, which in turn results in critical blood flow and oxygen delivery to the heart and brain. Rescuers often do not compress the chest deeply enough despite the recommendation to “push hard.” While a compression depth of at least 2 inches (5 cm) is recommended, the 2015 Guidelines Update incorporates new evidence about the potential for an upper threshold of compression depth (greater than 2.4 inches [6 cm]), beyond which complications may occur. Compression depth may be difficult to judge without use of feedback devices, and identification of upper limits of compression depth may be challenging. It is important for rescuers to know that the recommendation about the upper limit of compression depth is based on 1 very small study that reported an association between excessive compression depth and injuries that were not life-threatening. Most monitoring via CPR feedback devices suggests that compressions are more often too shallow than they are too deep.