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Every five years the CPR training industry undergoes some revisions and updates to its protocol. It's important to know what those updates are, so you can put into place the current recommendations that have been proven more effective.
In this lesson, we'll be covering the 2020 updates in the American Heart Association's emergency cardiovascular care guidelines. These were published at the end of 2020.
Even with all the changes and improvements, the American Heart Association states that less than 40 percent of adults receive layperson adult CPR and fewer than 12 percent have an AED applied before EMS's arrival. There haven't been significant improvements in survival rates since 2012 for out-of-hospital cardiac arrest. While out-of-hospital rates remain the same, in-hospital cardiac arrest outcomes continue to improve.
Now let's go over the new recommendations for lay rescuer CPR and basic life support.
Lay rescuers should initiate CPR in presumed cardiac arrest because new evidence shows that the risk of harm to the patient is low if the patient isn't in cardiac arrest.
It may be difficult to determine with accuracy if the victim has a pulse for lay rescuers. And the risk of withholding CPR from a pulseless victim exceeds the harm from unneeded chest compressions.
Lay rescuers must now receive training on how to respond to victims of opioid overdose, including the administration of naloxone.
This has been unchanged and reaffirmed. It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance.
This is a vital piece for how to handle all things that encompass lay rescuer CPR – debriefing and referral for follow-up care or emotional support for all rescuers after cardiac arrest is beneficial.
Care and support during recovery include three new recommendations:
Because pregnant patients are more prone to hypoxia, oxygenation and airway management should be prioritized during resuscitation from cardiac arrest. And because of potential interference with maternal resuscitation, fetal monitoring should not be taken.
For adults (those older than 14 years of age) that have a pulse but are having trouble breathing on their own, with absent or inadequate respiratory effort, give 1 breath every 6 seconds. This rate has been decreased from 1 breath every 5 seconds.
For infants and children with a pulse but absent or inadequate respiratory effort, give 1 breath every 2-3 seconds (20-30 breaths per minute). This rate has been increased from 1 breath every 3-5 seconds.
There are three updated recommendations in this area.
Newborn resuscitation requires anticipation and preparation by providers who train individually and as teams. Most of the time, newborn infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with the mothers after birth.
Pro Tip: The prevention of hypothermia is an important focus for neonatal resuscitation. The importance of skin-to-skin care in healthy babies is reinforced to promote bonding, breastfeeding, and normothermia.
Inflation and ventilation of the lungs are the priorities in newborns who need support after birth. A rise in heart rate is the most important indicator of effective ventilations.
We believe that more frequent training in smaller bite-sized pieces conducted when it's most convenient is vital. There is just too much wasted time and effort with attending traditional classroom training.
It's refreshing to see that the science and the AHA is now backing distance and online training. Here is what these updates specifically say:
The use of deliberate practice and mastery learning can improve skill acquisition during life support training while incorporating repetition with feedback and minimum passing standards.
Booster training and spaced-learning include three recommendations:
These recommendations were made because new studies show that video-based training is as effective as instructor-led training and that the addition of booster training sessions (brief, frequent sessions) focused on the repetition of prior content for resuscitation courses improves the retention of CPR skills.
Specifically for lay rescuers, the new AHA guidelines state the following: