1. Home>
2. Specialties>
3. Cardiology>
4. Clinical Practice Guideline Watch

New AHA Guidelines for CPR and Emergency Cardiovascular Care

A new compression-to-ventilation ratio of 30:2 is one of several key changes in these guidelines.

Sponsoring Organization: American Heart Association

Purpose: The science of resuscitation has advanced since CPR and ECC guidelines were last published in 2000. The 2005 guidelines include several critical changes in approach, all geared toward improving patients’ chances of survival.

Key Points:
1. The importance of effective chest compressions to produce blood flow is a major area of emphasis. The guidelines now encourage rescuers to "push hard and fast" at a rate of about 100 compressions per minute, with about equal time for compression and relaxation and as few interruptions in compressions as possible.

2. The guidelines have set a new compression-to-ventilation ratio for lone rescuers of 30:2 for all victims from infants (excluding newborns) through adults. This is a change from the previous recommendation of 15:2 for adults and 5:1 for infants and children. The new approach should ensure that rescuers deliver a longer series of uninterrupted chest compressions.

3. The guidelines now recommend that rescue breaths last 1 second and cause the chest to rise. Previously, the duration standard was not precise and mentioned durations of 1 to 2 seconds, now deemed too long.

4. For defibrillation, the new guidelines recommend 1 shock followed by immediate CPR with chest compressions. (Previously, the rule was 3 shocks without CPR between them, which resulted in potentially harmful interruptions in compressions.) The new system increases the chances that the heart can create blood flow after the shock.

5. Basic life support is now emphasized over pulse checks and drug administration. Rescuers should not sacrifice chest compressions right after a shock to do pulse checks or administer drugs, although neither of these practices was eliminated from the guidelines.

6. The new guidelines recommend the use of automated external defibrillators for all children age 1 year or older.

7. There is a new recommendation that unconscious adults with return of spontaneous circulation after out-of-hospital cardiac arrest be cooled to 32° to 34° Celsius for 12 to 24 hours when the initial rhythm was ventricular fibrillation.

Comment: These new AHA recommendations, which are based on the strongest evidence available, should be incorporated rapidly into practice. The challenge will be to get people to change embedded habits, but these new recommendations have great potential to improve the effectiveness of resuscitation efforts.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology January 26, 2006

Citation(s):

ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005 Dec 13; 112:Suppl:IV-1-IV-211.

American Heart Association. Currents in Emergency Cardiovascular Care. Volume 16 Number 4. Winter 2005-2006.