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What are the Newest advances in CPR?

( Updated June 14th, 2024)

Every five years The American Heart Association (AHA) updates their Guidelines for CPR and Emergency cardiovascular care (ECC). These updates are based on the data coming from both Hospital Emergency departments, and from EMTs in the field for the treatment of Cardiac Arrest.

A major change is occurring throughout many areas of the US, and The AHA is closely monitoring the progress. The standard for an adult for CPR  in hospitals clinics, and EMS( Emergency medical services) is still The AHA recommendation of 30:2 (thirty compressions followed by two ventilations for an adult in cardiac arrest (not intubated with a chest tube).However, the big change is moving to Continuous Chest Compressions (CCC) before a patient is intubated, and even moving away from intubation, and forced ventilations to passive ventilations with Cardiocerebral Resuscitation (CCR).

Passive ventilations, as opposed to forced ventilations in CPR allows air to enter the lungs more naturally with each compression, and decompression (recoil) of the chest, like we breathe. While it is well known that Chest compressions circulate blood to the brain and heart these compressions also vacuum air into the lungs with negative pressure when the chest recoils between compressions. CCR also minimizes interruptions in compressions and allows oxygen to be drawn in continuously. EMTs facilitate keeping a patients airway open with airway adjuncts then they attach a Non-rebreather mask (NRB) with 100% oxygen similar to the oxygen masks that are deployed on airplanes if cabin pressure suddenly drops.

EMTs in Eugene Oregon are providing Continuous Chest Compressions (CCC), and then insert a King Airway designed to close the esophagus. A NRB with 100% oxygen is then attached. The importance of closing off the esophagus is to avoid Gastric Inflation (air entering the stomach), which leads to vomitting. Even though the air is not forced in with a bag valve mask, pressure on the chest with compressions vacuums up stomach contents. Problem solved with the king Airway. Nationwide, more amd more counties are moving to continous chest compressions without forced ventilations.

What is the difference between Cardiopulmonary Resuscitation (CPR) and Cardiocerebral Resuscitation (CCR)?

CCR keeps a continuous flow of  circulation to the heart and brain of a victim in cardiac arrest until a defibrillator can shock the heart back into a normal rhythm. Whereas with CPR the compressions are interrupted to deliver breaths. The AHA first developed CardioPulmonay Resuscitation (CPR) in1960 and for the past 61 years the focus has been placed on interrupting compressions to deliver ventilations after compressions, hence emphasis on the pulmonary component of CPR. 

How does Cardiocerebral Resuscitation work?

Cardiocerebral Resuscitation (CCR) circulates blood continuously to the heart and brain without interruptions. Although CCR was not included in the 2020 AHA guidelines, the CCR algorithm was recently developed by The AHA [2]. This should be updated in the 2025 AHA guidelines that will be published by March 2026.

CCR Two rescuer Demonstration

A similar, scaled down benefit is achieved when bystanders perform Hands-only CPR for an Adult, witnessed Cardiac Arrest (please read our article on staying alive/ Hands-only CPR for more details.)  

Bystanders can improve oxygen intake if before beginning compressions they  open the airway, so that oxygen can be drawn in with each compression. A towel or article of clothing can be placed  behind the person’s neck to prop the airway open.  If that’s not possible then someone can maintain an open airway by titling the head back while compressions are being provided.

The benefits of CCC, also know as Hands Only CPR on a smaller degree.

The benefit of CCC is that the perfusion pressure(Blood pressure) remains higher than traditional CPR, and it is more like the natural rhythm of the heartbeat. With traditional CPR we interrupt compressions every thirty times to deliver ventilations, and It takes several compressions to get that pressure back again every time we resume compressions. Sadly our of 30 compressions only 24 of them are effective! Providing continuous compressions is significantly better than stopping every 30 compressions to deliver 2 minuscule breaths!

The Sarver Heart Center in Arizona recently published that providing continuous chest compressions/ AKA Hands-only CPR can nearly double a person’s chances of survival from 14% to 23%! [3].

Why is it taking so long for The AHA to implement more of these changes into AHA training curriculums? 

This trend with Emergency Medical Services (EMS) moving away from traditional CPR to treat Cardiac Arrest, and utilizing CCR will eventually move into the AHA training curriculum in BLS and CPR classes by 2030. The good news is that many Emergency Medical Service agencies are way ahead of the next AHA Guideline update in 2025 and are increasing survival rates from cardiac arrest with CCR today!

By Roy Gordon, NREMT/ BLS, CPR Instructor

Come join us for an AHA CPR class, or BLS Class at Revive CPR Training in San Francisco, Mission Bay. Receive a complimentary rescue breathing barrier key-chain with every CPR class.

Revive CPR Training San Francisco

Please note:

As an Authorized AHA Training Site we are  currently following The AHA 2020 Guidelines for all of our CPR classes in San Francisco, and for our BLS classes (Basic Life Support) CPR certification classes at Revive CPR. California hospitals, clinics, and  Emergency Medical Services (EMS) only except The American Heart Association BLS Provider certification.

 References

1] Santa Clara County New CPR Protocol

https://emsagency.sccgov.org/sites/g/files/exjcpb266/files/General/700-S01.pdf

2] CCR Algorithm 

American Heart Association 

https://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_453938.pdf

3] CCC Video University of Arizona Sarver Heart Center

Hands-Only CPR is a trademark of the American heart Association

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