( 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 protocol for an adult in Cardiac arrest for both BLS, and ACLS 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 (not intubated with a chest tube).However, a big change is transpiring nationwide soon moving to Continuous Chest Compressions (CCC) before a patient is even intubated, and even moving away from intubation all together for the treatment of Cardiac Arrest. Cardiocerebral Resuscitation (CCR) will soon replace CPR in emergency medical settings. In fact, this change is already taking place in many states in the US.
EMTs in Eugene Oregon, and in Santa Clara County in California are providing Continuous Chest Compressions (CCC), and inserting a King Airway designed to close the esophagus and allow more air to enter into the lungs through passive ventilation. A NRB mask with 100% oxygen is then attached to the patient. The King tube avoids gastric Inflation (air entering the stomach), which leads to vomiting. Even though the air is not forced into the lungs with a bag valve mask, pressure on the chest with compressions vacuums up stomach contents leading to more gastric inflation. This problem is solved with the king Airway. Nationwide, more and more counties are moving to continuous chest compressions with Passive ventilation vs. forced ventilations with a bag valve mask.
Passive ventilations ventilations in CPR allow more air to enter the lungs 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.
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 the efficiency of compressions only CPR by opening the airway with the head tilt– chin lift method. This way oxygen can be drawn in with each compression. A towel, or article of clothing can be placed behind the person’neck to prop the airway open.
why is CCR drastically more effective than CPR for the treatment of Cardiac Arrest?
The benefit of CCR is that the perfusion pressure(Blood pressure) remains higher than traditional CPR, and continuous, uninterrupted compressions are 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!a
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].
The AHA will implement more of these changes into BLS class curriculums soon.
This movement away from traditional CPR to treat Cardiac Arrest into utilizing CCR will eventually make its way the AHA training curriculum in BLS classes by 2030. The good news is that many EMS agencies are way ahead of the next AHA Guideline update in 2025, and are helping to increase survival rates from cardiac arrest today.
Roy Gordon, AHA BLS instructor/ EMT
Revive CPR, 148 Townsend St., San Francisco, CA 94107
side notes:
All of our classes are instructor led with personalized feedback. Please be aware of companies that advertise CPR classes that only offer a voice assisted mannikin, VAM , which is a machine with a computer guiding you through steps. People prefer in person CPR classes with instructors, not impersonal, confusing machines. No VAM at Revive CPR in San Francisco.
Come join us for an engaging 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.
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
Eugene Oregon, and Springfield OR. CCR protocol
https://www.eugene-or.gov/DocumentCenter/View/9464/CCR-Pamphlet?bidId=
https://www.jems.com/patient-care/study-compares-passive-oxygen-0
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
