‘Out with the old and in with the new’.
Well, not so fast! 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. While the standard for CPR in hospitals and clinics is still The AHA recommendation of 30 compressions followed by two ventilations for an adult in cardiac arrest EMTs in Santa Clara County are providing Continuous Chest Compressions (CCC) and delivering one ventilation with a Bag-Valve-Mask every six compressions [1]. Similarly, nationwide different counties are moving to continous chest compressions. Previously, the move to CCC was only done after a patient was intubated with a chest tube, but now the focus is moving away from intubation and forced ventilations to passive ventilations with Cardiocerebral Resuscitation (CCR).
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?
Now, the modern equivalent of CPR is Cardiocerebral Resuscitation (CCR) which circulates blood continuosly 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].
CCR utilizes Continuous Chest Compressions (CCC) and passive ventilations as opposed to forced ventilations in CPR. While it is well known that Chest compressions circulate blood to the brain and heart-compressions also vacuums 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.
Cardiocerebral Resuscitation video
Bystander are saving lives with CCC
AKA Hands-Only CPR
A similar 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/ Hands-Only CPR
The benefits of CCC/ Hands-Only CPR is that the perfusion pressure(Blood pressure) remains high which mimics 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 each 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 2025. 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
Revive CPR Training San Francisco
Please note:
As an Authorized AHA Training Site we are currently following The AHA 2020 Guidelines for our CPR classes and for our BLS classes (Basic Life Support) CPR certification classes. California hospitals, clinics, and Emergency Medical Services (EMS) only except The American Heart Association BLS Provider certification.
Come join us for an
American Heart Association CPR class today!
Healthcare Providers:
AHA BLS Provider certification & BLS Renewal
References
1] Santa Clara County New CPR Protocol
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
