Guideline changes

It is well documented that interruptions in chest compression are common11, 12 and are associated with a reduced chance of survival.13 The ‘perfect’ solution is to deliver continuous compressions whilst giving ventilations independently. This is possible when the victim has an advanced airway in place, and is discussed in the adult advanced life support (ALS) chapter. Compression-only CPR is another way to increase the number of compressions given and will, by definition, eliminate pauses. It is effective for a limited period only (probably less than 5 min)14 and is not recommended as the standard management of out-of-hospital cardiac arrest.

It is also known that chest compressions, both in hospital and outside, are often undertaken with insufficient depth and at the wrong rate.12, 15 The following changes in the BLS guidelines have been made to reflect the importance placed on chest compression, particularly good quality compressions, and to attempt to reduce the number and duration of pauses in chest compression:

1. When obtaining help, ask for an automated external defibrillator (AED), if

one is available.

2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1.

3. Give each rescue breath over 1 s rather than 2 s.

4. Do not stop to check the victim or discontinue CPR unless the victim starts to

show signs of regaining consciousness, such as coughing, opening his eyes,

speaking, or moving purposefully AND starts to breathe normally.

5. Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care. In addition, advice has been added on the use of oxygen, and how to manage a victim who regurgitates stomach contents during resuscitation.