I helped teach CPR to our latest EMT class this past week. This class is always a good reminder of how fast emergency medicine changes.
Here in their first week, the new students are beginning to hear our warnings.
“You are going to hear about many different ways to perform this skill. Some are older methods than the ones we are teaching you today. Some are newer. Some things you are learning will quickly go away. New methods, new machines and new research are all in progress. That doesn’t mean what you are learning right now is wrong. It is an imperfect method. Prepare for change.”
Some students get stressed over the idea that CPR isn’t a gold standard technique handed down unchanged for decades. I worry for their future. Like the banner says, “Medicine moves fast.” …You know the rest.
When you consider everything that needs to happen for changes to occur in the CPR techniques of EMS providers around the globe, it really is remarkable how fast this single skill adapts and morphs over a period of relatively few years. When you consider the logistics of it, change really should take decades.
Have you ever wondered where these changes come from? Here’s a fly-by of the process:
- Research looking at survival rates and outcomes of our current CPR and resuscitation techniques is funded and conducted at various centers around the globe.
- The current research is prepared, published, vetted and deemed to be relevant and worthy of consideration or unhelpful.
- Various committees and groups convene at regular intervals and review all the latest research. These groups include; Australian Resuscitation Council (ARC), European Resuscitation Council, New Zealand Resuscitation Council, American Heart Association (AHA) and the big boy on the block, International Liaison Committee on Resuscitation. They discuss and debate the research and form official recommendations for CPR education.
- Local medical directors and program administrators look at the recommendations and decide how and when it would be best to implement new guidelines, methods and techniques.
- Then … every EMS professional on the face of the planet gets retrained.
Read that last bullet point one more time and consider the scope of it. Consider the challenge of accomplishing just that one final, necessary objective.
If you’re wondering what’s new in CPR, here are some of the things we’re teaching right now that may be different from what you learned in your last CPR class. I hesitate to call any of these recommendations new because they’re not. We’re actually at the end of a recommendation cycle.
That’s right; most of this stuff comes from the 2005 flurry of activity. There’s a new ILCOR conference getting ready to convene in 2010 and the whole cycle will kick into high gear again.
But for now:
- There is a huge emphasis on hard, fast, effective compressions. We do compressions poorly and slowly … and we stop too much. 100 per minute on everyone.
- Change the compression rescuer every two minutes.
- Lay rescuers aren’t feeling for pulses. They keep going until they see signs of life, or an AED says stop, or we tell them to stop.
- Some guidelines are suggesting compressions alone for primary cardiac arrest in adults or if the rescuer is untrained or not-confident in their CPR.
- Everyone who does get compressions gets a 30/2 compression ventilation cycle except for two rescuer kid and infant CPR.
- AED users should jump right back on compressions after one shock and turn off the machine if it hasn’t been reprogrammed for this yet. (No pulse checks or rhythm checks here. Just get back on it.)
For us professionals, a few other considerations:
- We stop compressions even more than lay rescuers. The current recommendations are to not stop compressions for anything. (Including airway interventions.) If you can do it while the compressions are going fine. If not, don’t stop compressions.
- Do on-like-Donkey-Kong compressions for 2 minutes then shock immediately.
- Don’t delay the continuation of compressions for post shock pulse and rhythm checks.
- Do that 5 times.
- Adrenaline is the front line drug for cardiac arrest pharmacology. (Or Vasopressin.) All other drugs are a lower priority.
That’s the major nuts and bolts for now. I’m sure we’ll be back to talk about it again after the 2010 ILCOR conference. Everything changes. It’s as it should be.
Now it’s your turn: What CPR guideline is your agency currently following? Do your protocols reflect the latest recommendations? Do you think we change our CPR standard to frequently or not fast enough? Leave a comment before you move on. I’d like to hear from you.