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Basic Life Support

CoSTR – Evidence to Guidelines

ARC & NZRC Guideline Update

Jennifer Dennett

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COUNCIL Consensus 2010 process (C2010)

ARC &NZRC BLS guidelines were reviewed utilising the BLS, EIT and Paediatric Taskforces

This equated to an evaluation of 45 EIT worksheets, 54 BLS worksheets and 8 Paediatric (BLS) worksheets.

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Changes have been made to 8 BLS guidelines

•Guideline 2 – Priorities in an Emergency

•Guideline 3 – Unconsciousness

•Guideline 4 – Airway

•Guideline 5 – Breathing

•Guideline 6 – Compressions

•Guideline 7 – (New Guideline) AED use in BLS

•Guideline 8 – CPR (including the BLS Flow chart)

•Guideline 10.1 – CPR Training

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Major changes to the previously published guidelines relate to: 1. ‘Re-emphasis’ on the provision of good CPR (including minimising the interruptions to CPR) 2. AED role in BLS both in and out of hospital 3. DRS ABCD – new flow chart

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COUNCIL Guideline 2

Priorities in an Emergency

•Priorities in an emergency

•General principles of management of the collapsed person

•Moving an injured person

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Combined and changed to cover a range of emergency situations not just cardiac arrest and includes collapsed and injured victims

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Guideline 3 Unconsciousness

•Unconsciousness

•Positioning an Unconscious Victim

Combined and a focus on the breathing unconscious victim

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COUNCIL Guideline 4

Airway

•minor change to flow chart.

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COUNCIL Guideline 5 Breathing

•“Signs of Life” removed

•Unresponsive and not breathing normally – now the indicators for resuscitation

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Guideline 6 Compressions

•CPR commences with chest compressions rather than ventilations

•High-quality chest compressions with minimal interruptions

•Pulse check remains unreliable and continues to be de-emphasised as sole indicator of presence or absence of cardiac arrest

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The victim who is unresponsive and not breathing normally, CPR commences with chest compressions rather than rescue breaths.

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In adult and paediatric patients in cardiac arrest (pre-hospital [OHCA], in-hospital [IHCA]) (P), does the use

of compressions first (30:2) (I) compared with standard care (2:30) (C), improve outcome (e.g. ROSC,

survival) (O).

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There is no published human or animal evidence to determine whether starting with compressions or

ventilations improves outcomes.

There is some evidence (manikin) that demonstrates that starting with compressions reduces delays

There is evidence that delays to compressions and interruptions to compressions reduce survival rates

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“Push hard, push fast, minimise interruptions; allow full chest recoil,

and don’t hyperventilate”

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Guideline 7 AED use in BLS

•New guideline recognising the role of AEDs as part of BLS in both out of hospital and in hospital environments.

•It has clear recommendations that training in AED use should be part of BLS education

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Guideline 8 CPR

Putting it all together

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Changes

•Green – international sign for first aid

•DRSABCD– Danger, Response, Send for help, Breathing, Compressions, Defibrillation

•Send for help – often missed

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If unwilling/unable to perform rescue breathing, then perform compression

only CPR

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PICO question X 3

In adult/paediatric patients suffering from a cardiac arrest (P) does the provision of chest compressions

(without ventilation) from bystanders, both trained and

untrained, (I) compared with chest compressions plus mouth-to-mouth

breathing (C) improve survival to hospital discharge (O)?

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PICO question X 2

In adults in cardiac arrest (P) does the provision of chest compressions

(without ventilation) by EMS (I) compared with chest compressions

plus ventilations (C) improve survival to hospital discharge (O)?

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COUNCIL •No human studies have compared compression only CPR with standard CPR (30:2)

•There is some supportive evidence in animal studies/mathematical models for compression only CPR

•Compression only CPR is better than no CPR

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If unwilling/unable to perform rescue breathing, then perform compression

only CPR

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Any attempt at resuscitation is better

than no attempt