2015 – 2020 BLS ACLS Guideline Updates

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The AHA updated its Emergency Cardiovascular Care guidelines in 2015 to strengthen the recommendations made in 2010. Refer to the AHA’s summary document for a thorough review of the changes.

Below are the major changes for the 2015 – 2020 BLS guidelines:

  • An important change to the CAB (Compressions, Airway, Breathing) sequence from the traditional ABC (Airway, Breathing, Compressions) sequence. Chest compressions must be initiated without delay, which dramatically improves outcomes.
  • Rescuers are likely to have a mobile phone on hand, allowing for the use of speakerphone. By using speakerphone, the rescuer can secure aid and treatment while simultaneously talking with the EMS dispatcher. The rescuer no longer has to decide between leaving a patient and calling emergency medical services.
  • Rescuers who lack training should only apply hands-only CPR as guided by the EMS dispatcher immediately when the patient is seen to be unconscious.
  • Rescue breathing should be done by trained rescuers providing CPR.
  • Whenever narcotic overdose is seen as a cause for the patient’s unresponsiveness, trained BLS rescuers can use naloxone via the intramuscular or intranasal route. Individuals without a pulse should only receive this after CPR has begun
  • High-quality chest compressions have been confirmed as important, with studies recommending ideal depths and rates.
    • Compressions should be administered at a rate of 100 to 120 per minute; faster compressions may reduce perfusion and not allow for cardiac refill.
    • For adults, they should be administered at a depth of 2 to 2.4 inches (or 5 to 6 cm); greater depths may cause injury to vital organs.
    • For children less than one year old, they should be administered at a depth of one-third the chest, or about 1.5 to 2 inches (4 to 5 cm).
    • Full chest recoil must be allowed between compressions to help cardiac filling.
    • Accurately judging the quality of your chest compressions can be difficult; audiovisual feedback devices can be used to help achieve ideal CPR delivery.
    • Chest compression interruptions should be as short as possible, including pre- and post-AED shocks.
  • For patients without advanced airways in place, the preferred compression to ventilation ratio remains 30:2.
  • Patients with advanced airways set in require uninterrupted chest compressions with ventilations being administered once every six seconds.
  • The defibrillator should be used immediately in situations of cardiac arrest.
  • As soon as a shock is delivered, chest compressions should be continued.
  • Older monophasic defibrillators should never be used when biphasic defibrillators are available, as they are better at terminating life-threatening rhythms.
  • The device’s specific guidelines should be followed, as energy settings may vary by manufacturer.
  • Standard dose epinephrine (1 mg every 3 to 5 minutes) is the preferred vasopressor. Higher doses of epinephrine and vasopressin are not recommended, as they are not more effective.
  • Angiography should be administered for cardiac arrests that are caused by suspected coronary artery blockage.
  • A constant temperature of 32 to 36 degrees C for at least 24 hours should be maintained.
  • It is not recommended to routinely cool individuals in prehospital environments.

The following points are a summary of the 2010 changes:

  • ABC (Airway, Breathing, Compressions) had previously been the initial steps. Starting compressions early will increase survival rates, and therefore the steps have been adjusted to CAB, or Compressions, Airway, Breathing. This encourages early CPR and avoids the withholding of CPR.

  • “Look, listen, and feel” is an outdated concept for breathing. Begin CPR immediately if the patient is having trouble breathing, has no pulse, or is unresponsive or unconscious. The goal is to deliver chest compressions as early as possible to persons experiencing cardiac arrest.
  • High-quality CPR requires the following:
    • Compression rate of 100 to 120 beats per minute
    • Compression depth of 2 to 2.4 inches for adults and children, or 1.5 inches for infants
    • Complete chest recoil between each compression
    • Except when using an AED or changing positions, minimize CPR interruptions
    • Do not over-ventilate
    • Work as a team when administering CPR
  • Cricoid pressure is no longer recommended.
  • Check the pulse every 10 seconds; if there is no pulse or if you are uncertain, begin compressions.
  • Infants require manual defibrillators. If not available, an AED with pediatric dose attenuator is recommended for infants. If this is not available, use an adult AED on the infant.
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