What are the current guidelines for cardiopulmonary resuscitation (CPR) in adults?

Current Guidelines for Adult Cardiopulmonary Resuscitation (CPR)

The 2020 American Heart Association (AHA) guidelines recommend that all rescuers should, at minimum, provide chest compressions for victims of cardiac arrest, with a compression depth of 5-6 cm at a rate of 100-120 compressions per minute, allowing for complete chest recoil between compressions. 1

Basic Life Support Algorithm for Adults

Initial Assessment

• Check for responsiveness by shouting and tapping the victim 1
• If unresponsive, activate emergency response system and get an AED (or send someone to do so) 1
• Look for no breathing or only gasping and check pulse simultaneously (within 10 seconds) 1

CPR Sequence

1. If no pulse is detected within 10 seconds:

   • Begin CPR immediately with chest compressions 1
   • Perform cycles of 30 compressions followed by 2 breaths 1
   • Use the AED as soon as it becomes available 1

2. For lay rescuers:

   • Untrained rescuers should provide compression-only CPR 1
   • Trained rescuers may provide ventilation (rescue breaths) in addition to compressions 1
   • After identifying cardiac arrest, a lone responder should activate emergency response system first, then begin CPR 1

High-Quality CPR Components

• Compression technique:

  • Push hard (at least 2 inches/5 cm deep) 1
  • Push fast (100-120 compressions per minute) 2
  • Allow complete chest recoil between compressions 1
  • Minimize interruptions in compressions 1

• Compression-to-ventilation ratio:

  • 30:2 for single rescuer 1
  • Each breath should take about 1 second and produce visible chest rise 1

Advanced Life Support Components

Rhythm Assessment and Defibrillation

• Check rhythm every 2 minutes 1
• For shockable rhythms (VF/pVT):
  • Deliver shock immediately 1
  • Resume CPR for 2 minutes before reassessing rhythm 1

Medication Administration

• Establish IV/IO access 1
• Administer epinephrine every 3-5 minutes 1
• For refractory VF/pVT, consider amiodarone or lidocaine 1

Special Considerations

Rescue Breathing

• For victims with a pulse but no normal breathing:
  • Provide rescue breathing at a rate of 1 breath every 6 seconds (10 breaths/minute) 1
  • Check pulse every 2 minutes 1
  • For suspected opioid overdose, administer naloxone if available 1

Compression-Only CPR vs. Conventional CPR

• Bystander-administered chest compression-only CPR increases survival to hospital discharge compared to conventional CPR with pauses for rescue breathing 3
• However, for healthcare providers, there is high-quality evidence that continuous chest compressions with asynchronous rescue breathing may result in slightly lower rates of survival compared to interrupted chest compressions with rescue breathing 3

Common Pitfalls and Caveats

• Pulse check delays: Healthcare providers often take too long to check for a pulse, leading to delays in starting compressions 1
• Inadequate compression depth: Many rescuers do not compress deeply enough, which reduces effectiveness 2
• Excessive interruptions: Minimizing pauses in chest compressions is critical for survival 2
• Slow compression rate: Compressions performed too slowly reduce cardiac output 4
• Incomplete chest recoil: Leaning on the chest between compressions prevents full cardiac refilling 1

Monitoring During CPR

• End-tidal CO2 monitoring can help assess CPR quality and predict likelihood of successful resuscitation 2
• Ventricular fibrillation waveform analysis may guide interventions and predict outcomes 5

Remember that early defibrillation remains the most effective intervention for ventricular fibrillation, which accounts for a significant proportion of cardiac arrests 6. The use of automated external defibrillators (AEDs) by bystanders is one of the most promising interventions for improving survival from cardiac arrest 5.