2010 American Heart Association

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Part 16: Education, Implementation, and Teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Farhan Bhanji, Mary E. Mancini, Elizabeth Sinz, David L. Rodgers, Mary Ann McNeil, Theresa A. Hoadley, Reylon A. Meeks, Melinda Fiedor Hamilton, Peter A. Meaney, Elizabeth A. Hunt, Vinay M. Nadkarni and Mary Fran Hazinski Circulation 2010;122;S920-S933 DOI: 10.1161/CIRCULATIONAHA.110.971135 Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 72514 Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S920 Subscriptions: Information about subscribing to Circulation is online at http://circ.ahajournals.org/subscriptions/ Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Fax: 410-528-8550. E-mail: journalpermissions@lww.com Reprints: Information about reprints can be found online at http://www.lww.com/reprints Downloaded from circ.ahajournals.org at NATIONAL TAIWAN UNIV on October 18, 2010
Part 16: Education, Implementation, and Teams 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Farhan Bhanji, Chair; Mary E. Mancini; Elizabeth Sinz; David L. Rodgers; Mary Ann McNeil; Theresa A. Hoadley; Reylon A. Meeks; Melinda Fiedor Hamilton; Peter A. Meaney; Elizabeth A. Hunt; Vinay M. Nadkarni; Mary Fran Hazinski Cardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post–cardiac arrest care. The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest. The use of evidence-based education and implementation strategies can optimize the links of that chain. Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based Chain of Survival. Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community- and hospitalbased resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feedback, and change provides fundamental information necessary to optimize resuscitation care and maximize survival. This chapter reviews key educational issues that affect the quality of resuscitation performance and describes major implementation and team-related issues shown to improve outcomes. The information is organized into four major categories: willingness to perform CPR, educational design, improving resuscitation quality, and issues related to implementation and outcomes. While important concepts identified in the 2010 International Liaison Committee on Resuscitation (ILCOR) and American Heart Association (AHA) evidence evaluation process are applied below, 1,2 this document does not include all education, implementation, and team-related topics contained within the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiac Care Science With Treatment Recommendations. 1,2 Willingness to Perform Without immediate initiation of CPR, most victims of cardiac arrest will die. Bystander CPR can significantly improve survival rates from cardiac arrest, 3 but recent evidence indicates that only 15% to 30% of victims of out-of-hospital arrest receive CPR before EMS arrival. 4 Strategies to increase the incidence of bystander-initiated CPR and the use of automated external defibrillators (AEDs) are addressed in this section. Barriers to Bystander CPR Commonly cited reasons for reluctance to perform lifesaving maneuvers include concern for injuring the victim, 5–7 fear of performing CPR incorrectly, 6,8–11 physical limitations, 12 fear of liability, 12 fear of infection, 10 or victim characteristics. 13–16 Opportunities exist to overcome many of these barriers through education and encouragement to perform when the bystander is faced with a victim in cardiac arrest. In a study of actual bystanders interviewed following a 911 call in which the EMS dispatcher encouraged performance of CPR, nonresponders most frequently cited panic (37.5%) and The American Heart Association requests that this document be cited as follows: Bhanji F, Mancini ME, Sinz E, Rodgers DL, McNeil MA, Hoadley TA, Meeks RA, Hamilton MF, Meaney PA, Hunt EA, Nadkarni VM, Hazinski MF. Part 16: education, implementation, and teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S920–S933. (Circulation. 2010;122[suppl 3]:S920–S933.) © 2010 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.110.971135 Downloaded from circ.ahajournals.org at NATIONAL S920 TAIWAN UNIV on October 18, 2010
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Circulation 2010;122;S640-S656 DOI:
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