2010 American Heart Association
2010 American Heart Association 2010 American Heart Association
Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Andrew H. Travers, Thomas D. Rea, Bentley J. Bobrow, Dana P. Edelson, Robert A. Berg, Michael R. Sayre, Marc D. Berg, Leon Chameides, Robert E. O'Connor and Robert A. Swor Circulation 2010;122;S676-S684 DOI: 10.1161/CIRCULATIONAHA.110.970913 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/S676 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 4: CPR Overview 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Andrew H. Travers, Co-Chair*; Thomas D. Rea, Co-Chair*; Bentley J. Bobrow; Dana P. Edelson; Robert A. Berg; Michael R. Sayre; Marc D. Berg; Leon Chameides; Robert E. O’Connor; Robert A. Swor Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest. 1 Although the optimal approach to CPR may vary, depending on the rescuer, the victim, and the available resources, the fundamental challenge remains: how to achieve early and effective CPR. Given this challenge, recognition of arrest and prompt action by the rescuer continue to be priorities for the 2010 AHA Guidelines for CPR and ECC. This chapter provides an overview of cardiac arrest epidemiology, the principles behind each link in the Chain of Survival, an overview of the core components of CPR (see Table 1), and the approaches of the 2010 AHA Guidelines for CPR and ECC to improving the quality of CPR. The goal of this chapter is to integrate resuscitation science with real-world practice in order to improve the outcomes of CPR. Epidemiology Despite important advances in prevention, cardiac arrest remains a substantial public health problem and a leading cause of death in many parts of the world. 2 Cardiac arrest occurs both in and out of the hospital. In the US and Canada, approximately 350 000 people/year (approximately half of them in-hospital) suffer a cardiac arrest and receive attempted resuscitation. 3–7 This estimate does not include the substantial number of victims who suffer an arrest without attempted resuscitation. While attempted resuscitation is not always appropriate, there are many lives and life-years lost because appropriate resuscitation is not attempted. The estimated incidence of EMS-treated out-of-hospital cardiac arrest in the US and Canada is about 50 to 55/100 000 persons/year and approximately 25% of these present with pulseless ventricular arrhythmias. 3,8 The estimated incidence of in-hospital cardiac arrest is 3 to 6/1000 admissions 4–6 and similarly, approximately 25% of these present with pulseless ventricular arrhythmias. 7 Cardiac arrest victims who present with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) have a substantially better outcome com- pared with those who present with asystole or pulseless electric activity. 1,7,9 The vast majority of cardiac arrest victims are adults, but thousands of infants and children suffer either an in-hospital or out-of-hospital cardiac arrest each year in the US and Canada. 7,10 Cardiac arrest continues to be an all-too-common cause of premature death, and small incremental improvements in survival can translate into thousands of lives saved every year. Key Principles in Resuscitation: Strengthening the Links in the Chain of Survival Successful resuscitation following cardiac arrest requires an integrated set of coordinated actions represented by the links in the Chain of Survival (see Figure 1). The links include the following: ● Immediate recognition of cardiac arrest and activation of the emergency response system ● Early CPR with an emphasis on chest compressions ● Rapid defibrillation ● Effective advanced life support ● Integrated post–cardiac arrest care Emergency systems that can effectively implement these links can achieve witnessed VF cardiac arrest survival of almost 50%. 11–14 In most emergency systems, however, survival is lower, indicating that there is an opportunity for improvement by carefully examining the links and strengthening those that are weak. 3 The individual links are interdependent, and the success of each link is dependent on the effectiveness of those that precede it. Rescuers have a wide variety of training, experience, and skills. The cardiac arrest victim’s status and response to CPR maneuvers, as well as the settings in which the arrests occur, can also be heterogeneous. The challenge is how to encourage early, effective CPR for as many victims as possible, taking The American Heart Association requests that this document be cited as follows: Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, Berg MD, Chameides L, O’Connor RE, Swor RA. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S676–S684. *Co-chairs and equal first co-authors. (Circulation. 2010;122[suppl 3]:S676–S684.) © 2010 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.110.970913 Downloaded from circ.ahajournals.org at NATIONAL S676 TAIWAN UNIV on October 18, 2010
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Part 4: CPR Overview: <strong>2010</strong> <strong>American</strong> <strong>Heart</strong> <strong>Association</strong> Guidelines for<br />
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care<br />
Andrew H. Travers, Thomas D. Rea, Bentley J. Bobrow, Dana P. Edelson, Robert A.<br />
Berg, Michael R. Sayre, Marc D. Berg, Leon Chameides, Robert E. O'Connor and<br />
Robert A. Swor<br />
Circulation <strong>2010</strong>;122;S676-S684<br />
DOI: 10.1161/CIRCULATIONAHA.110.970913<br />
Circulation is published by the <strong>American</strong> <strong>Heart</strong> <strong>Association</strong>. 7272 Greenville Avenue, Dallas, TX<br />
72514<br />
Copyright © <strong>2010</strong> <strong>American</strong> <strong>Heart</strong> <strong>Association</strong>. All rights reserved. Print ISSN: 0009-7322. Online<br />
ISSN: 1524-4539<br />
The online version of this article, along with updated information and services, is<br />
located on the World Wide Web at:<br />
http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S676<br />
Subscriptions: Information about subscribing to Circulation is online at<br />
http://circ.ahajournals.org/subscriptions/<br />
Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters<br />
Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Fax:<br />
410-528-8550. E-mail:<br />
journalpermissions@lww.com<br />
Reprints: Information about reprints can be found online at<br />
http://www.lww.com/reprints<br />
Downloaded from<br />
circ.ahajournals.org at NATIONAL TAIWAN UNIV on October 18, <strong>2010</strong>
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