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AHA launches new emergency cardiac care guidelines

Washington, DC - The American Heart Association (AHA) unveiled new recommendations for cardiopulmonary resuscitation (CPR) and the treatment of cardiopulmonary emergencies. These new, international Emergency Cardiovascular Care (ECC) guidelines were presented at a news conference on August 15, 2000, and will be published in the August 22, 2000 issue of Circulation.

STREAMLINED CPR TECHNIQUES RECOMMENDED FOR "GOOD SAMARITANS"

The emphasis of the new guidelines is placed on streamlined CPR techniques that are faster to learn and easier to remember than the old guidelines from 1992, and early defibrillation with easy access to automated external defibrillators (AEDs), according to Dr Vinay Nadkarni (EI duPont Hospital for Children, Wilmington, DE). "The changes in the CPR guidelines are aimed at simplifying training by focusing on the most effective aspects of resuscitation," said Dr Rose Marie Robertson (President, AHA; Vanderbilt University Medical Center, Nashville, TN). "Everyone can save a life."

The AHA will no longer recommend lay rescuers administering chest compressions check an unconscious person's pulse, because assessment has been proven incorrect in at least 35% of cases, according to the AHA. Instead, bystanders should look for normal breathing movement, response to stimulation and other signs of circulation before beginning chest compression, Nadkarni recommended.

In addition, the AHA recommends the same ratio of two breaths to 15 chest compressions for infants, children and adults, regardless of the presence of one or two rescuers.

CALL FOR GREATER AVAILABILITY OF DEFIBRILLATORS IN PUBLIC PLACES

The AHA urges AEDs to be installed in all facilities "where there is a reasonable probability of sudden cardiac arrest," including airports, sports arenas, fire trucks, or casinos. "If you walk through O'Hare Airport in Chicago, you are never more than a minute away from a defibrillator, and they are saving lives," said Robertson.

Electric shocks should be attempted to be delivered within 5 minutes, the AHA recommends, in order to improve the survival rate for cardiac arrest victims from only 5% to about 20%, which could save an estimated 50 000 lives each year. "With rescue rates of 49% and higher, these early defibrillation programs have the potential to be the single greatest advance in the treatment of prehospital sudden cardiac arrest since the invention of CPR," said Nadkarni. "AEDs have to be part of the culture, just like fire extinguishers," urged Robertson.

"Operation Heartbeat" is the AHA's community-based initiative across the US to achieve this goal. It follows a four-step "chain of survival," which includes early recognition of sudden cardiac arrest warning signs and a 911 call, immediate CPR, early defibrillation and early prehospital treatment. Programs for CPR instructions will be promoted in all schools, according to Ed Stapleton, an emergency paramedic and clinical assistant professor (University Hospital and Medical Center, Stony Brook, NY), who demonstrated the revised Basic Life Support techniques in a simulated CPR and AED administration at the AHA's press conference.

UPDATED RECOMMENDATIONS FOR HEALTHCARE PROFESSIONALS

Screening methods, diagnostic tools, and medication treatment protocols for heart attacks, strokes and sudden cardiac arrests have been updated as well, according to Dr John Field (Pennsylvania State University Medical Center, Hershey, PA). He pointed out that clot-busting drugs must be given within a few hours after the onset of symptoms and stressed the importance of prehospital electrocardiograms (ECGs) to identify candidates for clot-busters.

Vasopressin, a new agent for improving blood flow to the heart, has been found to be equivalent in efficacy to epinephrine, the current standard treatment, in a dose of 40 units intravenously in animals, Field told heartwire. Vasopressin could be effective in later stages of cardiac arrest, he said, due to its insensitivity to acidosis. The drug has been investigated in a large European trial, the results of which can be expected in 6 to 8 months, according to Field. He criticized the paucity of randomized controlled trials with antiarrhythmic agents, such as amiodarone, which has been shown to improve survival in the ARREST trial.