Resuscitation update - the latest advice

A phone app can recommend rate and depth of chest compressions, explains Professor Malcolm Woollard.

The emphasis remains on good quality chest compressions (Photograph: Istock)
The emphasis remains on good quality chest compressions (Photograph: Istock)

In October 2010, new resuscitation guidelines were released that include important changes relevant to the resuscitation of patients in primary care.

Agonal respirations
Agonal or gasping respirations have been misdirecting responders into believing a patient has a pulse and this has resulted in the failure to start CPR.

Agonal or gasping respirations in an unresponsive patient should always be assumed as indicating cardiac arrest.

Chest compressions
The emphasis remains on the importance of good quality chest compressions, started as soon as possible after the onset of arrest and continued with minimal interruptions.

The current standards are that no intervention should result in a pause in chest compressions of more than 10 seconds.

Two additional changes aim to improve the efficacy of chest compressions. Firstly, the recommended rate for chest compressions is now 100 to 120 per minute. Secondly, the depth for chest compressions in an adult is 5-6cm.

If a rescuer is unable to give ventilations, compression-only CPR should be administered instead.

Research shows that the standard of chest compressions given by even professional rescuers is often poor, and so the new guidelines encourage the use of feedback devices, which prompt users to compress at the correct rate and depth.

These come in a number of forms, from applications on smart phones providing verbal prompts and a metronome; an iPhone application which uses the accelerometer to prompt on rate and depth; to stand-alone pucks and automated external defibrillator (AED) electrodes with built-in accelerometers.

No compressions interval
For those practices with a defibrillator, the emphasis is on minimising interruptions in chest compressions, and the guidelines now recommend that chest compressions be continued while the device is charging.

To ensure safety, the rescuer providing the compressions should be the person to press the shock button, and as soon as he or she has done so they should resume compressions.

The target is to reduce the 'no compressions interval' to less than five seconds for each shock. If an older AED is used it is necessary to stop compressions while the device is analysing the rhythm but some modern devices use algorithms, which permit compressions to be continued during the check.

  • Professor Woollard is professor in pre-hospital and emergency care at Coventry University.


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