2020 Updated CPR Guidelines Released by American Heart Association

In light of opioid related cardiac deaths and post hospital essential care for victims, the American Heart Association (AHA) has released new guidelines this week.

Entitled the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care, the AHA describes an additional “recovery phase” link to the “Chain of Survival”, in which multiple steps help to maximize a patient’s survival.

Within this 6th link, the AHA recommends:

• structured assessment for anxiety, depression, posttraumatic stress and fatigue for cardiac arrest survivors and their caregivers;
• rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary and cognitive impairments before discharge from the hospital; and
• comprehensive, multidisciplinary discharge planning for cardiac arrest survivors and their caregivers, including medical and rehabilitative treatment recommendations and return to activity/work expectations.

Less than 40% of non-hospitalized patients suffering from cardiac arrest will be first treated by a layperson. And 90% of cardiac arrest cases occur outside of the hospital.

The AHA continues to recognize the important role non-medical professionals play in a cardiac arrest patient’s survival.

Additional updates to the 491 recommendations for CPR include:

Reaffirming the adult chest compression protocol – During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches, or 5 cm, for an average adult while avoiding excessive chest compression depths (greater than 2.4 inches, or 6 cm) at a rate of 100-120 beats per minute.

Recommend lay people initiate CPR for “presumed” cardiac arrest as the risk of harm to patients is low if they are not in cardiac arrest.

Recommend when faced with opioid overdose to not delay waiting for naloxone to work in activating emergency response measures and to initiate CPR if a person is in cardiac arrest.

Recommend when performing infant and pediatric CPR to target a respiratory rate range of 1 breath every 2 to 3 seconds (20–30 breaths/min).

Pediatric fluid management for septic shock changed from 20ml/kg bolus to administering fluid in 10-mL/kg or 20-mL/kg aliquots with frequent reassessment.

A summary of the guidelines can be found here.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

@DrDaliah