2020 Guidelines Update - CPR and First Aid

Every five years the CPR training industry undergoes some revisions and updates to its protocol. It's important to know what those updates are, so you can put into place the current recommendations that have been proven more effective.

In this lesson, we'll be covering the 2020 updates in the American Heart Association's emergency cardiovascular care guidelines. These were published at the end of 2020.

Even with all the changes and improvements, the American Heart Association states that less than 40 percent of adults receive layperson adult CPR and fewer than 12 percent have an AED applied before EMS's arrival. There haven't been significant improvements in survival rates since 2012 for out-of-hospital cardiac arrest. While out-of-hospital rates remain the same, in-hospital cardiac arrest outcomes continue to improve.

Now let's go over the new recommendations for lay rescuer CPR and basic life support.

Early Initiation of CPR for Lay Rescuers

Lay rescuers should initiate CPR in presumed cardiac arrest because new evidence shows that the risk of harm to the patient is low if the patient isn't in cardiac arrest.

It may be difficult to determine with accuracy if the victim has a pulse for lay rescuers. And the risk of withholding CPR from a pulseless victim exceeds the harm from unneeded chest compressions.

Lay Rescuer Opioid Overdose

Lay rescuers must now receive training on how to respond to victims of opioid overdose, including the administration of naloxone.

Real-Time Audio-Visual Feedback

This has been unchanged and reaffirmed. It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance.

Care and Support During Recovery

This is a vital piece for how to handle all things that encompass lay rescuer CPR – debriefing and referral for follow-up care or emotional support for all rescuers after cardiac arrest is beneficial.

Care and support during recovery include three new recommendations:

1. Cardiac arrest survivors should have multimodal rehabilitation assessment and treatment for physical, neurological, cardiopulmonary, and cognitive impairments before being discharged.
2. Cardiac arrest survivors and their caregivers should receive comprehensive multidisciplinary discharge planning to include medical and rehabilitative treatment recommendations and return to activity or work expectations.
3. Structured assessments should be given for anxiety, depression, post-traumatic stress, and fatigue for cardiac arrest survivors and their caregivers.

Cardiac Arrest During Pregnancy

Because pregnant patients are more prone to hypoxia, oxygenation and airway management should be prioritized during resuscitation from cardiac arrest. And because of potential interference with maternal resuscitation, fetal monitoring should not be taken.

Adult Rescue Breathing

For adults (those older than 14 years of age) that have a pulse but are having trouble breathing on their own, with absent or inadequate respiratory effort, give 1 breath every 6 seconds. This rate has been decreased from 1 breath every 5 seconds.

Pediatric Rescue Breathing

For infants and children with a pulse but absent or inadequate respiratory effort, give 1 breath every 2-3 seconds (20-30 breaths per minute). This rate has been increased from 1 breath every 3-5 seconds.

Pediatric Opioid Overdose

There are three updated recommendations in this area.

1. For patients in respiratory arrest, rescue breathing, or bag-mask ventilation should be maintained until spontaneous breathing returns. And standard pediatric basic life support measures should continue if the return of spontaneous breathing does not occur.
2. For pediatric opioid overdose, administer intramuscular or intranasal naloxone if there is a pulse, no normal breathing, or only gasping.
3. For patients suspected of being in cardiac arrest, standard resuscitative measures should take priority over naloxone administration with a focus on high-quality CPR.

Neonatal Life Support

Newborn resuscitation requires anticipation and preparation by providers who train individually and as teams. Most of the time, newborn infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with the mothers after birth.

Inflation and ventilation of the lungs are the priorities in newborns who need support after birth. A rise in heart rate is the most important indicator of effective ventilations.

Guideline Recommendations in Education

We believe that more frequent training in smaller bite-sized pieces conducted when it's most convenient is vital. There is just too much wasted time and effort with attending traditional classroom training.

It's refreshing to see that the science and the AHA is now backing distance and online training. Here is what these updates specifically say:

The use of deliberate practice and mastery learning can improve skill acquisition during life support training while incorporating repetition with feedback and minimum passing standards.

Booster training and spaced-learning include three recommendations:

1. It's reasonable to implement booster sessions when utilizing a massed-learning approach for resuscitation training.
2. It's reasonable to use a spaced-learning approach in place of a massed-learning approach for resuscitation training.
3. Provided that students can attend all sessions, spaced-learning is preferable to massed-learning.

These recommendations were made because new studies show that video-based training is as effective as instructor-led training and that the addition of booster training sessions (brief, frequent sessions) focused on the repetition of prior content for resuscitation courses improves the retention of CPR skills.

Specifically for lay rescuers, the new AHA guidelines state the following:

1. A combination of self-instruction and instructor-led teaching with hands-on training is recommended. If instructor-led training is not available, self-directed training is recommended.
   
   This shift to self-directed training will likely lead to a higher percentage of trained lay rescuers, and that's good for all of us.
2. The latest studies have proven that self-directed training works and increases the likelihood that people will act and provide CPR when it's needed.
3. It's recommended to train middle school and high school-aged children to perform CPR. By training school-aged children, it will help to instill confidence and a positive attitude about performing CPR.
4. In situ training may be beneficial. In other words, resuscitation education in actual clinical spaces can be used to enhance learning outcomes and improve resuscitation performance.
5. Virtual reality and gamified learning can also be incorporated into resuscitation training.
6. Bystander CPR training should target socioeconomic, racial, and ethnic populations and address gender-related barriers.
7. EMS systems should monitor how much exposure their providers receive in treating cardiac arrest victims. Variability in exposure among providers in a given EMS system may be supported by implementing targeted strategies of supplementary training and/or staffing adjustments.
8. Healthcare providers should complete an adult ACLS course or its equivalent.
9. It is reasonable to increase bystander willingness to perform CPR through CPR training, mass CPR training, CPR awareness initiatives, and the promotion of hands-only CPR.
10. The use of mobile phone technology to alert willing bystanders to nearby events that may require CPR or AED use is now reasonable. The use of mobile phone technology has yet to be studied in North America, but the suggestion of benefits in other parts of the world makes this a high priority for future research.