AHA 2005 ACLS Guidelines

Increased Emphasis On: Effective CPR –“Push hard and push fast” –Chest compressions

Airway- New 5 cycles of CPR/ 2 min prior to phoning 911 for infants/children No jaw thrust (lay people) Health care providers may use head- chin tilt in injured patients if jaw thrust fails

Airway- Old 1 min of CPR prior to phoning 911 for infants/children Jaw thrust only for injured patients (both health care providers and lay people)

Breathing ALL rescue breaths over 1 s, with adequate volume to produce visible chest rise Lay people: check for normal breathing in adults Normal (not deep) breath prior to AR Continuous cycles when intubated only 8-10 resps per min when intubated (q 6-8 s) No rescue breathing without compressions for lay people

Breathing- Old Rescue breaths over 1-2 s Varying tidal volumes suggested resps/min once intubated

Circulation- New Single compression to ventilation ratio for ALL single rescuers for ALL victims (excluding newborns) –30:2 (100/min) –5 cycles (2 min) CPR in between rhythm checks –Health care providers (2 rescuer): Adults 30:2 Infants/children 15:2

Circulation- New Limit interruptions in compressions Rescuers may use one or two hands for child CPR Unwitnessed arrests: may consider 5 cycles of CPR prior to defibrillation (or response time > 4 min)

Circulation- Old Minimizations in interruptions not emphasized Adult: 15:2 Infant and child: 5:1 Rhythm and pulse checks after defibrillation

Defibrillation- New Single shocks followed by immediate CPR for VF/ pulseless VT –360 J for monophasic defibrillators –Biphasic defibrillators: device dependent ( J) No rhythm/pulse check prior to initial 5 cycles, then pulse check only if organized rhythm present Rhythm checks every 5 cycles (2 min)

Defibrillation- Old 3 stacked shocks for initial defibrillation –200 J, 300 J, 360 J Single shock for subsequent defibrillations –360 J

Adjuncts AED’s –Use of AED’s in children 1-8 years old (use pediatric system if available) –New AED’s will prompt rescuers for reassessment –Single shocks without rhythm check following –Use as soon as available except out of-hospital HC provider with child (not sudden arrest) or adult (unwitnessed arrest) 5 cycles CPR prior

Adjuncts Airway: –LMA/Combitubes Pacing: –No longer used in asystolic arrest

Algorithms Polymorphic VT –Unsynchronized (defibrillation) shocks Bradycardia –Atropine dose 0.5 mg Arrest –Drugs timed to be delivered with CPR ASAP after rhythm check VF/ pulseless VT –Antiarrhythmics: Amiodarone preferred, then lidocaine

Algorithms Tachycardia –Simplified to one algorithm –Wide vs narrow complex; irreg vs reg –Simplified suggested drugs