Академический Документы
Профессиональный Документы
Культура Документы
CLINICAL STATEMENTS
AND GUIDELINES
2017 American Heart Association Focused
Update on Adult Basic Life Support and
Cardiopulmonary Resuscitation Quality
An Update to the American Heart Association Guidelines for Cardio-
pulmonary Resuscitation and Emergency Cardiovascular Care
I
n 2015, the American Heart Association (AHA) published the “2015 AHA Guide- MMEd
lines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Mark Terry, MPA, NRP
Care” including recommendations for adult basic life support (BLS) and cardiopul- Robin Hemphill, MD, MPH
monary resuscitation (CPR) quality.1 That guidelines update was based on the “2015 Raúl J. Gazmuri, MD, PhD
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardio- Mary Fran Hazinski, MSN,
vascular Care Science With Treatment Recommendations” (CoSTR) developed by the RN, FAHA
International Liaison Committee on Resuscitation (ILCOR).2 As planned, ILCOR is now Andrew H. Travers, MD,
transitioning to a process of continuous evidence evaluation, with the intent to issue MSc
updated systematic reviews and CoSTR statements when prompted by the publica-
tion of new evidence. A description of the evidence review process and a glossary of
terms are available in the 2017 BLS CoSTR summary.3 When indicated, the AHA
will publish focused updates for guidelines related to the areas reviewed by ILCOR.
The frst topics selected by ILCOR as part of the continuous evidence evaluation
process are related to BLS, including dispatch-assisted CPR, the use of continuous
versus interrupted chest compressions by emergency medical services (EMS) provid-
ers, and the use of chest compression–only (hands-only) CPR versus CPR using chest
compressions with ventilation in both the in-hospital and out-of-hospital settings.
The evidence evaluated included studies used to support the 2015 CoSTR2 and new
literature published since 2015.
It is important to note that this focused update covers only those topics ad-
dressed by ILCOR’s new continuous evidence evaluation process as of 2017. The
ILCOR systematic reviews use the Grading of Recommendations Assessment, Devel-
opment, and Evaluation methodology and its associated nomenclature for strength
of recommendation and level of evidence. The expert writing group for this adult
BLS–focused update reviewed the studies cited in the 2017 BLS CoSTR summary3
and carefully considered the ILCOR consensus recommendations in light of the
structure and resources of the out-of-hospital and in-hospital resuscitation systems Key Words: AHA Scientifc
that use AHA guidelines. In addition, the writing group determined classes of rec- Statements ◼ basic life support
ommendation and levels of evidence according to the most recent report by the ◼ cardiopulmonary resuscitation
◼ emergency treatment
American College of Cardiology/AHA on clinical practice guidelines (Table)4 by using
the process detailed in part 2 of the 2015 guidelines update.5 All other recommen- © 2017 American Heart
dations and algorithms published in the 2015 guidelines update1 and the “2010 Association, Inc.
Table. ACC/AHA Recommendation System: Applying Class of Recommendation and Level of Evidence to Clinical
Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015)
American Heart Association Guidelines for Cardiopul- 2. Updated recommendations (may be updated in
monary Resuscitation and Emergency Cardiovascular wording, class, level of evidence, or any combina-
Care”6 remain the offcial recommendations of the AHA tion of these)
Emergency Cardiovascular Care Science Subcommittee At the request of the AHA Training Network, we
and writing groups. have also clarifed the descriptions of lay rescuers as
Recommendations for each topic addressed in this follows:
adult BLS–focused update are classifed as follows: 1. Untrained
1. Unchanged recommendations 2. Trained in chest compression–only CPR
CLINICAL STATEMENTS
AND GUIDELINES
3. Trained in CPR using chest compressions and ven- 2. For lay rescuers trained in chest compres-
tilation (rescue breaths) sion–only CPR, we recommend they provide
chest compression–only CPR for adults in
OHCA (Class I; Level of Evidence C-LD).
DISPATCH-ASSISTED CPR 3. For lay rescuers trained in CPR using chest
The 2017 BLS CoSTR summary3 and systematic review compressions and ventilation (rescue breaths),
considered instructions for dispatch-assisted chest com- it is reasonable to provide ventilation (res-
pression–only CPR for out-of-hospital cardiac arrest cue breaths) in addition to chest compres-
(OHCA). sions for the adult in OHCA (Class IIa; Level
of Evidence C-LD).
seconds) to provide asynchronous ventilation 2017 Focused Update: Adult BLS Recommendations
during continuous chest compressions before Year Last
placement of an advanced airway (Class IIb; Reviewed Topic Recommendation Comments
Level of Evidence C-LD). 2017 Dispatch- We recommend that when Updated
2. These updated recommendations do not assisted CPR dispatchers’ instructions are for 2017
needed, dispatchers should
preclude the 2015 recommendation that a
provide chest compression–only
reasonable alternative for EMS systems that CPR instructions to callers for
have adopted bundles of care is the initial use adults with suspected OHCA
(Class I; Level of Evidence C-LD).
of minimally interrupted chest compressions
(ie, delayed ventilation) for witnessed shock- 2017 Bystander For adults in OHCA, untrained Updated
CPR: lay rescuers should provide for 2017
able OHCA (Class IIb; Level of Evidence C-LD). untrained lay chest compression–only CPR
rescuer with or without dispatcher
assistance (Class I; Level of
Evidence C-LD).
CPR FOR CARDIAC ARREST
2017 Bystander For lay rescuers trained in Updated
The 2017 BLS CoSTR summary3 and systematic review CPR: lay chest compression–only CPR, for 2017
considered the use of continuous versus interrupted rescuer trained we recommend they provide
in chest chest compression–only CPR for
chest compressions after placement of an advanced compression– adults in OHCA (Class I; Level of
airway in the hospital setting. only CPR Evidence C-LD).
2017 Bystander CPR: For lay rescuers trained in CPR Updated
lay rescuers using chest compressions and for 2017
2017 Summary of Evidence trained in CPR ventilation (rescue breaths),
using chest it is reasonable to provide
No new studies were reviewed for this topic. compressions ventilation (rescue breaths) in
and ventilation addition to chest compressions
(rescue breaths) for the adult in OHCA (Class IIa;
2017 Recommendations—Updated Level of Evidence C-LD).
2017 EMS-delivered We recommend that before Updated
1. Whenever an advanced airway (tracheal CPR focus placement of an advanced for 2017
tube or supraglottic device) is inserted dur- on chest airway (supraglottic airway or
ing CPR, it may be reasonable for providers to compression– tracheal tube), EMS providers
to–ventilation perform CPR with cycles of 30
perform continuous compressions with pos- ratios compressions and 2 breaths
itive-pressure ventilation delivered without (Class IIa; Level of Evidence
B-R).
pausing chest compressions (Class IIb; Level
of Evidence C-LD). It may be reasonable for 2017 EMS-delivered As an alternative, it is Updated
CPR focus reasonable for EMS providers for 2017
the provider to deliver 1 breath every 6 sec- on chest to perform CPR in cycles of 30
onds (10 breaths per minute) while continu- compression– compressions with 2 breaths
ous chest compressions are being performed to–ventilation without interrupting chest
ratios compressions to give breaths
(Class IIb; Level of Evidence C-LD). (Class IIa; Level of Evidence
B-R).
2017 EMS-delivered It may be reasonable for EMS Updated
CHEST COMPRESSION–TO– CPR focus providers to use a rate of 10 for 2017
on chest breaths per min (1 breath every
VENTILATION RATIO compression– 6 s) to provide asynchronous
to–ventilation ventilation during continuous
The 2017 BLS CoSTR summary3 and systematic review ratios chest compressions before
considered the compression-to-ventilation ratio for placement of an advanced
adult BLS. airway (Class IIb; Level of
Evidence C-LD).
2017 EMS-delivered These updated Updated
2017 Summary of Evidence CPR focus
on chest
recommendations do
not preclude the 2015
for 2017
No new studies were reviewed for this topic. compression– recommendation that a
to–ventilation reasonable alternative for EMS
ratios systems that have adopted
bundles of care is the initial
2017 Recommendation—Updated use of minimally interrupted
chest compressions (ie, delayed
1. It is reasonable for rescuers trained in CPR ventilation) for witnessed
using chest compressions and ventilation shockable OHCA (Class IIb;
(rescue breaths) to provide a compression- Level of Evidence C-LD).
to-ventilation ratio of 30:2 for adults in car- (Continued )
diac arrest (Class IIa; Level of Evidence C-LD).
CLINICAL STATEMENTS
AND GUIDELINES
2017 Focused Update: Adult BLS Recommendations interest of a member of the writing panel. Specifcally, all mem-
(Continued) bers of the writing group are required to complete and submit
a Disclosure Questionnaire showing all such relationships that
Year Last
Reviewed Topic Recommendation Comments might be perceived as real or potential conficts of interest.
This focused update was approved by the American Heart
2017 CPR for Whenever an advanced airway Updated
cardiac (tracheal tube or supraglottic for 2017 Association Science Advisory and Coordinating Committee
arrest with device) is inserted during on September 15, 2017, and the American Heart Association
an advanced CPR, it may be reasonable Executive Committee on October 9, 2017. A copy of the doc-
airway for providers to perform
ument is available at http://professional.heart.org/statements
continuous compressions with
positive-pressure ventilation by using either “Search for Guidelines & Statements” or the
delivered without pausing chest “Browse by Topic” area. To purchase additional reprints, call
compressions (Class IIb; Level of 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.
Evidence C-LD).
The American Heart Association requests that this doc-
2017 CPR for After placement of an Unchanged ument be cited as follows: Kleinman ME, Goldberger ZD,
cardiac advanced airway, it may be for 2017
Rea T, Swor RA, Bobrow BJ, Brennan EE, Terry M, Hemp-
arrest with reasonable for the provider
an advanced to deliver 1 breath every 6 s hill R, Gazmuri RJ, Hazinski MF, Travers AH. 2017 Ameri-
airway (10 breaths per min) while can Heart Association focused update on adult basic life
continuous chest compressions support and cardiopulmonary resuscitation quality: an up-
are being performed (Class IIb;
date to the American Heart Association guidelines for car-
Level of Evidence C-LD).
diopulmonary resuscitation and emergency cardiovascular
2017 Chest It is reasonable for rescuers Updated care. Circulation. 2017;136:eXXX–eXXX. DOI: 10.1161/CIR.
compression– trained in CPR using chest for 2017
to–ventilation compressions and ventilation 0000000000000539.
ratio (rescue breaths) to provide a Expert peer review of AHA Scientifc Statements is conduct-
compression-to-ventilation ed by the AHA Offce of Science Operations. For more on AHA
ratio of 30:2 for adults in statements and guidelines development, visit http://professional.
cardiac arrest (Class IIa; Level of
Evidence C-LD).
heart.org/statements. Select the “Guidelines & Statements”
drop-down menu, then click “Publication Development.”
BLS indicates basic life support; CPR, cardiopulmonary resuscitation; EMS, Permissions: Multiple copies, modifcation, alteration, en-
emergency medical services; and OHCA, out-of-hospital cardiac arrest.
hancement, and/or distribution of this document are not permit-
ted without the express permission of the American Heart Asso-
ciation. Instructions for obtaining permission are located at http://
FOOTNOTES www.heart.org/HEARTORG/General/Copyright-Permission-
The American Heart Association makes every effort to avoid any Guidelines_UCM_300404_Article.jsp. A link to the “Copyright
actual or potential conficts of interest that may arise as a result Permissions Request Form” appears on the right side of the page.
of an outside relationship or a personal, professional, or business Circulation is available at http://circ.ahajournals.org.
DISCLOSURES
Writing Group Disclosures
Writing Other Speakers’ Consultant/
Group Research Bureau/ Expert Ownership Advisory
Member Employment Research Grant Support Honoraria Witness Interest Board Other
Monica E. Children’s Hospital None None None None None None None
Kleinman Boston
Erin E. Kingston Resuscitation None None None None None None None
Brennan Institute (research grant
in CPR education)*
Bentley J. Arizona Department None None None None None None None
Bobrow of Health Services
(Continued )
This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conficts of interest as reported on
the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “signifcant” if
(a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the
voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than
“signifcant” under the preceding defnition.
*Modest.
†Signifcant.
Reviewer Disclosures
Other Speakers’ Consultant/
Research Bureau/ Expert Ownership Advisory
Reviewer Employment Research Grant Support Honoraria Witness Interest Board Other
Lorrel E. Brown University of Louisville None None None None None None None
Tomas Drabek University of Pittsburgh None None None None None None None
Judith Finn Curtin University NHMRC (director of the None None None None None None
(Australia) Australian Resuscitation
Outcomes Consortium [Aus-
ROC], an NHMRC Centre of
Research Excellence)*
(Continued )
CLINICAL STATEMENTS
AND GUIDELINES
Reviewer Disclosures
Other Speakers’ Consultant/
Research Bureau/ Expert Ownership Advisory
Reviewer Employment Research Grant Support Honoraria Witness Interest Board Other
Fredrik Folke Gentofte University None None None None None None None
Hospital, Hellerup
(Denmark)
Guillaume Geri Ambroise Paré Hospital None None None None None None None
(France)
James T. Harbor–UCLA Medical None None None None None None None
Niemann Center
This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conficts of interest as reported on the Disclosure
Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “signifcant” if (a) the person receives $10 000 or more
during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns
$10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “signifcant” under the preceding defnition.
*Modest.
4. Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis
REFERENCES RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA,
Ikonomidis J, Joglar J, Pressler SJ, Wijeysundera DN. Further evolution
1. Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ,
of the ACC/AHA clinical practice guideline recommendation classifca-
Gazmuri RJ, Travers AH, Rea T. Part 5: adult basic life support and cardio-
tion system: a report of the American College of Cardiology/American
pulmonary resuscitation quality: 2015 American Heart Association guide-
Heart Association Task Force on Clinical Practice Guidelines. Circulation.
lines update for cardiopulmonary resuscitation and emergency cardio-
2016;133:1426–1428. doi: 10.1161/CIR.0000000000000312.
vascular care. Circulation. 2015;132(suppl 2):S414–S435. doi: 10.1161/
5. Morrison LJ, Gent LM, Lang E, Nunnally ME, Parker MJ, Callaway CW,
CIR.0000000000000259.
Nadkarni VM, Fernandez AR, Billi JE, Egan JR, Griffn RE, Shuster M, Haz-
2. Travers AH, Perkins GD, Berg RA, Castrén M, Considine J, Escalante R,
inski MF. Part 2: evidence evaluation and management of conficts of
Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto
interest: 2015 American Heart Association guidelines update for cardio-
T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C; on behalf of
pulmonary resuscitation and emergency cardiovascular care. Circulation.
the Basic Life Support Chapter Collaborators. Part 3: adult basic life sup- 2015;132(suppl 2):S368–S382. doi: 10.1161/CIR.0000000000000253.
port and automated external defbrillation: 2015 International Consensus 6. Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF,
on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: adult basic life support:
Science With Treatment Recommendations. Circulation. 2015;132(suppl 2010 American Heart Association guidelines for cardiopulmonary resusci-
1):S51–S83. doi: 10.1161/CIR.0000000000000272. tation and emergency cardiovascular care [published correction appears in
3. Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, At- Circulation. 2011;124:e402]. Circulation. 2010;122(suppl 3):S685–S705.
kins DL, Berg RA, Bingham R, Brooks SC, Castrén M, Chung SP, Considine doi: 10.1161/CIRCULATIONAHA.110.970939.
J, Couto TB, Escalante R, Gazmuri RJ, Guerguerian AM, Hatanaka T, Koster 7. Iwami T, Kitamura T, Kiyohara K, Kawamura T. Dissemination of chest
RW, Kudenchuk PJ, Lang E, Lim SH, Løfgren B, Meaney PA, Montgomery compression-only cardiopulmonary resuscitation and survival after out-
WH, Morley PT, Morrison LJ, Nation KJ, Ng KC, Nadkarni VM, Nishiyama of-hospital cardiac arrest. Circulation. 2015;132:415–422. doi: 10.1161/
C, Nuthall G, Ong YKG, Perkins GD, Reis AG, Ristagno G, Sakamoto T, CIRCULATIONAHA.114.014905.
Sayre MR, Schexnayder SM, Sierra A, Singletary EM, Shimizu N, Smyth 8. Nichol G, Leroux B, Wang H, Callaway CW, Sopko G, Weisfeldt M, Stiell
MA, Stanton D, Tijssen JA, Travers AH, Vaillancourt C, Van de Voorde P, I, Morrison LJ, Aufderheide TP, Cheskes S, Christenson J, Kudenchuk P,
Hazinski MF, Nolan JP; on behalf of the ILCOR Collaborators. 2017 In- Vaillancourt C, Rea TD, Idris AH, Colella R, Isaacs M, Straight R, Stephens
ternational Consensus on Cardiopulmonary Resuscitation and Emergency S, Richardson J, Condle J, Schmicker RH, Egan D, May S, Ornato JP; ROC
Cardiovascular Care Science With Treatment Recommendations summary. Investigators. Trial of continuous or interrupted chest compressions during
Circulation. 2017;136:XXX–XXX. doi: 10.1161/CIR.0000000000000541. CPR. N Engl J Med. 2015;373:2203–2214. doi: 10.1056/NEJMoa1509139.