(upbeat music)
- Now we're gonna cover a summary or highlights
of the latest information
in the 2020 American Heart Association
emergency cardiovascular care guidelines
that were published at the end of October of 2020.
Now, even with all of the changes and improvements
in the recent years,
the American Heart states that
less than 40% of adults receive lay person initiated CPR
and actually fewer than 12%
have an AED applied to them prior to EMS's arrival.
There hasn't been a significant improvement
in survival rates since 2012
for out of hospital cardiac arrest.
While out of hospital survival rates remain about the same,
the good news is in hospital cardiac arrest outcomes
have continued to improve.
So first let's discuss the new recommendations
for lay rescuer CPR and basic life support.
Now let's look at early initiation of CPR by lay rescuers.
Lay persons should initiate CPR for presumed cardiac arrest
because the risk of harm to the patient is low
if the patient is not in cardiac arrest.
Why do we make the statement?
Well, new evidence shows that the risk of harm
to a victim who receives chest compressions
when they're not in cardiac arrest is quite low.
Lay rescuers are usually not able to determine with accuracy
whether a victim has a pulse
and the risk of withholding CPR
from a pulseless victim exceeds the harm
from unneeded chest compressions.
Lay persons should receive training
in how to respond to victims of opioid overdose
including the administration of Naloxone.
In regard to real-time audio visual feedback
this was really unchanged and reaffirmed.
It may be reasonable to use audio visual feedback devices
during CPR for real-time optimization of CPR performance.
Now let's cover care and support during recovery
which is a vital and important piece
to how to handle all of the things that encompass
a rescuer whether they're lay rescuer or professional
when it comes to providing CPR
to a loved one or a patient.
Debriefings and referral for followup for emotional support
whether they're a lay rescuer EMS provider,
or a hospital-based healthcare worker
after a cardiac arrest event is definitely beneficial.
Care and support during recovery
included three new recommendations.
One, cardiac arrest survivors
should have a multimodal rehabilitation assessment
and treatment for physical, neurological, cardiopulmonary
and cognitive impairments
before discharged from the hospital.
Secondly, 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.
Thirdly, structured assessment should be given
for anxiety, depression, post-traumatic stress and fatigue
for cardiac arrest survivors and their caregivers.
Next let's look at cardiac arrest in pregnancy.
Because pregnant patients are more prone to hypoxia,
oxygenation and airway management should be prioritized
during resuscitation from cardiac arrest in pregnancy.
Now because of potential interference
with maternal resuscitation,
fetal monitoring should not be undertaken
during cardiac arrest in pregnancy.
Next let's look at pediatric rescue breathing.
For infants and children with a pulse,
but absent or inadequate respiratory effort,
it is reasonable to give one breath
every two to three seconds
or about 20 to 30 breaths per minute.
The rate was increased from the old standard of one breath
every three to five seconds.
Now let's look at pediatric opioid overdose.
There were three updated recommendations
under this topic alone.
For patients in respiratory arrest rescue breathing
or bag mask ventilation should be maintained
until spontaneous breathing returns
and standard pediatric BLS measures should continue
if return of spontaneous breathing does not occur.
Secondly, for a patient with suspected opioid overdose
who has a definite pulse
but no normal breathing
or only gasping like in respiratory arrest,
in addition to providing standard pediatric BLS
it's also reasonable for responders
to administer intramuscular or intra-nasal Naloxone.
Lastly, for patients known or suspected
to be in cardiac arrest
in the absence of a proven benefit from the use of Naloxone,
standard resuscitative measures should take priority
over Naloxone administration
with a focus on high quality CPR.
Next let's look at neonatal life support key changes.
Newborn resuscitation requires anticipation and preparation
by providers who train individually and as teams.
Mostly newborn infants do not require
immediate cord clamping or resuscitation
and can be evaluated and monitored
during skin to skin contact with their mothers after birth.
Prevention of hypothermia is an important focus
for neonatal resuscitation.
The importance of skin to skin care
in healthy babies is reinforced
as a means of promoting parental bonding,
breastfeeding and normal thermia.
Inflation and ventilation of the lungs
are the priority in newly born infants
who need support after birth.
A rise in heart rate is the most indicator
of effective ventilation
and response of resuscitative interventions.
Now let's discuss guideline recommendations in education.
And this is extremely near and dear
to our heart here at Pro Trainings,
as we've really, truly always believed
that having more frequent trainings
in smaller bite sized pieces,
when it's most effective for you
in a location most effective for you was vitally important.
There was always too much distance
between an initial in-classroom training
and your two year recertification.
And it's refreshing to see that the science
and the American Heart Association
is now also backing this forum of online
and distance learning that's self-paced
and delivered in small booster training sessions.
Let's take a closer look at what these updates actually say.
First let's look at deliberate and mastery practice.
The use of deliberate practice and mastery learning,
during life support training
and incorporating repetition with feedback
and minimum passing standards,
can improve skill acquisition.
Booster training and spaced-learning
includes three recommendations.
It's recommended to implement booster sessions
when utilizing a master learning approach
for resuscitation training.
It's reasonable to use a spaced-learning approach
in place of a mass learning approach
for resuscitation training.
Provided that individual students can attend all sessions,
separating training into multiple sessions,
in other words spaced-learning,
is preferable to mass learning.
So why was this recommendation made?
Well studies have shown
that the addition of booster training sessions,
which are brief, frequent sessions
focused on repetition of prior content
to resuscitation courses,
improves the retention of CPR skills.
Specifically for lay rescuers
the new American Heart guidelines state the following,
a combination of self-instruction
and instructor-led teaching with hands-on training
is recommended as an alternative
to instructor-led courses for lay rescuers.
If instructor-led training is not available,
self-directed training is recommended for lay rescuers.
Why was the recommendation made?
Well, the American Heart Association guidelines
state that studies have found that self-instruction
or video-based instruction is as effective
as instructor-led training for lay rescuers CPR training.
A shift to more self-directed training may lead
to a higher proportion of trained lay rescuers
thus increasing the chances
that a trained lay rescuer will be available
to provide that important CPR when it's needed most.
The bottom line is that the latest scientific studies
have proven that self-directed training works.
The goal of lay rescuer CPR training
is to increase the likelihood
that people will act and provide CPR when it's needed.
In addition, the new guidelines state
that it is recommended to train middle school
and high school age children
in how to perform high quality CPR.
By training school aged children,
it'll help to instill confidence
and a positive attitude toward providing CPR
from an early age.
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.
Virtual reality which is the use of a computer interface
to create an immersive environment
and a gamified learning,
which is play and competition with other students
can be incorporated into resuscitation training
for lay persons and healthcare providers.
Bystander CPR training should target specific
socioeconomic, racial and ethnic populations
who have historically exhibited
lower rates of bystander CPR.
CPR training should address gender related barriers
to improve rates of bystander CPR performed on women.
EMS systems should monitor how much exposure
their providers receive in treating cardiac arrest victims.
Variability and exposure among providers
in a given EMS system may be supported
by implementing targeted strategies
of supplementary training and or staffing adjustments.
Healthcare providers should complete an adult ACLs course
or its equivalent.
It is reasonable for increased bystander willingness
to perform CPR through CPR training, mass CPR training,
CPR awareness initiatives,
and promotion of hands only CPR.
I'd like to conclude the guideline update
with a note on mobile phone technology.
The use of mobile phone technology
by emergency dispatch systems 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 countries
make this a high priority for future research.