Part 5: Adult Basic Life Support

Abstract

Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

Advances in Resuscitation

“…16 The concept of "look, listen, feel" has been removed because it was considered to be inconsistently applied and time-consuming. 20 Untrained laypersons are now instructed to begin compression-only CPR because a number of studies have demonstrated bystander compression-only CPR to be equivalent to conventional bystander CPR.…”

“…The recommended chest compression depth is now at least 2 inches on the basis of studies that demonstrated improved defibrillation success and short-term outcomes with increased compression depth, and the recommended compression rate is at least 100 per minute. 16,24,25 In addition to guideline changes, public education and CPR training are paramount because laypersons trained in CPR are significantly more likely to perform CPR. 26 …”

“…16 For example, the A-B-C mnemonic has been rearranged to C-A-B to place emphasis on and to reduce delays in providing chest compressions. 20 This has been incorporated into the new adult BLS algorithm for healthcare providers, as shown in Figure 2, which emphasizes CPR and defibrillation before any ventilation strategies.…”

“…20 This has been incorporated into the new adult BLS algorithm for healthcare providers, as shown in Figure 2, which emphasizes CPR and defibrillation before any ventilation strategies. 16 Support for this emphasis is derived from research demonstrating that bystander CPR is a significant predictor of survival in OHCA. 27 Evidence from studies of minimally interrupted cardiac resuscitation and cardiocerebral resuscitation supports the new decreased emphasis on pulse checks to promote continuous CPR with minimal interruptions.…”

“…16,17 A coordinated regional system of care can promote specialized postresuscitation programs and direct patients to centers prepared to provide optimal care. 18,19 This article discusses recent advances in resuscitation science for the adult patient experiencing SCD.…”