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Re: CPR Guidelines: Differences and changes

Dear Editor,

It is with interest that I have read the article by Dr Wanis Ibrahim titled Recent advances and controversies in adult cardiopulmonary resuscitation (1) in which the changes to the guidelines and the evidence for these is summarised.

I note that the differences in the cardiopulmonary resuscitation (CPR) guidelines between the American Heart Association (AHA) and the European resuscitation council (ERC) are not mentioned in this article. This difference relates to the delivery of rescue breaths if the victim is not breathing. The AHA recommends two rescue breaths if the victim is not breathing (2) and the ERC (3) as well as the Resuscitation Council of the United Kingdom (4) (RCUK) recommend that chest compressions should be started immediately if there are no signs of life.

Regarding the pulse check during CPR by healthcare providers the AHA recommends that the pulse check occur for not more than 10 seconds after it has been established that the patient is not breathing and the two rescue breaths have been delivered (2). The RCUK recommends simultaneous check for breathing and carotid pulse whilst looking for signs of life (lack of movement, normal breathing or coughing) in not more than 10 seconds (4). This ensures CPR is promptly started. Studies have shown that even healthcare providers checks of pulses can have low accuracy (5, 6).

Another change to the guidelines has been that rescuers should be taught to place their hands on the center of the chest, rather than to spend more time using the ‘rib margin’ method (3, 4).

1. Ibrahim W H. Recent advances and controversies in adult cardiopulmonary resuscitation. Postgraduate Medical Journal 2007;83:649- 654

2. Part 4: Adult basic life support. Circulation. 2005;112:IV-19 – IV -34.)

3. Nolan J P, Deakin C D, Soar J, Bottiger W, Smith G. European Resuscitation Council Guidelines for Resuscitation 2005. Section 4: Advanced Life Support. Resuscitation (2005) 67S1, S39—S86

4. Adult basic life support. http://www.resus.org.uk/pages/bls.pdf

5. Lapostolle F, Le Toumelin P, Agostinucci JM, Catineau J, Adnet F. Basic cardiac life support providers checking the carotid pulse: performance, degree of conviction, and influencing factors. Acad Emerg Med. 2004; 11: 878–880

6. Eberle B, Dick WF, Schneider T, Wisser G, Doetsch S, Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation. 1996; 33: 107–116

Conflict of interest: none