Author: Anthony Handley (UK)

1. Resuscitation Guidelines 2005 What’s new and why? Dr Anthony J Handley MD FRCP Chairman, BLS/AED Subcommittee, Resuscitation Council (UK) Chief Medical Adviser, RLSS UK Honorary Medical Officer, Irish Water Safety Honorary Medical Adviser, ILSE

2. The development process Did we need to change the guidelines ? What’s new in basic life support & why ? What’s new in defibrillation & why ? Resuscitation Guidelines 2005 What’s new and why?

3. International Liaison Committee on Resuscitation Australian Resuscitation Council

4. CoSTR 2005 International Liaison Committee on Resuscitation Consensus on Science and Treatment Recommendations

7. Overall survival 5 % Bystander CPR doubles survival from out-of-hospital cardiac arrest Did we need to change the guidelines ?

8. Poor skill acquisition and retention The Problems Too many interruptions in chest compression

9. Six months after the course only 6.8% of trainees were able to perform safe and effective CPR Morgan et al. BMJ 1996; 313:912-916 Lay members of the public Acquisition and retention of skills

10. Curry & Gass. Canadian Med Ass J. 1987;137:491-496 Six months after training … the physicians’ and nurses’ … skills had deteriorated to near pre-training levels Healthcare professionals Acquisition and retention of skills

11. What is the solution ? Acquisition and retention of skills

15. 4-step 8-step Correct sequence of actions Handley & Handley. Resuscitation 1998; 36:3-8 Acquisition and retention of skills

16. 4-step 8-step Correct sequence of actions Handley & Handley. Resuscitation 1998; 36:3-8 Acquisition and retention of skills

17. 4-step 8-step Correct sequence of actions Handley & Handley. Resuscitation 1998; 36:3-8 Acquisition and retention of skills

18. 4-step 8-step Correct sequence of actions Handley & Handley. Resuscitation 1998; 36:3-8 Acquisition and retention of skills

19. Handley’s Equation Handley. Singapore Med J 2001 (Suppl); 36-37  Facts remembered 1 _________________ Facts taught

20. Handley & Handley. Resuscitation 1998; 36:3-8 Simplify the sequences The Solution

21. Too many interruptions in chest compression The Problem

22. Probability of success % Time without CPR before shock given - sec Eftest Ø l et al. Circulation 2002; 105:2270-2273 Interruptions in compression

23. Probability of success % Eftest Ø l et al. Circulation 2002; 105:2270-2273 Time without CPR before shock given - sec Interruptions in compression

24. Probability of success % Eftest Ø l et al. Circulation 2002; 105:2270-2273 Time without CPR before shock given - sec Interruptions in compression

25. Simplify the sequences The Solutions Fewer interruptions in compressions

26. Did everything change ? Resuscitation Guidelines 2005

27. Rubens: death of Adonis (1614) Resuscitation Guidelines 2005

28. Rubens 1614 Guidelines 2005 Resuscitation Guidelines 2005

29. Diagnosis of cardiac arrest Compression : ventilation ratio Hand position on chest Infants and children Resuscitation Guidelines 2005

30. Check responsiveness Check breathing 2 rescue breaths Check for signs of a circulation Diagnosis of cardiac arrest

31. Ruppert et al. Ann Emerg Med. 1999; 34:720-729 Perkins et al. Resuscitation 205; 64:109-113 No evidence that checking for movement, breathing, or coughing is diagnostically superior to the pulse check Diagnosis of cardiac arrest

32. A diagnosis of cardiac arrest should be made if a casualty is unresponsive and not breathing normally Diagnosis of cardiac arrest

33. Simplify the sequences Diagnosis of cardiac arrest Fewer interruptions in compressions

34. Simplify the sequences √ Diagnosis of cardiac arrest Fewer interruptions in compressions

35. Simplify the sequences √ √ Diagnosis of cardiac arrest Fewer interruptions in compressions

36. Hand position for chest compression

37. Hand position for chest compression Handley. Resuscitation 2002; 53: 29-36

38. Rescuers should be taught to place their hands on the centre of the chest Hand position for chest compression

39. Simplify the sequences Hand position for chest compression Fewer interruptions in compressions

40. Simplify the sequences √ Hand position for chest compression Fewer interruptions in compressions

41. Simplify the sequences √ √ Hand position for chest compression Fewer interruptions in compressions

42. Compression : ventilation ratio 15:2 30:2 50:2 50:5 100:2 ? Insufficient evidence

43. Babbs et al (Theoretical) Ann Emerg Med. 2002; 40: 553-562 30:2 Dorph et al (Pig) Resuscitation 2004; 60: 309-318 30:2 50:2 Dorph et al (Pig) Resuscitation 2003; 58: 193-201 Sanders et al (Pig) Ann Emerg Med. 2002; 40: 553-562 100:2 Best ratio Compression : ventilation ratio

44. Compression : ventilation ratio

45. Compression : ventilation ratio

46. Dorph & Wik. Resuscitation 2002; 54: 259-264 15:2 Compression : ventilation ratio

47. For ease of teaching, a uniform ratio of 30:2 is recommended for lay rescuers Compression : ventilation ratio

48. Simplify the sequences Compression : ventilation ratio Fewer interruptions in compressions

49. Simplify the sequences √ Compression : ventilation ratio Fewer interruptions in compressions

50. Simplify the sequences √ √ Compression : ventilation ratio Fewer interruptions in compressions

51. CPR if unconscious & not breathing normally Compression : ventilation ratio 30:2 for all Hands in centre of chest Adult basic life support

52. Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths ERC Guidelines 2005 for BLS

53. Have they been successful ? Evidence-based guidelines for basic life support

54. Roessler et al. Resuscitation 2007; 74: 102-107 29 volunteers taught BLS guidelines 2000 30 volunteers taught BLS guidelines 2005 Skills tested Then taught alternative guidelines Skills tested Have they been successful ?

55. Roessler et al. Resuscitation 2007; 74: 102-107 2000 guidelines 2005 guidelines Correctly followed sequence Time to first compression 37 sec 15 % 41 % 21 sec Have they been successful ?

56. Evidence-based guidelines for basic life support What next ? Guidelines 2010

57. Adult basic life support

58. Resuscitation Guidelines 2005 What’s new and why? Dr Anthony J Handley MD FRCP Chairman, BLS/AED Subcommittee, Resuscitation Council (UK) Chief Medical Adviser, RLSS UK Honorary Medical Officer, Irish Water Safety Honorary Medical Adviser, ILSE