CPR, The Change
Okay, so by now anyone who cares knows about the AHA changes to CPR, right?
Or do they?
Give me about 5 minutes
(less if you’re a fast reader) to highlight some important points that I’ve brought back from the AHA National Faculty Roll-Out in Chicago, you’ll be able to entertain your friends at dinner parties with your amazing inside knowledge of Emergency Cardiac Care Guidelines. But first promise me that you’ll stop going to dinner parties where this is the kind of thing that you talk about.
1) They’re not the AHA’s changes.
They are associated with the AHA, whose mission it is to help promote and organize the research that’s being done related to emergency cardiac care (ECC), but it’s more accurate to say that these recommendations come from the International Liaison Committee on Resuscitation (ILCOR, pronounced ill cor). They’re this big committee of crazy-smart people who get together to ask questions about cardiac treatment (How effective is Lidocaine in cardiac arrest? Should paramedics stop compressions to place an ET tube?) and then collect and evaluate all the research they can from around the world to help answer those questions. It takes them about 5 years to do this, which is why that’s how often they publish their findings in the Consensus on Resuscitation Science and Treatment Recommendations paper (CoSTR, pronounced Co-Star).
2) Like #1, they’re not the AHA’s changes.
While the AHA certainly adopts the CoSTR recommendations in their training courses, so does the American Red Cross, who works directly with the AHA in the production of the CoSTR paper. In fact, representatives of other training agencies like Medic First Aid and the National Safety Council are all involved in sections of CoSTR and ultimately will adopt the recommendations of each CoSTR paper as it comes out. The differences between the agencies are typically only in the structure of the courses and the course materials, not in whether you should do CPR with your hands or with a toilet plunger.
3) They’re not even “changes”.
Those of use who’ve been around for a while (specifically pre-2000 CoSTR paper) are used to the “changes to CPR” to mean drastic deviation from previous practice. For instance, compression ratios going from 5:1 to 15:2 to 30:2 and Sodium Bicarb going from “first thing you do” to “maybe sometimes, probably never”. This year, the changes are largely in how strongly different items are recommended. There’s no new “magic med” that raises the dead in one dose. There aren’t even new numbers in CPR. The “change” with the biggest press (ABC to CAB) isn’t even much of a change at all. They just dropped the “look-listen-feel” step and got right to compressions which most of my students, from lay-person to physician, have been trying to do for years anyway!
4) They’re not “somebody’s” changes, they’re “everybody’s” changes.
This is related to #2 above, but it’s more than that. This is the 50th anniversary of CPR as we know it. When we look back at how resuscitation recommendations have come out in those 50 years we see that it went through basically three phases.
WHEN THEY BEGAN: A bunch of docs sat around a table and picked some things that they’ve seen work.
LATER: A bunch of docs sat around a table with a whole bunch of scientific papers and picked the ones that they though were the best.
NOW: A bunch of physicians, scientists and representatives of other health fields (nurses, medics, firefighters, manufacturers, agency reps) get together and, using questions that arose from the last CoSTR, look at thousands and thousands of scientific papers and decide what treatments have strong enough scientific backing to become recommendations. Some recommendations still hang in there (I’m looking at you epi!) simply because “we’ve always done it that way.”
Since we’ve been using that last process for more than a decade, fewer startling new discoveries have been made (yes, yes, I see you waving your hand Therapeutic Hypothermia, we’ll get to you later) as science zeros in on what we know works and what doesn’t.
I doughnut have the time for this
So how can you know what ILCOR has looked at? What exactly is in that thousand plus page long CoSTR document? Is there any way to get more info than you find in the AHA 2010 Recommendations book, without going mad with the science, oh the science?!?
Yes, yes there is, but you’ll have to give me until next month to post it, right now I’m busy wishing you and your family a happy and safe holiday season and a happy New Year!