Highlights of the 2020 American Heart Association's Guidelines for CPR and ECC

Introduction

• The 2020 Guidelines by the American Heart Association (AHA) are a comprehensive revision covering adult, pediatric, neonatal resuscitation, education science, and systems of care.
• They focus on significant or controversial issues that affect training and practice.
• Comprised of 491 recommendations, 161 are class 1, 293 are class 2, and 37 are class 3.
• Few recommendations are based on high-quality Level A evidence, indicating challenges in resuscitation research.

Adult Basic and Advanced Life Support

Key Issues and Changes

• 350,000 adults experience nontraumatic out-of-hospital cardiac arrest (OHCA) annually in the US.
• Less than 40% receive layperson-initiated CPR; fewer than 12% have AEDs applied before EMS arrival.
• Enhanced algorithms and visual aids for BLS and ACLS.
• Emphasis on early CPR initiation and early epinephrine administration.
• Use of real-time audiovisual feedback for CPR quality.
• IV access preferred for medication administration.
• Post-ROSC care requires attention to oxygenation, blood pressure, and other factors.

Algorithms and Visual Aids

• Updated to reflect new evidence and improve clarity.
• New algorithms introduced including for opioid emergencies and cardiac arrest in pregnancy.

Major Recommendations

• Early initiation of CPR by lay rescuers and early administration of epinephrine.
• Real-time audiovisual feedback and physiologic monitoring for CPR quality.
• IV access is preferred over IO.

Pediatric Basic and Advanced Life Support

Key Issues and Changes

• Over 20,000 pediatric cardiac arrests annually in the US.
• Algorithms revised to improve clarity and incorporate new science.
• Increased assisted ventilation rate recommendations.
• Early epinephrine administration emphasized.
• New focus on post-ROSC care including seizure monitoring and treatment.

Recommendations

• Emphasis on early epinephrine administration for nonshockable rhythms.
• Cuffed ETT preferred to reduce air leaks.

Neonatal Life Support

Key Issues and Changes

• Focus on anticipation and preparation for resuscitation.
• Importance of skin-to-skin contact and prevention of hypothermia.
• Updated airway management recommendations for meconium-stained amniotic fluid.
• Emphasis on umbilical vein for vascular access.

Resuscitation Education Science

Key Issues and Changes

• Effective education is crucial for improving survival outcomes.
• Use of deliberate practice, mastery learning, and booster training suggested.
• Self-directed training recommended for lay rescuers.

Systems of Care

Key Issues and Changes

• Emphasis on integrated systems for resuscitation and long-term recovery.
• Use of mobile technology to alert bystanders.
• Importance of data registries for monitoring performance and outcomes.

Major Recommendations

• Incorporate deliberate practice and mastery learning.
• Use spaced learning and booster training.
• Tailor CPR training to specific demographic needs to improve outcomes.