Overview
Summary of the 2020 American Heart Association (AHA) Basic Life Support (BLS) guideline updates, including adult and pediatric protocols, major changes in resuscitation algorithms, and key considerations for healthcare providers.
Major 2020 AHA BLS Guideline Updates
- A sixth link, "recovery," was added to the adult Chain of Survival, focusing on post-cardiac arrest care and rehabilitation.
- Emphasis on early activation of the emergency response system, especially using a mobile device if available.
- Introduction of the CPR coach role to ensure high-quality compressions and adherence to protocols.
Adult Basic Life Support Key Steps
- Assess patient responsiveness by tapping and shouting; ensure environmental safety before initiating CPR.
- Activate emergency response system immediately, preferably using a mobile phone.
- Check for breathing and pulse within 10 seconds; start CPR if no pulse.
- Perform chest compressions at 100–120/min, at least 2 inches deep, allowing full recoil, with minimal interruptions.
- Compression-to-ventilation ratio of 30:2 for adults; switch compressors every 2 minutes.
- Follow AED prompts, ensuring everyone is clear before shock delivery; resume CPR immediately after shock/no-shock prompt.
Airway and Breathing Updates
- Use head-tilt chin-lift or jaw thrust for airway management; provide 1 breath every 6 seconds for respiratory arrest (with or without advanced airway).
- Ensure visible chest rise and avoid excessive ventilation to prevent reduced cerebral blood flow.
AED and Defibrillator Use
- Turn on AED immediately upon arrival and follow device prompts.
- Remove wet clothing or medication patches; place pads as instructed.
- For patients under 8, use child pads if available; otherwise, place adult pads so they do not touch each other.
- Use adult pads exclusively for those aged 8 and older.
Pediatric Basic Life Support Highlights
- Definitions: neonate (0–28 days), infant (28 days–1 year), child (1 year to puberty), adolescent (post-puberty).
- For unresponsive, non-breathing children with no pulse, start CPR; do not leave for help unless alone and without a phone after one round of CPR.
- Single rescuer infant CPR now allows for two-finger, two-thumb, or one-hand techniques.
- Compression depth: 4 cm for infants, 5 cm for children, never more than 6 cm.
- Infant/child compression rate: 100–120/min.
- Compression: ventilation ratio: 30:2 single rescuer, 15:2 for two rescuers.
- Pediatric rescue breaths: 1 every 2–3 seconds (20–30/min), with or without an advanced airway.
Foreign Body Airway Obstruction Protocols
- Confirm severe airway obstruction and obtain consent before intervention; use abdominal or chest thrusts for adults/children, back slaps and chest thrusts for infants.
- If victim becomes unresponsive, activate emergency response and begin CPR; check for visible obstruction before giving rescue breaths.
Opioid-Associated Emergencies
- New algorithm prioritizes assessment of normal breathing and early consideration of naloxone administration.
- Naloxone is now under prevention/deterioration, not as a standalone intervention.
- For patients with pulse and inadequate breathing, provide ventilation and consider naloxone; prioritize standard BLS for cardiac arrest.
Decisions
- Add “recovery” as sixth link to Chain of Survival.
- Immediate emergency response system activation using mobile devices recommended.
- Introduction of dedicated CPR coach role.
- Rescue breathing standardized to 1 breath every 6 seconds for adults; every 2–3 seconds for pediatrics.
Action Items
- TBD – All providers: Familiarize with 2020 AHA BLS guidelines and updates.
- TBD – Training coordinators: Update training materials and protocols to reflect new guidelines.