The American Heart Association (AHA) has updated guidelines for Dispatcher-Assisted Cardiopulmonary Resuscitation (DA-CPR). As the global source for official resuscitation science and education, the 2020 American Heart Association Guidelines for CPR and ECC is a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics.
The AHA provides training organizations and healthcare professionals the highest quality of care and is committed to ensuring that guidelines are periodically reviewed. These updates highlight any significant or controversial recommendations that result in training and practice changes. Below is an overview of the latest changes, with a focus on how they impact the work of Emergency Cardiovascular Care (ECC) dispatchers and out-of-hospital cardiac arrest (OHCA).
Adult Basic and Advanced Life Support Updates
Initiation of CPR
The AHA has updated the early initiation of CPR by lay rescuers and now recommends that laypersons initiate CPR for presumed cardiac arrest even when the victim may still have a pulse. New evidence shows that there is a low risk of harm to patients who receive chest compressions while not in cardiac arrest. Because lay rescuers are often unable to determine with accuracy if a victim has a pulse, the risk of withholding CPR exceeds the harm from unneeded chest compressions. Ultimately, early and effective CPR and early defibrillation are major contributors to OHCA resuscitation success.
Real-time AV Feedback
The stance on real-time audiovisual feedback for 2020 remains the same and suggests it may be reasonable for audiovisual feedback devices to be used during CPR. The AHA suggests audiovisual feedback as a means to maintain CPR quality. Consistent with this recommendation, the ZOLL® AEDs with integrated CPR feedback technology guide lay rescuers in performing high-quality CPR and provides real-time audio and visual feedback to support the process.
Debriefings and Referrals
The AHA has changed debriefings and referral suggestions for follow up for lay rescuer emotional support. They claim rescuers may experience anxiety or post traumatic stress about providing or not providing basic life support. Dispatchers may also share in the lay rescuer's sense of inadequacy when rescue attempts are unsuccessful. It’s important to note that approximately 10.4% of patients with OHCA survive their initial hospitalization, while only 8.2% survive with good functional status. Therefore, debriefings may allow a review of performance and provide support for the natural stressors associated with caring for a victim who does not survive.
Survivorship was added as a new link in the chain of survival. This introduces the concept that recovery continues after initial hospitalization and is a critical component of resuscitation. Long-term survivorship requires support from family and professional caregivers—including experts in cognitive, physical, and psychological rehabilitation and recovery—and systems-wide commitment to quality improvement at every level of care is essential.
Changes to Systems of Care
While lay responders can improve OHCA outcomes, most communities experience low rates of bystander CPR and AED use. The AHA now considers it reasonable practice to use mobile phone technology to alert bystanders to nearby events that may require CPR or AED. The technology was associated with shorter bystander response times, higher CPR rates, shorter time to defibrillation and higher rates of survival to hospital discharge. Additionally, the AHA now suggests new recommendations for the “No-No-Go” approach regarding bystanders. If a bystander reports a patient as unconscious and not breathing, it is now recommended that dispatchers should initiate CPR instructions immediately.
While these differences in clinical outcomes were seen in observational data—and the use of mobile phone technology has yet to be studied in North America—the AHA acknowledges the suggestion of these benefits in other countries makes this technology a high priority for future research.
Knowing Where to Find Your Closest AED is Essential
State laws often include provisions to ensure AEDs are readily available. Most bills enacted between 1997 and 2001 included provisions to expand access to AEDs, according to the National Conference of State Legislators. This often included the requirement to notify the local emergency response agencies as to where the AEDs are located.
The National AED Registry™ takes this one step further by enabling dispatchers to know exactly where the caller’s closest AED is located and which 911 response agency has jurisdiction. The registry stores this information in an organized cloud file easily accessible to the dispatcher. Armed with access to this registry means dispatchers can direct callers to their closest AED, and forward distress calls to their closest agency to ensure the most rapid response.
As a dispatcher, knowing where to find the right lifesaving equipment is as important as knowing how to guide someone to use it. Combining the use of a national registry with the latest AHA guidelines means you’re able to give the best emergency assistance possible.
Click here to learn more about the National AED Registry™.
Ensuring operations are ready for emergency rescue.
AEDLink™ enables dispatchers to provide life-saving responses to the community. The software communicates with dispatch systems and displays registered AEDs in close proximity when call codes for sudden cardiac arrest are identified. It then automatically notifies nearby registered citizen AED responders with instructions to retrieve their AED.
Not only does it provide complete access to National AED Registry™, AEDLink™ is also integrated with PlusTrac™, the leading AED Program Management solution. The PlusTrac™ AED management program is an interactive web-based program that makes it simple to keep your AEDs properly managed and ready for use.
Click here to start your free PlusTrac™ AED management trial.