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AHA releases 2020 AHA Guidelines for CPR and ECC

The American Heart Association (AHA) recently published its 2020 AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC) in the organization’s flagship journal, Circulation. Among the major changes are the addition of a sixth link focused on recovery in the AHA’s Chain of Survival, a widely-adopted series of critical actions that work to maximize the chance of someone surviving cardiac arrest.

The latest research shows that the recovery phase following cardiac arrest continues long after hospitalization. The physical, social, and emotional aspects of recovery among patients and their caregivers are emphasized after survivors leave the hospital.

The guidelines contain updated or new algorithms and graphics to reflect the latest resuscitation science, including:

  • a new Recovery link in the Chain of Survival was created for in-hospital and out-of-hospital cardiac arrest in infants, children, adolescents, and adults;
  • a new algorithm and updated recommendations on resuscitation during pregnancy focuses on the best outcomes for both the mother and baby. Team planning for cardiac arrest in pregnancy should be done in collaboration with the obstetric, neonatal, emergency, anesthesiology, intensive care, and cardiac arrest services;
  • addressing the increase in respiratory and cardiac arrests due to opioid overdoses, two new opioid-associated emergency algorithms are included for lay rescuers and for trained responders; and
  • new data on respiratory rates during CPR in children are now available, and the recommendations for pediatric CPR is one breath every 2 – 3 seconds (20 – 30 breaths per minute).

The AHA Chain of Survival now includes a sixth link focused on recovery.

Guidance calls for increasing bystander CPR

The 2020 guidelines offer suggestions for increasing lay rescuer CPR rates, noting that currently less than 40% of non-hospitalized adults who experience cardiac arrest receive layperson-initiated CPR before the arrival of emergency medical services. Among the new or updated suggestions are the following:

  • raise awareness of the need for laypersons to initiate CPR for presumed cardiac arrest, underscoring that the risk of harm to the patient is low;
  • emergency dispatch systems are encouraged to use cell phone technology to recruit laypersons to assist with CPR rescues, especially in under-resourced areas in an effort to increase the rate of bystander CPR and automated external defibrillator use; and
  • bystander CPR training should target specific socioeconomic, racial, and ethnic populations who have historically exhibited lower rates of bystander CPR. CPR training should address gender-related barriers to improve bystander CPR rates for women.

 

Bringing science to life

For the first time ever, the latest resuscitation science is reflected in new high-quality CPR programs that released simultaneously in the form of a new digital resuscitation portfolio — a milestone achievement and breakthrough for the AHA.

The programs are rooted in a true adaptive learning design that delivers personalized instruction tailored to individual needs and knowledge and confidence levels.

The simultaneous release upholds an AHA Guiding Value – Bringing Science to Life.

The AHA also released Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS) course materials for instructor-led training.

Guidelines’ approach and history

The approach for the 2020 Guidelines reflects alignment with the International Liaison Committee on Resuscitation (ILCOR) and associated member councils and includes varying levels of evidence reviews specific to the scientific questions considered of greatest clinical significance and new evidence.

Since the first AHA Guidelines for CPR and ECC were published in 1966, the guidelines have been reviewed, updated, and published periodically by the AHA.

In 2015, the process of five-year updates was transitioned to an online format that uses a continuous evidence evaluation process rather than periodic reviews. This allowed for significant changes in science to be reviewed in an expedited manner and then incorporated directly into the guidelines if deemed appropriate.

The AHA has been a leader in resuscitation science and innovation for over 50 years, training millions of people each year in CPR, first aid and advanced cardiovascular care around the world through its programs and awareness campaigns.

 Visit the ECC Digital Digest to view infographics that cover key guidelines changes and listen to podcasts from resuscitation experts who were involved in creating the guidelines.

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Dad’s quick thinking and CPR save his son after near-drowning experience

Pictured left to right: Max, Adam and Eleanor

By Gina Mayfield

In May 2019, just as San Antonio, Texas, started to heat up for the summer, Adam Biechlin decided to take his two kids for a swim while his girlfriend, Jennifer, finished making dinner. As he was heading out the door, he had a fleeting thought that barely registered in his mind: It’s always better not to be outnumbered by kids at the pool. And off they went.

That day, wind ripped around the 21-floor condominium tower where Jennifer lives, but Adam made it to the ground floor pool where he watched his 5-year-old daughter, Eleanor, do handstands in the water and played catch with his 3-year-old son, Max.

Eventually, Jennifer texted to say dinner was ready, and Adam called for both kids and watched them come running out of the water. He began collecting their belongings, which the wind had strewn across a small area, when Eleanor asked for just one more “Watch this, Dad!” moment.

Adam, who had turned his back for a few seconds knowing both kids had cleared the pool, turned back around. Then it hit him.

“I didn’t see Max,” he remembers. “I said, ‘Where’s your brother?’ Eleanor turned completely pale. My heart just sank. And then it started racing.”

Adam ran toward the pool and found Max floating face first in just 4 feet of water.

“It was an indescribable feeling,” Adam says.

He just remembers thinking, ”This is not happening. This can’t happen. This is not going to happen.”

Adam pulled Max from the pool. “He was like a sack of potatoes. His face was white, his eyes were closed, his lips were blue,” Adam says. “I just started screaming at the top of my lungs for someone to call 911.” But there wasn’t anybody around. “I had to do something,” he says.

Adam laid Max on the ground and began performing CPR. Turns out Adam’s cousin is married to longtime American Heart Association employee, Kelly Griesenbeck Carter, who had offered Adam and other relatives an Infant CPR class right before Eleanor was born. Everything he learned that day came rushing back to him.

After several attempts to revive Max, nothing seemed to help. So, Adam scooped him up and ran through a gate into a patio area where they found an elderly doctor they knew.

Once again Adam laid Max on the ground and began chest compressions, while the doctor stood watch.

“Keep going Dad, you’re doing alright,” the doctor said.

Then it happened. Max projectile vomited the Slurpee he had enjoyed earlier that day all over Adam.

“It was the most wonderful feeling,” Adam says with a smile of that first sign of recovery. Then, Max took a breath and started crying.

About that time, the paramedics arrived. (Residents as high as eight stories up had heard Adam’s frantic cries for help and called 911.) They checked Max’s vitals and rushed him off to the local children’s hospital.

It was there that Adam learned what had happened during the 10 seconds his back was turned. “I got blown in,” Max still explains to this day. Yes, that heavy wind had literally blown him right into the water as he was running.

Today, he’s a perfectly happy and healthy 5-year-old – and a strong swimmer. But about a month after the incident Adam learned how truly fortunate he was that he took that Infant CPR class all those years ago.

Pictured: Max

He ran into the doctor who had stood over him while he performed CPR at the pool that day. The doctor pulled Adam aside and said, “I just want to tell you, Dad, you did a great job because that boy was dead.”

In the year that has followed that fateful day, Adam has become an evangelist for CPR in his Alamo Heights community, warning other parents not to be lulled into a false sense of security at even a crowded community pool, often staffed by teenage lifeguards who are just kids themselves.

“Pay attention and stay hypervigilant near the water,” he says. “This happened in 10 seconds. Ten seconds. Things change in the blink of an eye.”

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Nurse uses CPR to save passenger’s life on cruise

Pictured above: Mark and Diane Jones

By Gina Mayfield

Their week-long cruise had returned to port the night before, and with the ship safely docked in Fort Lauderdale, Florida, Mark and Diane Jones had slept in knowing that their disembarkation time was still hours away.

But just as the Joneses started to rouse, they heard a loud thump next door.

“Next thing I know, I hear a lady screaming at the top of her lungs in the hallway,” Diane recalls. “She was really, really screaming.”

Still in her nightgown, Diane ran out the door and found a small crowd gathered outside Andy and Michelle Katon’s room.

Inside, Andy had collapsed against the bathroom door. Mark, who had closely followed Diane, had to pull Andy away from the door and flip him over. That’s when Diane realized he was “extremely diaphoretic and cyanotic.” Those are the words an RN who spent a good part of her 38-year career in critical care uses to describe someone who is sweating profusely and turning blue.

“Get me an AED unit, call 911, get me some help here,” Diane said to the crowd while supporting Andy’s airway and constantly checking his pulse … until there wasn’t one.

She started Hands-Only CPR and waited for an AED unit. When it finally arrived, they shocked Andy once and his pulse returned to normal. He eventually started breathing on his own, and they transported him to a local hospital.

Then it was time for Diane and Mark to go downstairs – and have breakfast. When they met their friends, the conversation started with, “You guys aren’t going to believe what happened … .” What a morning it had been.

Turns out, Andy had a widow maker heart attack, which is almost always fatal without emergency care. “You’re only alive because of your next door neighbor’s actions,” the cardiologist told Andy.

Turns out this was the second time Diane used CPR to save a life outside of the hospital, the first time being at a college football game.

“I tell people, I don’t leave home without her,” Mark says with a laugh.

Since the rescue, the Joneses and Katons, who had never met before this incident, have gotten to know each other and planned on being together to mark the one-year anniversary of Andy’s survival in March 2020, then COVID-19 got in the way. Still, their bond is strong.

“It’s like we have a new family,” Mark says. “They’re very, very good people.”

“They call me their hero,” Diane says. “They always say they know Andy survived because of what I did. It was real rewarding to know that I saved his life. He was only 49 years old and had three children at home. They’ve all reached out to me to say, ‘Thank you for saving my dad.’ ”

Visit our Hands-Only CPR webpage to learn the two easy steps to save a life and check out Heartsaver® First Aid CPR AED for additional eLearning opportunities.

 

 

 

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Youth baseball coach saves assistant coach’s life using CPR

Left to right: David Dibble and Zach Sievers

By Gina Mayfield

In Spring 2017, youth baseball coach Zach Sievers got a call from former player David Dibble looking to land a spot on a local team. After having a hard time finding a place for the 19-year-old college freshman, Zach did the next best thing and offered him an assistant coaching position on his own 16 and under Wisconsin Wave team in Kenosha.

June rolled around, and David was in the bullpen going through the usual drills with the team.

“Then it happened,” Zach remembers. “David threw a pitch, the catcher threw it back to him. David looked at me, grabbed his chest and fell to his knees.”

Then came the face plant, which was so slow and controlled that Zach wasn’t sure what to make of it.

“I thought he might be playing a prank on somebody.” But David didn’t budge, even after Zach called out to him.

Zach ran over and realized this was no joke.

“David’s eyes were glazed over, his face was gray, his lips were purple,” Zach recalls. He directed another coach to call 911 and sprung into action.

“I checked David’s airways and didn’t feel any breath. I couldn’t see his chest rising. I checked for a pulse and couldn’t find one, so I started CPR.”

No one else at the ballpark that day knew CPR. Thankfully, Zach had been an electronics technician in the Navy, where he went through regular CPR and AED  training.

While to Zach it felt like 15 seconds had passed between the time he started CPR and the time a fire truck arrived, it had actually been nine to 12 minutes.

“Where we were wasn’t the easiest place to get to, and we were between fire zones,” he says. One fireman took over CPR, while the other ran to get the portable AED.

“When I heard the AED announce it couldn’t detect a pulse, I knew for a fact at that point that David was in some trouble. At that point it became real.”

When Zach got to the hospital, paramedics told him they had to stop the ambulance twice to restart David’s heart. He still wasn’t stable.

“I was really just hoping he was going to make it,” Zach says.

Eventually the doctor came out and pulled him aside.

“He told me that if I hadn’t done what I did, David would have died. He wasn’t out of the woods yet, but his chances of living were much better. That was hard to hear. It could have gone either way.”

Flight for Life flew David to a major hospital in Milwaukee where it was discovered that he had atrial fibrillation (AFib).

“So, essentially his heart was just beating out of control, so much so that he didn’t have a pulse,” Zach says. “It was beating at such an interval that it was more like a flutter than a beat.”

David had a defibrillator inserted and spent a week in the hospital. While he was still there his Aunt Connie had an epiphany. She realized that what happened to David could happen to anyone. She went on to start the Dibbs17 CPR Challenge (a name created by combining David’s nickname and number) with the goal of training 1,700 people on CPR within one year.

Connie partnered with the American Heart Association and used its tools to train every last one of them, and that was just the beginning of the organization. They’ve also hosted AED Challenges, where participants take pictures of the AED in whatever building they’re in, just to see if they can find it.

“Connie has done more for David than I ever did,” Zach says humbly.

These days, Dibbs17 is still going strong, and so is David. He got cleared to play baseball again and is back on the field at the University of Wisconsin-Superior. But the Dibble family never forgot what Zach did for them.

“They call me their angel,” he says. “But it’s hard for me to hear ‘thank you’ because I just did what I was supposed to do.”

To hear more about Dibbs17 and David’s story, watch this video on YouTube.