National Center for Early Defibrillation

American Heart Association Releases New Guidelines for Emergency Care

November 28, 2000

Pulse Check No Longer Recommended for Layperson CPR

The American Heart Association has unveiled a major revision of recommendations for cardiopulmonary resuscitation (CPR) and the treatment of cardiovascular emergencies. These new emergency cardiovascular care (ECC) guidelines cover a variety of topics such as CPR, automated external defibrillators (AEDs) and recommendations for emergency medical personnel. One of the major changes is the recognition that a pulse check is unreliable, and recommendation that no pulse check be done before bystanders begin administering chest compressions to an unconscious person. The new guidelines were published in the August 22 issue of Circulation: Journal of the American Heart Association.

The International CPR and ECC Guidelines 2000 are designed for both lay rescuers and healthcare providers and include the most effective methods for treating cardiovascular emergencies such as sudden cardiac arrest, heart attack and stroke. They were developed by an international panel of experts following a process of scientific evidence evaluation, debate and consensus development.

"These are lifesaving measures and we wanted them to reflect the most up-to-date science," says Rose Marie Robertson, MD, president of the American Heart Association and professor of medicine at Vanderbilt University Medical Center in Nashville.

"We recognize that it is very difficult for a layperson to assess whether a patient has a pulse within the first few seconds of a cardiovascular emergency," says Vinay Nadkarni, MD, chairman-elect of the association's ECC committee and director of pediatric intensive care at the A. I. duPont Hospital for Children in Wilmington, Del. He says research indicates that at least 35 percent of lay rescuers are wrong about whether or not a victim has a pulse. Therefore, the new guidelines recommend that the general public instead look for normal breathing, movement, response to stimulation and other signs of circulation when deciding whether to begin chest compressions.

The deletion of the pulse check from layperson CPR training has already been successfully implemented by the United Kingdom and European Resuscitation Councils, Nadkarni says. However, the guidelines continue to recommend that trained healthcare professionals check for a pulse before doing chest compressions.

The changes in CPR guidelines mean that individuals who have previously been trained in CPR will need to be re-trained when their current certification expires. The new CPR and advanced training materials will be available for widespread use by next summer.

The updated guidelines place major emphasis on early defibrillation for ventricular fibrillation and AEDs as a tool to increase sudden cardiac arrest survival. AEDs are easy to use. Two electrodes are applied to the chest and the device automatically senses the heart rhythm and determines whether a lifesaving electric shock is necessary. The AED prompts the user to deliver a shock and all the bystander has to do is press the "shock" button. Prompt bystander CPR combined with early defibrillation have produced survival rates exceeding 50 percent in some early defibrillation programs.

The guidelines urge greater availability of AEDs--and people trained to use them--in fire trucks, ambulances, police cars, public buildings, sports arenas, theaters and airports. "If you walk through O'Hare Airport in Chicago, you are never more than a minute away from a defibrillator, and they are saving lives." says Robertson. "This means the general public has easy access to AEDs in the event an individual goes into sudden cardiac arrest at the airport and requires quick defibrillation.

"The changes in the CPR guidelines are aimed at simplifying training by focusing on the most effective aspects of resuscitation. The public can be assured that people trained using these guidelines are getting the most up-to-date science," says Robertson. "These updated guidelines will enable the trained rescuer to do a better job in assisting individuals experiencing a cardiovascular emergency."

Other new recommendations include:

• Streamlining/standardizing the ratio of chest compressions to breaths during adult CPR.
• Updated recommendations for emergency medical personnel such as medication treatment protocols for heart attacks, stroke and cardiac arrest in victims of all ages.
• Simplification of CPR instruction. For example, techniques to teach management of choking (airway obstruction) in an unconscious victim have been greatly simplified.

The use of abdominal thrusts (commonly known as the Heimlich maneuver) to clear an object from the airway of a conscious person will still be taught under the new guidelines.