ILCOR's 2015 Guidelines for CPR

The International Liaison Committee on Resuscitation (ILCOR) is a forum for resuscitation organizations worldwide to communicate and work together on developing and refining CPR and ECC guidelines. Members include the American Heart Association (AHA) and similar organizations in Europe, Canada, New Zealand, Africa, and Australia.

On October 15, the organization published new guidelines for CPR and emergency cardiovascular care. Here are some of the high points:

Emergency dispatchers should provide CPR instructions immediately to callers. The new guidelines emphasize rapid identification of a possible cardiac arrest scenario on the part of dispatchers, and the immediate provision of CPR instructions. Since mobile phones are so ubiquitous now, callers can often call 911 without leaving the victim’s side and are able to provide CPR immediately if they know how. Dispatchers can reasonably assume that if someone is unconscious and either breathing abnormally or not breathing, cardiac arrest is the cause, but they should be trained to recognize a range of causes for these symptoms.

There’s an upper limit on how fast and deep compression should be. Previously, studies have identified that CPR often fails because the compression isn’t fast or deep enough. In the 2015 guidelines, however, there’s an upper limit as well—as compressions that are too fast may reduce the rate of return for spontaneous circulation and are sometimes associated with inadequate depth. The depth of compressions should be limited as well, because if compressions are too deep, they can cause injury.

The new guidelines include the following:

• Compressions for adult patients should be delivered at a rate of between 100 and 120 per minute; no faster than 120 per minute.
• Compression depth should be between 2-2.4 inches or 5-6 centimeters.
• CPR should be delivered as close to immediately as possible after cardiac arrest has occurred, and interruptions in compressions should be minimized as much as possible.

There is difficulty in gauging the correct compression depth, especially for lay rescuers. The new window of effectiveness for depth of chest compressions is very precise. While high-fidelity CPR training mannequins do provide feedback to students on the depth of compressions, it is unlikely that students even in the most rigorous programs will get enough practice to be able to gauge the appropriate depth on their own with a living patient.

There are devices on the market that evaluate compression depth while a rescuer is delivering CPR to a human patient. However, while these have yet to be tested thoroughly, one study has already found these not to be effective in improving CPR compressions. Setting the device up could also cause a delay that could reduce the chances of survival for the patient.

The chest should be allowed to recoil after each compression. “Recoil” involves letting the chest expand again fully after a compression. Often, rescuers put pressure on the chest in the split-second between one compression and another. This keeps the heart from fully filling with blood. Instructors in an in-person setting can identify when a rescuer is unconsciously leaning on the chest between compressions; it is usually not deliberate.

Mechanical chest compression devices are still iffy. Three studies have been conducted to evaluate the performance of mechanical chest compression devices against manual CPR. None of the studies showed that mechanical devices have better outcomes than manual CPR. However, these devices may still be worth using, especially in settings where performing manual compressions may be difficult or dangerous for rescuers.

New recommendations for CPR training. The organization provides new guidelines for training of both lay rescuers and medical professionals in CPR. These include using high-fidelity mannequins (mannequins with realistic simulated breathing, pulse, and other features) for ALS training when possible and the use of CPR feedback devices to mechanically evaluate delivery of care.

The guidelines also suggest that the two-year recertification time is too long, and that advanced life support and BLS certifications should require a more frequent training cycle.

ILCOR also states that self-instruction, through online and video training, is an effective method for lay rescuers to learn CPR, and self-instruction opportunities should be increased to improve the numbers of trained lay rescuers.

Much of the ILCOR guidelines are more relevant to healthcare professionals than to lay rescuers, but there are still some important updates that may affect lay rescuer training in the next five years. Important points include the depth and speed of compressions and a wider development of self-education programs for CPR training.