High-quality CPR continues to be of primary importance in optimizing outcomes for cardiac arrest. As a result, there have been changes to the BLS and CPR quality guidelines. These BLS and CPR quality changes are reviewed below.
The recommended depth of chest compressions will remain at, at least 2 inches (5 cm). In addition to this, the BLS and CPR quality changes for compression depth include avoiding excessive chest compressions.
Chest compression should not be deeper than 2.4 inches (6cm) allowing for complete chest recoil between each compression. This compression depth limit was implemented because there is evidence that complications may arise when compression depth exceeds this limit.
During cardiac arrest lay rescuers and health care providers should perform chest compressions at a rate of 100 to 120 per minute. This change added an upper limit of 120 because compression rates greater than 120 per minute negatively affect outcomes for cardiac arrest.
Full Chest Wall Recoil:
Another BLS and CPR quality change includes emphasizing to rescuers that they must avoid leaning on the chest between compressions. This will ensure that full chest wall recoil is achieved after each compression.
Full chest wall recoil ensures that the negative pressure involved in the return of blood flow to the heart and myocardial circulation is present. Leaning on the chest creates a slight positive pressure which can have a detrimental effect on resuscitation outcomes.
Emphasis is also being placed on minimizing interruptions in chest compressions. The goal for the percent of the time for performing chest compressions is recommended for at least 60% during CPR.
This percent of the time is known as the chest compression fraction time. Chest compression fraction is a measurement of the proportion of total resuscitation time that compressions are performed.
Health Care Provider BLS:
Health Care Providers (HCP) must call for nearby help upon finding a victim unresponsive, but it is practical for the HCP to continue to assess the breathing and pulse simultaneously before fully activating the emergency response system (or calling for backup).
This BLS and CPR quality change should help minimize the delay to chest compressions and encourage fast, flexible, and efficient assessment based responses.
Health Care Providers are encouraged to tailor the sequence of rescue actions to the most likely cause of arrest, and they should provide chest compressions and ventilations for all adult patients in cardiac arrest. Compression-only CPR should be limited to untrained rescuers.
Advanced Airway Ventilations:
For all patients from infant to adult, with an advanced airway in place, providers may deliver 1 breath every 6 seconds (10 breaths per minute) while chest compressions are being performed. This change was implemented to simplify the ventilation requirements during CPR with an advanced airway in place.