CPR Guideline Changes

In 2015, the AHA made some important changes to the CPR Guidelines. If you took an older CPR course, you will want to learn these important changes listed in the right side column.

Guideline Old Guideline 2015 Guideline
EMS Activation Provider should check for a response before activating EMS. Call for help immediately, preferably while assessing the victim (pulse and breathing).
EMS Activation

 

  Alone with no cell phone: Leave victim to activate EMS and get AED before CPR UNLESS an unwitnessed collapse of an infant or child. Give 2 minutes of CPR then activate EMS/get AED.

 

Alone with cell phone: Activate EMS first.

Not alone: Split duties; 1-2 people start CPR while 1-2 people activate EMS and get AED.

Sequence CAB (compressions, airway, breathing). Confirmed in the 2015 Guidelines: Do not delay the first 30 chest compressions.
Compression Depth Used “at least” without a maximum depth. Infants to children up to puberty: Compress the chest up to 1/3 of the chest diameter.

Puberty, adolescence, adult: Compression depth between 2 and 2.4 inches (5 to 6 cm).

Compression Frequency At least 100 compressions per minute. No less than 100, no more than 120 per compressions per minute.
Chest Recoil Allow the chest to fully recoil between compressions. Confirmed in the 2015 Guidelines: Do not lean on the chest between compressions; allow the heart to fully fill with blood.
Compression-Only CPR Compression-only CPR emerged since the 2010 update. It has been formalized in the 2015 guidelines for untrained rescuers. Untrained rescuers should provide chest compressions until EMS arrives or a trained provider arrives (or the victim starts to move). Rescue breathing should only be done if it can be done competently.
Naloxone New recommendation for 2015. Trained lay providers and EMS should provide intramuscular or intranasal naloxone in the case of known or suspected opioid overdose (abnormal or no breathing, no response, has a pulse)
Shock or CPR First? Highly complex recommendations that changed based on various circumstances Use AED in a witnessed cardiac arrest if immediately available; administer chest compressions until AED arrives and is on the victim, ready for use.

The CPR process for adults teaches one-rescuer CPR but also recognizes that there may be more rescuers available to help. In the CPR course, students learn both one- and two-rescuer CPR.

  • Secure the scene: Make sure you and the victim are not in immediate danger (e.g. move out of traffic).
  • Shake and shout: Does the victim respond? Is the victim breathing normally? No breathing or ineffective breathing is not normal breathing.
  • Activate EMS: Send someone to call for help. If you are alone, use your cell phone first, and then start CPR.
  • Research shows that beginning compressions early increases the chance of survival. Use “CAB” (Chest Compressions, Airway, Breathing).
  • High-quality CPR includes:
    • Perform compressions at a rate between 100 and 120 per minute, regardless of the age of the victim.
    • Chest compressions should be between 2 and 2.4 inches (5 to 6 cm) for adults and adolescents.
    • Chest compressions should be given to a depth of 1/3 the diameter of the chest in infants and children up to puberty. This is about 1.5 inches (4 cm) in infants and 2 inches (5 cm) in children.
    • Allow the chest to completely recoil between compressions.
    • Minimize interruptions to chest compressions. Do not interrupt compressions except to use an AED or change providers. Interruptions should be limited to no more than 10 seconds at a time.
    • Deliver each ventilation over 1 second, regardless of victim’s age.
    • Prevent over-inflation of the lungs by avoiding rapid ventilations.
    • Perform CPR as a team to perform activities more quickly and efficiently.