Summary of changes since 2005 Guidelines

Many of the recommendations made in the ERC Guidelines 2005 remain unchanged, either because no new studies have been published or because new evidence since 2005 has merely strengthened the evidence that was already available. Examples of this are the general design of the BLS and AED algorithms, the way the need for cardiopulmonary resuscitation (CPR) is recognised, the use of AEDs (including the shock protocols), the 30:2 ratio of compressions and ventilations, and the recognition and management of a choking victim. In contrast, new evidence has been published since 2005 that necessitates changes to some components of the 2010 Guidelines. The 2010 changes in comparison with the 2005 Guidelines are summarised here:

• Dispatchers should be trained to interrogate callers with strict protocols to elicit information. This information should focus on the recognition of unresponsiveness and the quality of breathing. In combination with unresponsiveness, absence of breathing or any abnormality of breathing should start a dispatch protocol of suspected cardiac arrest. The importance of gasping as sign of cardiac arrest should result in increased emphasis on its recognition during training and dispatch interrogation.
• All rescuers, trained or not, should provide chest compressions to victims of cardiac arrest. A strong emphasis on delivering high quality chest compressions remains essential. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression–ventilation ratio of 30:2. Telephone-guided CPR is encouraged for untrained rescuers who should be told to deliver uninterrupted chest compressions only.
• In order to maintain high-quality CPR, feedback to rescuers is important. The use of prompt/feedback devices during CPR will enable immediate feedback to rescuers, and the data stored in rescue equipment can be used to monitor the quality of CPR performance and provide feedback to professional rescuers during debriefing sessions.
• When rescuers apply an AED, the analysis of the heart rhythm and delivery of a shock should not be delayed for a period of CPR; however, CPR should be given with minimal interruptions before application of the AED and during its use.
• Further development of AED programmes is encouraged—there is a need for further deployment of AEDs in both public and residential areas.