2015 AHA ECC Guidelines

The new 2015 American Heart Association (AHA) Guidelines for CPR & ECC have been released (as of 10/15/2015). This page provides a summary of the changes made and links to official websites that have more information about this important update. The 2015 AHA Guidelines are not an “overhaul” of CPR, emergency cardiac care, and first aid, but rather it is a fine-tuning of past requirements.

Be sure to check out other links at the bottom of this page.

General CPR/AED Recommendations

Use of Mobile Phone to Call EMS. The use of mobile phone to activate the EMS system was added to the BLS algorithm for all patients.
Timing of EMS Call for BLS Professionals. Although bystanders should call EMS immediately for an unresponsive patient, BLS professionals should direct the call to be made following the 10-second check for pulse and breathing.
C-A-B vs. A-B-C Sequence. The C-A-B (compressions-airway-breathing) sequence is recommended for trained bystanders and BLS professionals treating adult, child, and infant patients except in the case of drowning.
A-B-C Sequence for Drowning. For drowning victim who are not breathing, first aid providers should use the A-B-C sequence due to the hypoxic nature of the patient’s condition. Mouth-to-mouth ventilations can be given during in-water rescues provided there is no delay in removing the person from the water. This supports the A-B-C sequence since chest compressions cannot be initiated until the patient is removed from the water.
Compression Rate. The compression rate for adult, child, and infant patients has been redefined as 100 to 120 compressions per minute (cpm).
A Continued Emphasis on High-Quality CPR. The 5 components of high-quality CPR are:
- Ensuring chest compressions of adequate rate (100 to 120 cpm)
- Ensuring chest compressions of adequate depth
- Allowing full chest recoil between compressions
- Minimizing interruptions in chest compressions (see “Compression Fraction”)
- Avoiding excessive ventilation
Compression Fraction. A compression fraction of at least 60% is recommended. Compression fraction refers to the total time giving chest compressions divided by the total time caring for the patient. For example, a bystander caring for an unconscious victim for 5 minutes will achieve a 60% compression fraction if 3 of those 5 minutes have been spent giving compressions. (In contrast, if only 1 minute of 5 has been spent giving chest compressions, this is only a 20% compression fraction, which means that the bystander is not pumping the patient’s blood adequately to vital organs!)
AED and CPR. If available, an AED should be used right away without the need to do CPR first. Transitions between AED analysis/shocks and CPR should be done as quickly as possible.

Adult Basic Life Support (BLS) Recommendations

Hand Placement. The heel of the hand should be placed in the center of the chest on the lower half of the sternum, and the heel of the other hand should be placed on top of the first hand so that they are overlapped and parallel. The use of the intermammary line as a landmark for hand placement is not reliable.
Compression Depth. The recommended compression depth for adult victims is at least 2 inches (5 cm) but no deeper than 2.4 inches (6 cm).
Compression-to-Ventilation Ratio. The best ratio has been reaffirmed as 30:2 for 1-rescuer or 2-rescuer CPR (no change from 2010).
2-Rescuer CPR. Changes in 2-rescuer CPR should be made every 2 minutes to prevent fatigue. The change should be made as quickly as possible.

Pediatric BLS Recommendations

Bradycardia with Poor Perfusion. If the pulse rate of a child or infant is <60 bpm and there is evidence of poor circulation (i.e., pallor, mottling, or cyanosis), BLS professionals should begin CPR.
Conventional vs. Compression-Only CPR. Conventional CPR (compressions and breaths) is strongly recommended for pediatric patients. Available data suggest that ventilations are critically important for children and infants in cardiac arrest. However, if rescuers are unwilling or unable to give breaths, compression-only CPR is better than doing nothing.
Hand Placement for Child CPR. One or two hands can be used depending on the size of the patient-two hands is recommended to prevent fatigue. The heel of the hand should be placed in the center of the chest on the lower half of the sternum, and the heel of the other hand should be placed on top of the first hand and fingers interlaced. The use of the intermammary line as a landmark for hand placement is not reliable. Rescuers should compress at least 1/3 the depth of the chest or about 2 inches (5 cm).
Finger Placement for Infant CPR. When performing 1-rescuer CPR, both trained bystanders and BLS professionals should compress the sternum with 2 fingers positioned just below the intermammary line. Rescuers should compress at least 1/3 the depth of the chest or about 1.5 inches (4 cm). The 2-thumbs–encircling hands technique is more effective than the 2-finger technique for chest compressions, but it is impractical to do unless another rescuer is available to give ventilations.
Compression-to-Ventilation Ratio. The best ratio for children and infants has been reaffirmed as 30:2 for 1-rescuer CPR and 15:2 for 2-rescuer CPR (no change from 2010).

First Aid Recommendations

Anaphylaxis Treatment. A second dose of epinephrine may be considered for extreme anaphylaxis if a first dose does not relieve signs and symptoms after 10 to 15 minutes.
Aspirin Administration for Chest Pain. Aspirin administration by first aid providers is recommended as long as the patient is not allergic or no other contraindications exist (e.g., patient takes blood thinner, etc.).
Avulsed (Knocked-Out) Teeth. A knocked-out tooth should be retrieved and re-implanted in the patient’s mouth as soon as possible. If the tooth cannot be re-implanted, it should be stored temporarily in a container of Hank’s Balanced Salt Solution, Propolis, egg whites, coconut water, ricetral, whole milk, or saline (in order of preference) and sent with the patient to the emergency room or dentist.
Burns. Active cooling of burns with nonfreezing cold water was reaffirmed. The recommended minimum time for cooling is 10 minutes. There was no recommendation given regarding wet vs. dry bandaging for thermal burns in a prehospital setting.
Cervical Collar Use by First Aid Providers. The use of cervical collars by first aid providers is not recommended due to possible complications and secondary injuries that might occur during application.
Concussion. The task force sought to evaluate the effectiveness of early clinical recognition of concussion by first aid providers using a simple scoring system. (Failure to properly recognize concussion can result in delay or absence of referral for definitive evaluation and care or inappropriate release to activity, which has the potential to worsen outcomes.) Although the task group thought the Glasgow Coma Scale (GCS) was not an appropriate tool for first aid providers, they had no recommendation and could neither support or refute the use of a simplified scoring system, such as Sport Concussion Assessment Tool (SCAT), the GCS, or AVPU scale versus standard first aid without a scoring system.
Exertion-Related Dehydration. 3% to 8% carbohydrate-electrolyte (CE) drinks are recommended for rehydration. If 3% to 8% CE drinks are not available or tolerated, alternate beverages for rehydration include water, coconut water, milk, tea, or tea-CE.
External Bleeding (Severe). Hemostatic agents and tourniquets continue to be recommended for severe bleeding that cannot be stopped by direct pressure and bandaging. The task group found inadequate evidence to make a treatment recommendation on the use of proximal pressure points, localized cold therapy for external bleeding, or the elevation of an extremity for control of bleeding.
Eye Injuries by Chemicals. Large amounts of clean water is recommended over saline solutions or commercial eye irrigation solutions. The Poison Control Center should be consulted and all eye injuries of this kind should be evaluated by a physician.
Fractures. The task group made no recommendation about straightening angulated fractures vs. splinting a fracture in the position found. Part of their explanation includes this quote: “Consistent with the first aid principle of preventing further harm, and based on training and circumstance, providers may need to move an injured limb or person. In such situations, first aid providers should protect the victim, which includes splinting in a way that limits pain, reduces the chance for further injury, and facilitates safe and prompt transport.”
Internal Bleeding (Minor). Applying cold therapies with or without direct pressure for minor internal bleeding on extremities is recommended for hemostasis.
Low-Blood-Sugar Treatment. Glucose tablets are recommended for first aid care of symptomatic hypoglycemia. If glucose tablets are not available, various forms of dietary sugars can be considered. In test subjects, the change in glucose levels took between 10 to 15 minutes.
Recovery Position. A lateral recumbent (side lying) position is now recommended over supine positioning for unconscious patients who are breathing. (In 2010, the recommendation was to leave the patient in supine position unless the patient vomited.) The HAINES technique was not considered superior to any other side-lying positions.
Shock Position. It is recommended that patients in shock assume a supine position as opposed to an upright position.
Stroke Assessment. First aid providers should use FAST (facial droop, arm weakness, speech difficulty, time of onset) to check a patient for signs of a stroke.
“Sucking Chest” Wounds. The use of an occlusive dressing is no longer recommended. Open chest wounds should be handled with direct pressure but should not be sealed as this may cause or worsen tension pneumothorax (collapsed lung).
Use of Supplemental Oxygen for First Aid. Although the routine use of oxygen administration for first aid was not shown to benefit patients with COPD (chronic obstructive pulmonary disease), some benefit was shown in patients suffering from decompression sickness and advanced cancer with shortness of breath. This led the task force to conclude that no change should be made to current practice. They did recommend that supplemental oxygen only be delivered by those trained in oxygen administration.

General CPR/AED Recommendations

Adult Basic Life Support (BLS) Recommendations

Pediatric BLS Recommendations

First Aid Recommendations

Other Important 2015 ECC Links