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CPR Curriculum and AHA and ILCOR Guidelines Compliance

Following AHA and ILCOR Guidelines

Emergency University's Online CPR Training and Online AED Training programs are developed in accordance with the internationally accepted guidelines established by ILCOR*, the International Liaison Committee on Resuscitation and published by the American Heart Association (2010 Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science) Circulation. 2010:122[suppl 3]: S640-S933. Please see below how Emergency University's online CPR and AED training courses are developed in accordance with the latest guidelines published by ILCOR and AHA.

*ILCOR members include the Australian Resuscitation Council, the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Inter-American Heart Foundation, the New Zealand Resuscitation Council, and the Resuscitation Council of Southern Africa.

ILCOR 2005AHA 2005AHA 2010EU Program Location
Rescuers should start CPR if the victim is unconscious (unresponsive), not moving, and not breathing. Even if the victim takes occasional gasps, rescuers should suspect that cardiac arrest has occurred and should start CPR. Circulation 2005;112;IV-19-25 Circulation 2005;112;III-5,6CPR training should emphasize how to recognize occasional gasps and should instruct rescuers to give rescue breaths and proceed with the steps of CPR when the unresponsive victim demonstrates occasional gasps. Circulation 2005;112;IV-23Lone lay Rescuers should start CPR if the victim is unresponsive and has absent or abnormal breathing. Circulation, 2010;122:S686 Adult CPR Training Frame 8, 14; Adult CPR Practice Scenario 1; Answer to Adult CPR Practice Scenario 2; Adult CPR Test Practice Question 3 and Question 4; Adult CPR Test Question 3 and Question 4
Use of AEDs by trained lay and professional responders is recommended to increase survival rates in patients with cardiac arrest. Circulation 2005;112;III-18Bystanders can perform 3 of the 4 links in the Chain of Survival. Circulation 2005;112;IV-12,19,20Bystanders can perform 3 of the 4 links in the Chain of Survival. Circulation, 2010;122:S686 Anatomy & Physiology Frame 10, Anatomy & Physiology Test Question 5
 Once the rescuer has ensured that the scene is safe, the rescuer should check for response. Circulation 2005;112;IV-21Once the rescuer has ensured that the scene is safe, the rescuer should check for response. Circulation, 2010;122:S686 Adult CPR Training Frame 9
 To check for response, tap the victim on the shoulder and ask, 'Are you all right?' Circulation 2005;112;IV-21If a lone rescuer finds an unresponsive adult (no movement or response to stimulation) or witnesses an adult who suddenly collapses, after ensuring that the scene is safe, the rescuer should check for a response by tapping the victim on the shoulder and shouting at the victim. Circulation, 2010;122:S686Adult CPR Training Frames 9-10; Adult CPR Practice Scenario 2; Adult CPR Practice Test Question 1; Adult CPR Test Question 1.
 If a lone rescuer finds an unresponsive adult (i.e., no movement or response to stimulation), the rescuer should activate the EMS system (phone 911), get an AED (if available), and return to the victim to provide CPR and defibrillation if needed. Circulation 2005;112;IV-21If a lone rescuer finds an unresponsive adult (i.e., no movement or response to stimulation), the rescuer should activate the EMS system (phone 911), get an AED (if available), and return to the victim to provide CPR and defibrillation if needed. Circulation, 2010;122:S677-78Anatomy and Physiology Frame 10; Anatomy and Physiology Test Question 5; Adult CPR Training Frames 10-14; Adult CPR Test Practice Question 2; Adult CPR Test Question 2.
  While no published human or animal evidence demonstrates that starting CPR with 30 compressions rather than 2 ventilations leads to improved outcomes, beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression. Circulation 2010;122:S688 Adult CPR Training Frame 14; Adult CPR Test Practice Question 4; Adult CPR Test Question 4.
Rescuers should open the airway by using the head tilt chin lift maneuver. Circulation 2005;112;IV-21 Circulation 2005;112;III-6The lay rescuer should open the airway using a head tilt-chin lift maneuver for both injured and non-injured victims. Circulation 2005;112;IV-21The trained lay rescuer who feels confident that he or she can perform both compressions and ventilations should open the airway using a head tilt-chin lift maneuver. Circulation 2010;122:S691 Adult CPR Practice Scenario 6; Adult CPR Test Practice Question 5, Adult CPR Test Practice Question 8; Adult CPR Test Question 5; Adult CPR Test Question 8.
 While maintaining an open airway, look, listen, and feel for breathing. Circulation 2005;112;IV-22-24 Rescuers should start CPR immediately if the adult victim is unresponsive and not breathing or not breathing normally (i.e., only gasping). The directive to "look, listen, and feel for breathing" to aid recognition is no longer recommended. Circulation, 2010;122:S678Adult CPR Training Frames 14; Adult CPR Test Practice Question 3; Adult CPR Test Question 3
It is reasonable to give each breath within a 1-second inspriratory time to achieve chest rise. Circulation 2005; 112;III-7Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise. Circulation 2005;112;IV-23Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise. Circulation 2010;122:S688. Circulation 2010;122: S692 Adult CPR Training Frame 19, 20; Adult CPR Test Practice Question 6, 9; Adult CPR Test Question 6, 9.
Rescuers should be encouraged to do compression-only CPR if they are unwilling to do airway and breathing maneuvers. Circulation 2005; 112;III-9Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths. Circulation 2005;112;IV-27Laypersons should be encouraged to provide chest compressions (either Hands-Only or conventional CPR, including rescue breaths) for anyone with a presumed cardiac arrest. Circulation 2010;122: S691Adult CPR Training Frames 3, 9-22; Adult CPR Practice Scenario Question 1; Adult CPR Test Practice Question 3 and Question 4; Adult CPR Test Question 3 and Question 4
Cardiac arrest victims should be placed supine on a firm surface. Circulation 2005; 112;III-8To maximize the effectiveness of compressions, the victim should lie supine on a hard surface. Circulation 2005;112;IV-25To maximize the effectiveness of compressions, the victim should lie supine on a hard surface. Circulation, 2010;122:S689Adult CPR Training Frame 15
Position the heel of their dominant hand in the center of the chest of an adult victim, with the non-dominant hand on top. Circulation 2005;112;III-7The rescuer should place the heel of the hand on the sternum in the center (middle) of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel. Circulation 2005;112;IV-26The rescuer should place the heel of one hand on the center (middle) of the victim's chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel. Circulation, 2010;122:S690Adult CPR Training Frames 15, 16; Adult CPR Practice Scenario 7;
To give effective chest compressions push hard and push fast. "Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 1/2 to 2 inches." Circulation 2005;112;IV-25,26 Circulation 2005;112;III-8To give effective chest compressions push hard and push fast. "Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 1/2 to 2 inches." Circulation 2005;112;IV-25,26The adult sternum should be depressed at least 2 inches (5 cm)... It is reasonable for lay rescuers and healthcare providers to perform chest compressions for adults at a rate of at least 100 compressions per minute. Circulation, 2010;122:S690Adult CPR Training Frame 15-17; Adult CPR Practice Scenarios 7
It is reasonable to use a duty cycle (i.e., ratio between compression and release ) of 50%. Circulation 2005; 112; III-8Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times. Circulation 2005;112;IV-25Chest compressions and chest recoil/relaxation times should be approximately equal. Allow the chest to completely recoil after each compression. Circulation, 2010;122:S690Adult CPR Training Frame 17
When feasible, rescuers should frequently alternate compressor" duties, regardless of whether they feel fatigued, to ensure that fatigue does not interfere with delivery of adequate chest compressions." Circulation 2005;112;IV-26 Circulation 2005;112;III-8When 2 or more rescuers are available, it is reasonable to switch the compressor about every 2 minutes (or after 5 cycles of compressions and ventilations at a rate of 30:2). Circulation 2005;112;IV-26When 2 or more rescuers are available it is reasonable to switch chest compressors approximately every 2 minutes (or after about 5 cycles of compressions and ventilations at a rate of 30:2)Circulation, 2010;122:S690Adult CPR Training Frames 18, 21
 Lay rescuers should continue CPR until an AED arrives, the victim begins to move, or EMS personnel take over CPR. Circulation 2005;112;IV-26Lay rescuers should continue CPR until an AED arrives, the victim wakes up, or EMS personnel take over CPR. Circulation, 2010;122:S691Adult CPR Training Frame 22; Adult CPR Test Conclusion; Adult CPR Practice Test Conclusion.
ILCOR 2005AHA 2005AHA 2010EU Program Location
 Gently tap the victim and ask loudly, Are you OK?" Call the child's name if you know it. Look for movement. If the child is responsive, he or she will answer or move". Circulation 2005;112;IV-157Gently tap the victim and ask loudly, "Are you OK?" Call the child's name if you know it. If the child is responsive, he or she will answer, move, or moan. Circulation, 2010;122:S863 Child CPR Training Frame 22
 If the child is unresponsive and is not moving, shout for help and start CPR. Circulation 2005;112;IV-157If the victim is unresponsive and not breathing ( or only gasping) , begin CPR. Circulation, 2010;122:S863 Child CPR Training Frame 17; Child CPR Training Frames 22-26
A period of immediate CPR before phoning EMS and getting the AED (call fast) is indicated for most pediatric arrests because the are presumed to be asphyxial or prolonged. "lone rescuers should perform CPR for 5 cycles (about 2 minutes) before activating EMS." Circulation 2005; 112; III-74If you are alone, continue CPR for 5 cycles (about 2 minutes). One cycle of CPR for the lone rescuer is 30 compressions and 2 breaths. Then activate the EMS system and get an automated external defibrillator (AED). Circulation 2005;112;IV-157For the lone rescuer a compression-to-ventilation ratio of 30:2 is recommended. After the initial set of 30 compressions, open the airway and give 2 breaths. In an unresponsive infant or child, the tongue may obstruct the airway and interfere with ventilations. Open the airway using a head tilt-chin lift maneuver for both injured and non injured victims. After 2 minutes of CPR the lone rescuer activates the emergency response system and gets an AED if one is nearby. The lone rescuer should then return to the victim as soon as possible and use the AED (if available) or resume CPR, starting with chest compressions. Circulation, 2010;122:S864 Child CPR Training Frame 17
"In a witnessed sudden collapse (e.g.. During an athletic event), the cause is more likely to be VF, and the lone rescuer should phone for professional help and get the AED (when available) before starting CPR". Circulation 2005; 112; III-74If the arrest is witnessed and sudden (e.g., an athlete who collapses on the playing field), a lone healthcare provider should activate the EMS system (by telephoning 911 in most locales) and get an AED (if the child is 1 year of age or older) before starting CPR. Circulation 2005;112;IV-157It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. For example, if the arrest is witnessed and sudden (e.g. sudden collapse in an adolescent or a child identified at high risk for arrhythmia or during an athletic event), the healthcare provider may assume that the victim has suffered a sudden VS-cardiac arrest and as soon as the rescuer verifies that the child is unresponsive and not breathing (or only gasping) the rescuer should immediately phone the emergency response system, get the AED and then begin CPR and use the AED . Circulation, 2010;122:S865.Child CPR Training Frame 19
Cardiac arrest victims should be placed supine on a firm surface. Circulation 2005; 112;III-8If the victim is unresponsive, make sure that the victim is in a supine (face up) position on a flat, hard surface, such as a sturdy table, the floor, or the ground. Circulation 2005;112;IV-157For best results, deliver chest compressions on a firm surface. Circulation, 2010;122:S864Child CPR Training Frame 26
 If you must turn the victim, minimize turning or twisting of the head and neck. Circulation 2005;112;IV-157no changeChild CPR Training Frame 26
 If you are a lay rescuer, open the airway using a head tilt-chin lift maneuver for both injured and non-injured victims. Circulation 2005;112;IV-157Open the airway using a head tilt-chin lift maneuver for both injured and non-injured victims. Circulation, 2010;122:S864Child CPR Training Frame 29
 While maintaining an open airway, take no more than 10 seconds to check whether the victim is breathing: Look for rhythmic chest and abdominal movement, listen for exhaled breath sounds at the nose and mouth, and feel for exhaled air on you cheek. Periodic gasping, also called agonal gasps, is not breathing. Circulation 2005;112;IV-158Look to see if victim has regular breathing, or is not breathing or only gasping. Circulation, 2010;122:S863Child CPR Training Frames 16, 24, 26
 If the child is not breathing or has only occasional gasps: for the lay rescuer: maintain an open airway and give two breaths. "Give 2 breaths that make the chest rise." Circulation 2005;112;IV-158The CAB sequence for infants and children is recommended in order to simplify training with the hope that more victims of sudden cardiac arrest will receive bystander CPR Circulation, 2010;122:S863Child CPR Training Frames 24-32
There is no data to justify a change from the recommendation that the rescuer attempt mouth-to-mouth-and-nose ventilation for infants Circulation 2005:112:III-75In an infant, use a mouth-to-mouth-and-nose technique (LOE 7; Class Iib): in a child, use a mouth-to-mouth technique. Circulation 2005;112;IV-159To give breaths to an infant, use a mouth-to-mouth-and -nose technique; to give breaths to a child, use a mouth-to-mouth technique. Make sure the breaths are effective (i.e. the chest rises) Each breath should take about 1 second. If the chest does not rise, reposition the head, make a better seal, and try again. Circulation, 2010;122:S864Child CPR Training Frame 30, 31
Lay rescuers should start chest compressions for an unresponsive infant or child who is not moving or breathing. Circulation 2005; 112; III-74Lay rescuers are not taught to check for a pulse. The lay rescuer should immediately begin chest compressions after delivering 2 rescue breaths. Circulation 2005;112;IV-160Lay rescuers are unable to reliably detect a pulse. Circulation, 2010;122:S865
The two finger technique is recommended for 1-rescuer infant CPR to facilitate rapid transition between compression and ventilation and to minimize interruptions in chest compressions. It remains an acceptable alternative method of chest compressions for 2 rescuers. Circulation 2005; 112; III-75To give chest compressions, compress the lower half of the sternum but do not compress over the xiphoid. "In an infant victim, lay rescuers and lone rescuers should compress the sternum with 2 fingers place just below the intermammary line." Circulation 2005;112;IV-160For a child, lay rescuers should compress the lower half of the sternum at least one third of the AP dimension of the chest or approximately 5 cm (2 inches) with the heel of 1 or 2 hands. Do not press on the xiphoid or the ribs. There is no data to determine if the 1 or 2 hand method produces better compressions and better outcome. For an infant, lone rescuers should compress the sternum with 2 fingers placed just below the intermammary line. do not compress over the xiphoid or ribs. Rescuers should compress at least 1/2 the depth of the chest, or about 4 cm. (1.5 inches)Circulation, 2010;122:S863,864Child CPR Training Frame 27-28; Frame 33-34
 Push Hard: push with sufficient force to depress the chest approximately one third to one half the anterior-posterior diameter of the chest. Push Fast: push at a rate of approximately 100 compressions per minute. Release completely to allow the chest to fully recoil. Minimize interruptions in chest compressions. Circulation 2005;112;IV-160Push fast: push at a rate of at least 100 compressions per minute. Push hard; push with sufficient force to depress at least on third the AP diameter of the chest or approximately 1 1/2 inches(4cm) in infants and 2 inches (5 cm) in children. Allow complete chest recoil after each compression to allow the heart to refill with blood. Minimize interruptions of chest compressions. Avoid excessive ventilation. Circulation, 2010;122:S864Child CPR Training Frames 28
For ease of teaching and retention, a universal compressions ventilation ratio of 30:2 is recommended for the lone rescuer responding to infants, children, and adults. Circulation 2005; 112; III-75If you are the only rescuer, perform cycles of 30 chest compressions (Class Indeterminate) followed by 2 effective ventilations with as short a pause in chest compressions as possible. Circulation 2005;112;IV-161no changeChild CPR Training Frame 35
Trained rescuers should be encouraged to provide both ventilations and chest compressions. If rescuers are reluctant to provide rescue breaths, however, they should be encouraged to perform chest compressions alone without interruption. Circulation 2005; 112; III-75,76If a rescuer is unwilling or unable to provide ventilations, chest compressions alone are better than no resuscitation at all. Circulation 2005;112;IV-161no changeChild CPR Training Frame 32
ILCOR 2005AHA 2005AHA 2010EU Program Location
Chest thrusts, back blows/slaps, or abdominal thrusts are effective for relieving FBAO in conscious adults and children >1 year of age. "These techniques should be applied in rapid sequence until the obstruction is relieved". Circulation 2005;112;III-6Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children ? 1 year of age, for simplicity in training we recommend that the abdominal thrust be applied in rapid sequence until the obstruction is relieved Circulation 2005;112;IV-28Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children > 1 year of age, for simplicity in training we recommend that the abdominal thrust be applied in rapid sequence until the obstruction is relieved. If abdominal thrusts are not effective, the rescuer may consider chest thrusts. Circulation, 2010;122:S696Obstructed Airway Training Frames 4-7
Unconscious victims should receive CPR Circulation 2005;112;III-6If the adult victim of FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground, immediately activate EMS and then begin CPR. Circulation 2005;112;IV-29If the adult victim of FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground, immediately activate EMS and then begin CPR. Circulation, 2010;122:S696Obstructed Airway Training Frame 7
The finger sweep should be used in the unconscious patient with an obstructed airway only if solid material is visible in the airway. Circulation 2005;112;III-6 In an obstructed airway victim who becomes unresponsive, and is receiving CPR, each time the airway is opened during CPR, the rescuer should look for an object in the victim's mouth, and if found, remove it. Circulation, 2010;122:S696Obstructed Airway Training Frame 7
 For an infant deliver 5 back blows (slaps) followed by 5 chest thrusts repeatedly until the object is expelled or the victim becomes unconscious. Circulation 2005; 112;IV-162no changeObstructed Airway Training Frames 8-11
ILCOR 2005AHA 2005AHA 2010EU Program Location
Use of AED's by trained lay and professional responders is recommended to increase survival rates in patients with cardiac arrest. Circulation 2005;112;III-18 no changeAED Training Frame 2
 When any rescuer witnesses an out-of-hospital arrest and an AED is immediately available on-site, the rescuer should use the AED as soon as possible. Circulation 2005;112;IV-35When any rescuer witnesses an out-of-hospital arrest and an AED is immediately available on-site, the rescuer should use the AED as soon as possible. Circulation, 2010;122:S706AED Training Frame 6
Electrode pads should be placed on the exposed chest in an anterolateral position. Circulation 2005;112;III-18 For ease of placement and education, anterolateral is a reasonable default electrode placement. Circulation, 2010;122:S709AED Training Frames 19-21; AED Practice Scenario 6; AED Test Question 7; AED Practice Test Question 7
"Self adhesive defibrillation pads are safe and effective." Circulation 2005;112;III-19 no changeAED Training Frame 18-20
A 1-shock strategy may improve outcome by reducing interruption of chest compressions. A 3-stacked shock sequence can be optimized by immediate resumption of effective chest compressions after each shock (irrespective of the rhythm) and by minimizing the hands-off time for rhythm analysis. Circulation 2005;112;III-20The rescuer should deliver 1 shock and then immediately resume CPR, beginning with chest compressions. The rescuer should not delay resumption of chest compressions to recheck the rhythm or pulse. After 5 cycles (about 2 minutes) of CPR, the AED should then analyze the cardiac rhythm and deliver another shock if indicated. Circulation 2005;112;IV-36The rescuer should deliver 1 shock and then immediately resume CPR, beginning with chest compressions. The rescuer should not delay resumption of chest compressions to recheck the rhythm or pulse. After 5 cycles (about 2 minutes) of CPR, the AED should then analyze the cardiac rhythm and deliver another shock if indicated. Circulation, 2010;122:S707AED Training Frames 22-26; AED Practice Scenarios, Clinical Scenarios 1-3; AED Test Questions 8-11; AED Practice Test Questions 8-11
ILCOR 2005AHA 2005AHA 2010EU Program Location
Rescuers should start CPR if the victim is unconscious (unresponsive), not moving, and not breathing. Even if the victim takes occasional gasps, rescuers should suspect that cardiac arrest has occurred and should start CPR. Circulation 2005;112;IV-19-25 Circulation 2005;112;III-5,6Rescuers should start CPR if the victim is unconscious (unresponsive), not moving, and not breathing. Even if the victim takes occasional gasps, rescuers should suspect that cardiac arrest has occurred and should start CPR. Circulation 2005;112;IV-19-25 Circulation 2005;112;III-5,6Once the healthcare provider recognizes that the victim is unresponsive with no breathing, or no normal breathing (i.e. only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR. Circulation, 2010;122:S685Adult CPR Training Frame 9-10
 Bystanders can perform 3 of the 4 links in the Chain of Survival. Circulation 2005;112;IV-12,19,20Healthcare providers in hospital care settings can perform 5 links in the chain of survival. Circulation, 2010;122:S685Pro A&P Frame 10 Pro A&P Test Question 5
 Scene Safety Circulation 2005;112;IV-21A lone rescuer should first ensure that the scene is safe. Circulation, 2010;122:S685Adult CPR Frame 9
 To check for response, tap the victim on the shoulder and ask, 'Are you all right?' Circulation 2005;112;IV-21To check for responsiveness, the health care provider should check for no breathing or no normal breathing while checking for responsiveness. If there is no response and no normal breathing, the rescuer should assume the victim is in cardiac arrest and immediately activate the emergency response system. Circulation, 2010;122:S685,687Adult CPR Frame 8-9; Adult CPR Practice Question 2; Adult CPR Test Question 1-2.
 If a lone rescuer finds an unresponsive adult (i.e., no movement or response to stimulation), the rescuer should activate the EMS system (phone 911), get an AED (if available), and return to the victim to provide CPR and defibrillation if needed. Circulation 2005;112;IV-21no changeAdult CPR Frame 8-9; Adult CPR Practice Question 2; Adult CPR Test Question 1-2.
 For unresponsive victims of all ages with likely asphyxial arrest (e.g., drowning) the lone healthcare provider should deliver about 5 cycles (2 minutes) of CPR before leaving the victim to telephone the emergency response number and get the AED. Circulation 2005;112;IV-12It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. If a lone healthcare provider aids an adult drowning victim or a victim of foreign body airway obstruction who becomes unconscious, the healthcare provider may give 5 cycles (approximately 2 minutes) of CPR before activating the emergency response system. Circulation, 2010;122:S688Adult CPR Frame 11
Rescuers should open the airway by using the head tilt chin lift maneuver. "If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension." Circulation 2005;112;IV-22 Circulation 2005;112;III-6Rescuers should open the airway by using the head tilt chin lift maneuver. "If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension." Circulation 2005;112;IV-22 Circulation 2005;112;III-6Health care providers should use the head tilt-chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma. If healthcare providers suspect a cervical spine injury, they should open the airway using a jaw thrust without head extension. If this is not possible, use the head tilt-chin lift maneuver. Circulation, 2010;122:S691-692.Adult CPR Frame 19-20; Adult CPR Practice Test Question 6
 While maintaining an open airway, look, listen, and feel for breathing. Circulation 2005;112;IV-22-24Rescuers should start CPR immediately if the adult victim is unresponsive and not breathing or not breathing normally (i.e., only gasping). The directive to "look, listen, and feel for breathing" to aid recognition is no longer recommended. Circulation, 2010;122:S678Adult CPR Frame 13
It is reasonable to give each breath within a 1-second inspiratory time to achieve chest rise. Circulation 2005; 112;III-7 no changeAdult CPR Frame 16-18 Adult CPR Test Question 5
Give 2 to 5 breaths If no regular breathing. "It is reasonable to give each breath within a 1-second inspiratory time." Circulation 2005;112;IV-23-25 Circulation 2005;112;III-3,7Give 2 to 5 breaths If no regular breathing. "It is reasonable to give each breath within a 1-second inspiratory time." Circulation 2005;112;IV-23-25 Circulation 2005;112;III-3,7Following 30 chest compressions, provide 2 breaths. To provide mouth-to -mouth rescue breaths, open the victim's airway, pinch the victim's nose and create an airtight mouth to mouth seal. Give 1 breath over 1 second, take a regular(not a deep) breath, and give a second rescue breath over 1 second. Circulation, 2010;122:S692Adult CPR Frame 21-23
 After delivery of 2 rescue breaths, healthcare providers should attempt to feel a pulse in the unresponsive, non-breathing victim for no more than 10 seconds. If the provider does not definitely feel a pulse within 10 seconds, the provider should begin cycles of chest compressions and ventilations. Circulation 2005;112;IV-13Healthcare providers should interrupt chest compressions as infrequently as possible and try to limit interruptions to no longer than 10 seconds, expect for specific interventions such as insertion of an advanced airway or use of a defibrillator. Because of difficulties with pulse assessments, interruptions in chest compressions for a pulse check should be minimized during the resuscitation, even to determine if ROSC has occurred. Circulation, 2010;122:S691Adult CPR Frame 20 Adult CPR Test Question 6-7
 Healthcare providers will be taught to deliver rescue breaths without chest compressions for the victim with respiratory arrest and a perfusing rhythm. Rescue breaths without chest compressions should be delivered at a rate of about 10 to 12 breaths per minute for the adult and a rate of about 12 to 20 breaths per minute for the infant and child. Circulation 2005;112;IV-13If an adult victim with spontaneous circulation (i.e. strong and easily palpable pulses) requires support ventilation, the healthcare provider should give rescue breaths at a rate of about 1 breath every 5 to 6 seconds, or about 10-12 breaths per minute. Circulation, 2010;122:S692Adult CPR Frame 15
For ventilation with a bag valve mask with room air or oxygen it is reasonable to give each breath with a 1-second inspiratory time to achieve chest rise. Circulation 2005;112;III-7 Bag-mask ventilation is not the recommended method of ventilation for a lone rescuer during CPR. It is most effective when provided by 2 trained and experienced rescuers. One rescuer opens the airway and seals the mask to the face while the other squeezes the bag. The rescuer should deliver approximately 600 ml tial volume to adults, which is usually sufficient to produce visible chest rise. As long as the patient does not have an advanced airway in place, rescuers should deliver cycles of 30 compressions and 2 breaths during pauses in compressions, each breath delivered over 1 second. Circulation, 2010;122:S693Adult CPR Frame 24-25
During CPR with an advanced airway in place, it is reasonable to ventilate the lungs at a rate of 8 to 10 ventilations per minute without pausing during chest compressions to deliver ventilations. Circulation 2005;112;III-7Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times. Circulation 2005;112;IV-25During CPR with an advanced airway in place, continuous chest compressions are performed at a rate of 100 per minute without pauses for ventilation, and ventilations are delivered at the rate of 1 breath every 6-8 seconds, which will deliver approximately 8-10 breaths/minute. Circulation, 2010;122:S693Adult CPR Frame 26
Cardiac arrest victims should be placed supine on a firm surface. Circulation 2005; 112;III-8 To maximize the effectiveness of chest compressions, place the victim on a firm surface when possible, in a supine position. Circulation, 2010;122:S689-690.Adult CPR Frame 16
Position the heel of their dominant hand in the center of the chest of an adult victim, with the non-dominant hand on top. Circulation 2005;112;III-7 The rescuer should place the heel of one hand on the center (middle) of the victim's chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that hands are overlapped and parallel. Circulation, 2010;122:S690Adult CPR Frame 16 Adult CPR Practice Test Question 7
To give effective chest compressions push hard and push fast. "Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 1/2 to 2 inches." Circulation 2005;112;IV-25,26 Circulation 2005;112;III-8To give effective chest compressions push hard and push fast. "Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 1/2 to 2 inches." Circulation 2005;112;IV-25,26 Circulation 2005;112;III-8It is reasonable for healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches (5cm). Rescuers should allow complete recoil of the chest after each compression. Circulation, 2010;122:S688Adult CPR Frame 17-18 Adult CPR Practice Question 9
 The two rescuers should change compressor and ventilator roles approximately every 2 minutes to prevent compressor fatigue and deterioration in quality and rate of chest compressions. Circulation 2005;112;IV-13When 2 or more rescuers are available it is reasonable to switch chest compressors approximately every 2 minutes (or after about 5 cycles of compressions and ventilations at a ratio of 30:2) to prevent decreases in the quality of compressions. Circulation, 2010;122:S690Adult CPR Frame 25; Adult CPR Test Conclusion Frame
Chest thrusts, back blows/slaps, or abdominal thrusts are effective for relieving FBAO in conscious adults and children >1 year of age. "These techniques should be applied in rapid sequence until the obstruction is relieved". Circulation 2005;112;III-6 Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children > 1 year of age, for simplicity in training we recommend that the abdominal thrust be applied in rapid sequence until the obstruction is relieved. If abdominal thrusts are not effective, the rescuer may consider chest thrusts. Circulation, 2010;122:S696Obstructed Airway Training Frames 4-6
Unconscious victims should receive CPR Circulation 2005;112;III-6 If the adult victim of FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground, immediately activate EMS and then begin CPR. Circulation, 2010;122:S696Obstructed Airway Training Frame 7
The finger sweep should be used in the unconscious patient with an obstructed airway only if solid material is visible in the airway. Circulation 2005;112;III-6 In an obstructed airway victim who becomes unresponsive, and is receiving CPR, each time the airway is opened during CPR, the rescuer should look for an object in the victim's mouth, and if found, remove it. Circulation, 2010;122:S696Obstructed Airway Training Frame 7
 For an infant deliver 5 back blows (slaps) followed by 5 chest thrusts repeatedly until the object is expelled or the victim becomes unconscious. Circulation 2005; 112;IV-162no changeObstructed Airway Training Frames 9-11
 Gently tap the victim and ask loudly, Are you OK?" Call the child's name if you know it. Look for movement. If the child is responsive, he or she will answer or move". Circulation 2005;112;IV-157Gently tap the victim and ask loudly, "Are you OK?"Call the child's name if you know it. If the child is responsive, he or she will answer, move, or moan. Circulation, 2010;122:S863 Child CPR Training Frame 7 Child CPR Test Question 1
 If the child is unresponsive and is not moving, shout for help and start CPR. Circulation 2005;112;IV-157If the victim is unresponsive and not breathing (or only gasping), begin CPR. Circulation, 2010;122:S863 Child CPR Training Frame 4, 7 Child CPR Test Question 5
A period of immediate CPR before phoning EMS and getting the AED (call fast) is indicated for most pediatric arrests because the are presumed to be asphyxial or prolonged. "lone rescuers should perform CPR for 5 cycles (about 2 minutes) before activating EMS." Circulation 2005;112;IV-161,162 Circulation 2005; 112; III-74A period of immediate CPR before phoning EMS and getting the AED (call fast) is indicated for most pediatric arrests because the are presumed to be asphyxial or prolonged. "lone rescuers should perform CPR for 5 cycles (about 2 minutes) before activating EMS." Circulation 2005;112;IV-161,162 Circulation 2005; 112; III-74For the lone rescuer a compression-to-ventilation ratio of 30:2 is recommended. After the initial set of 30 compressions, open the airway and give 2 breaths. In an unresponsive infant or child, the tongue may obstruct the airway and interfere with ventilations. Open the airway using a head tilt-chin lift maneuver for both injured and non-injured victims. After 2 minutes of CPR the lone rescuer activates the emergency response system and gets an AED if one is nearby. The lone rescuer should then return to the victim as soon as possible and use the AED (if available) or resume CPR, starting with chest compressions. Circulation, 2010;122:S864 Child CPR Training Frame 4, 7
In a witnessed sudden collapse (e.g.. During an athletic event), the cause is more likely to be VF, and the lone rescuer should phone for professional help and get the AED (when available) before starting CPR. Circulation 2005; 112; III-74 It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. For example, if the arrest is witnessed and sudden (e.g. sudden collapse in an adolescent or a child identified at high risk for arrhythmia or during an athletic event), the healthcare provider may assume that the victim has suffered a sudden VS-cardiac arrest and as soon as the rescuer verifies that the child is unresponsive and not breathing (or only gasping) the rescuer should immediately phone the emergency response system, get the AED and then begin CPR and use the AED . Circulation, 2010;122:S865.Child/Infant CPR Pro Frame 5
 If the victim is unresponsive, make sure that the victim is in a supine (face up) position on a flat, hard surface, such as a sturdy table, the floor, or the ground. Circulation 2005;112;IV-157For best results, deliver chest compressions on a firm surface. Circulation, 2010;122:S864Child CPR Training Frame 12
Rescuers should open the airway by using the head tilt chin lift maneuver. "If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension." Circulation 2005;112;IV-22 Circulation 2005;112;III-6Rescuers should open the airway by using the head tilt chin lift maneuver. "If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension." Circulation 2005;112;IV-22 Circulation 2005;112;III-6Health care providers should use the head tilt-chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma. If healthcare providers suspect a cervical spine injury, they should open the airway using a jaw thrust without head extension. If this is not possible, use the head tilt-chin lift maneuver. Circulation, 2010;122:S691-692.Child CPR Training Frame 15
 While maintaining an open airway, take no more than 10 seconds to check whether the victim is breathing: Look for rhythmic chest and abdominal movement, listen for exhaled breath sounds at the nose and mouth, and feel for exhaled air on you cheek. Periodic gasping, also called agonal gasps, is not breathing. Circulation 2005;112;IV-158If an infant or child is unresponsive and not breathing, (gasps do not count as breathing) healthcare providers may take up to 10 seconds to attempt to feel for a pulse (brachial in an infant and carotid or femoral in a child. If, within 10 seconds, you don't feel a pulse or are not sure if you feel a pulse, begin chest compressions. Child CPR Training Frame 10-12; Child CPR Test Question 4
 In an infant, use a mouth-to-mouth-and-nose technique (LOE 7; Class Iib): in a child, use a mouth-to-mouth technique. Circulation 2005;112;IV-159To give breaths to an infant, use a mouth-to-mouth-and -nose technique; to give breaths to a child, use a mouth-to-mouth technique. Make sure the breaths are effective (i.e. the chest rises) Each breath should take about 1 second. If the chest does not rise, reposition the head, make a better seal, and try again. Circulation, 2010;122:S864Child CPR Training Frame 16, 19;
 After delivery of 2 rescue breaths, healthcare providers should attempt to feel a pulse in the unresponsive, non-breathing victim for no more than 10 seconds. If the provider does not definitely feel a pulse within 10 seconds, the provider should begin cycles of chest compressions and ventilations. Circulation 2005;112;IV-13If an infant or child is unresponsive and not breathing, (gasps do not count as breathing) healthcare providers may take up to 10 seconds to attempt to feel for a pulse (brachial in an infant and carotid or femoral in a child. If, within 10 seconds, you don't feel a pulse or are not sure if you feel a pulse, begin chest compressions. Circulation, 2010;122:S865Child CPR Training Frame 10-12
To give chest compressions, compress the lower half of the sternum but do not compress over the xiphoid. "The two finger technique is recommended for 1-rescuer infant CPR to facilitate rapid transition between compression and ventilation and to minimize interruptions in chest compressions. It remains an acceptable alternative method of chest compressions for 2 rescuers". Circulation 2005; 112; III-75 Circulation 2005;112;IV-160To give chest compressions, compress the lower half of the sternum but do not compress over the xiphoid. "The two finger technique is recommended for 1-rescuer infant CPR to facilitate rapid transition between compression and ventilation and to minimize interruptions in chest compressions. It remains an acceptable alternative method of chest compressions for 2 rescuers". Circulation 2005; 112; III-75 Circulation 2005;112;IV-160To give chest compressions, compress the lower half of the sternum but do not compress over the xiphoid. "The two finger technique is recommended for 1-rescuer infant CPR to facilitate rapid transition between compression and ventilation and to minimize interruptions in chest compressions. The two thumb encircling hands technique is recommended when CPR is provided by 2 rescuers. Circulation, 2010;122:S866Child CPR Training Frames 23, 13 , 20;
 Push Hard: push with sufficient force to depress the chest approximately one third to one half the anterior-posterior diameter of the chest. Push Fast: push at a rate of approximately 100 compressions per minute. Release completely to allow the chest to fully recoil. Minimize interruptions in chest compressions. Circulation 2005;112;IV-160Push fast: push at a rate of at least 100 compressions per minute. Push hard; push with sufficient force to depress at least one third the AP diameter of the chest or approximately 1 1/2 inches(4cm) in infants and 2 inches (5 cm) in children. Allow complete chest recoil after each compression to allow the heart to refill with blood. Minimize interruptions of chest compressions. Avoid excessive ventilation. Circulation, 2010;122:S864Child CPR Training Frame 14
For ease of teaching and retention, a universal compressions ventilation ratio of 30:2 is recommended for the lone rescuer responding to infants, children, and adults. Circulation 2005; 112; III-75no changeno change 
 When two healthcare providers are performing CPR, the compression-ventilation ratio should be 15:2 until and advanced airway is in place. Circulation 2005;112;IV-14A lone rescuer uses a compression-to-ventilation ratio of 30:2. For 2 rescuer infant and child CPR. One provider should perform chest compressions while the other keeps the airway open and performs ventilations at a ratio of 15:2. Deliver ventilations with minimal interruptions in chest compressions. If an advanced airway is in place, cycles of compressions and ventilations are no longer delivered. Instead the compressing rescuer should deliver at least 100 compressions per minute continuously without pauses for ventilation. The ventilation rescuer delivers 8-10 breaths per minute. Circulation, 2010;122:S867.Child CPR Training Frame 17-18
 For the Infant "When 2 healthcare providers are performing CPR, the healthcare provider who is compressing the chest should, when feasible, use the 2-thumb-encircling hands technique."Circulation 2005;112;IV-14The two thumb encircling hands technique is recommended when CPR is provided by 2 health care providers. Circulation, 2010;122:S866Child CPR Training Frame 23
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