There were not a lot of big changes in the 2015 AHA PALS recommendations. Nevertheless I did want to touch briefly on a few issues raised in the update, which you should all read. You can check out the full pdf here.
Prior to the 2010 guidelines the sequence of ABC – airway, breathing, circulation was engrained into the minds and hearts of medical providers. But, the 2010 AHA Guideline revised their position and recommended that rescuers follow the CAB – compressions, airway, breathing sequence. The aims of this change were to reduce latency in the delivery of chest compressions. There was even a media blitz designed around hands only CPR – suspecting that “mouth-to-mouth” limited bystander willingness to assist. In addition, since the majority of people that need bystander CPR are adults, and the majority of adult events are cardiac just performing compressions (rather than nothing at all) was a good idea. However, there is a paucity of evidence to completely, and unambiguously state that CAB is better than ABC in kids.
Infants and children suffer a much higher proportion of asphyxial arrest. That is, they stop breathing, desaturate, then develop bradycardia or an abnormal tachyarrhythmia which leads to eventual cardiac arrest. Concordantly, effective ventilation, which requires an airway through which to deliver those ventilations is the lynchpin to managing many a pediatric cardiorespiratory arrest and less to better outcomes.
Those in favor of chest compression first CPR argue that (at least based on studies on mannikins) that the 30 compressions before 2 breaths sequence only delayed the first ventilation by 18 seconds for a single rescuer, and 9 seconds or less for two rescuers. Regardless of which sequence you feel is best, and right now there is no evidence that states that one is substantially better than the other. But I agree with the AHA when they note that “a universal CPR algorithm for victims of all ages minimizes the complexity of CPR and offers consistency in teaching CPR to rescuers who treat infants, children, or adults.”
So, what should we do? Keep doing a great job performing the initial rapid cardiopulmonary assessment. This means that whether you check the airway first, or circulation first couple that examination with an assessment and plan. Patients without Unresponsive patients without pulses (exam) need high quality chest compressions (assessment and plan). A stuporous child with gurgling upper airway sounds (exam) needs to have their airway potency improved and maintained for them (assessment and plan).
