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 Table of Contents  
SHORT COMMUNICATION
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 143-145

Basic life support revisited – New American Heart Association, 2015, guidelines: An update for dental professionals


Department of Pediatric Dentistry and Orthodontic Sciences, Division of Pediatric Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia

Date of Web Publication19-Nov-2015

Correspondence Address:
Mohammed Nadeem Ahmed Bijle
Department of Pediatric Dentistry and Orthodontic Sciences, Division of Pediatric Dentistry, College of Dentistry, King Khalid University, Abha
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.169829

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  Abstract 

American Heart Association (AHA) - a professional organization dealing with appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke, portrays the necessity of continuous evaluated evidence-based medicine. Thus, AHA formally introduces every 5 years their guidelines for the Emergency Cardiovascular Care on the basis of a thorough evidence search to make provision of the best possible treatment for patients with cardiac emergencies. Since, new 2015 AHA guidelines are established very recently, awareness of our fellow dentists with its major changes at least with respect to basic life support (BLS) seems important. Hence, this communication is scripted to throw light on the significant changes in 2015 AHA guidelines has brought in BLS protocols.

Keywords: American Heart Associations, basic cardiac, cardiopulmonary, cardiopulmonary resuscitation, life support, resuscitation


How to cite this article:
Bijle MN. Basic life support revisited – New American Heart Association, 2015, guidelines: An update for dental professionals. J Dent Res Rev 2015;2:143-5

How to cite this URL:
Bijle MN. Basic life support revisited – New American Heart Association, 2015, guidelines: An update for dental professionals. J Dent Res Rev [serial online] 2015 [cited 2019 Oct 23];2:143-5. Available from: http://www.jdrr.org/text.asp?2015/2/3/143/169829


  Introduction Top


Every branch of medicine demands an evidence-based approach for diagnostic and therapeutic interventions in routine. Given same, American Heart Association (AHA) - a professional organization dealing with appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke, also portrays the necessity of continuously evaluated evidence-based medicine.[1] Thus, AHA formally introduces every 5 years their Guidelines for Emergency Cardiovascular Care (ECC) on the basis of thorough evidence search to make provision of the best possible treatment for patients with cardiac emergencies.. Their main scope of details lay with covering aspects related to resuscitation and post resuscitation - recognition, diagnosis, and applicable, appropriate therapeutic protocols. It has been long since the guidelines are being continuously scrutinized and updated based on the best of the evidence and recommendations available since 1966. So far, the guidelines have been revised for approximately five decades marking the published literature in years - 1974, 1980, 1986, 1992, 2000, 2005, 2010, and then recently in 2015.[2] A close look at the dates signifies that a decade or two earlier the pattern of publishing guidelines is regularized to every 5 years since the year 2000.

Dentistry is no different but a subset of medicine. ECC can also be an expected part of therapy when treating dental patients. Life uncertainty is known to everyone and cannot differ in any sense. Thus, the same applies to patients being treated in the dental chair. Medical emergencies can and do happen when providing dental treatment. Thus, dentist providing the treatment should also be aware regarding the management of such emergencies. Every emergency if not treated in time can lead to cardiac emergency ultimately requiring resuscitation for recovery. At least, therapy leading to basic stability of patients should be provided which thereby can be managed with advanced care once available. The majority of dental professionals are untrained in managing medical emergencies; the rationale of which lies with the lack of training (in some establishments) and continuous hands off the management of medical emergencies. It is justifiable if at least a dental surgeon irrespective of the specialty identifies emergencies and provides basic care to manage and stabilize the patient for further advanced care as and when the help arrives. Therefore, it is suggested that all dental surgeons undergo a regular training in the management of such emergencies and keep themselves updated with recent guidelines to provide optimum treatment required to stabilize the patient for further advanced care.

Basic life support (BLS) for Health Care Providers (HCP) should be a mandatory requirement for any dental professional who desires a license to practice in any country. However, some countries have implemented this concept, and few are yet to imply the said. The same should be regulated by their respective councils and ministries to have its effect in order dealing with prevention of any deleterious effects thereby occurring due to the lack of management of potential life threatening emergencies. A regular check should also be mandatory on timely update of existing knowledge and practice in the field of discussion. Since, AHA is one of the establishments considered significant in defining guidelines for BLS in consensus with International Liaison Committee on Resuscitation, abiding by its regular updates is also suggestible for one learning its established norms. As aforestated, the guideline receives its update every 5 years and so the year 2015 is in receipt of neo statements which needs a read through for proper implementation.

Since new 2015 AHA guidelines are established very recently, awareness of our fellow dentists with its major changes at least with respect to BLS seems important. Hence this communication is scripted to throw light on the significant changes, 2015 AHA guidelines has brought in BLS protocols.


  Significant Changes in 2015 American Heart Association Guidelines – Basic Life Support Top


For the ease of understanding and mimicking the statements as available in the highlights of recent guidelines, the details of changes are subdivided into following headings:

  • Adult-BLS (A-BLS) for HCP
  • Pediatric and Infant BLS (P-BLS)
  • Chain of survival.


Adult-basic life support for health care providers

Updated guidelines emphasize the following for A-BLS protocols:[3]

Flexibility in activation of emergency response system

The activation of emergency response system displays flexibility depending upon the scenario. In case, if the victim is unresponsive the HCP can activate the emergency response system post evaluation of breaths and pulse.

In the current era, the majority of the population carries their cell phones along. Activation of emergency response system through a call or application (as available among the specific populace) is given prior emphasis.

Recognition of pulse and breaths at 1 time

The witnessed unresponsive victim must receive the first compression in due course to avoid deleterious outcomes in the process of resuscitation. To reduce the time for receipt of its first compression, the recognition of pulse and breaths has been merged from hereon to practice. This will save time and thereby provide an intervention once the patient is recognized to be in arrest.

Integrated team efforts using a choreographed approach

So far a single staged manageable process was defined for BLS until and unless help arrives. With regards to HCP, which are surrounded by their teams, a multistage dynamic choreographed approach to the patient is recommended. Multiple activities can be processed together for efficient management of the patient. The same can also be emphasized for dental professionals whereby they are always working in a concerted team dynamics in their routine practice. Different personals can be given different tasks as applicable and available within the scenario.

Increased emphasis on high-quality cardiopulmonary resuscitation

Significant emphasis is given to components of high-quality cardiopulmonary resuscitation (CPR) as defined in the previous guidelines, viz., push hard and fast to provide compressions of adequate rate and depth, allow complete chest recoil, and avoid excessive ventilation.

Modified compression rate and depth

Compression rate has been reasonably set on to 100–120 compressions/min as compared to the previous guidelines defining the rate to be at least 100 compressions/min. The ill effects reported with greater compression rate were the rationale for recommendation. The depth is also modified by defining its lower and upper limits being 2–2.4 inches, respectively, to minimize potential injuries due to excessive depth established during CPR.

Allowance of complete chest recoil

The HCP have been cautioned for leaning on the chest wall while giving rescue breaths since it precludes allowance of complete chest recoil.

Minimizing interruptions to achieve a minimum compression fraction

Compression fraction is the actual number of compression provided by a rescuer during the sequence of CPR. The guidelines emphasize more on providing at least 60% compressions to the total time of CPR.

The introduction of simplified ventilation rate for ongoing cardiopulmonary resuscitation and advanced airway in place

For patients receiving advanced airway during CPR need to follow a simple ventilation rate of 1 breath per 6 s, i.e., 10 breaths/min, since it is one value to remember for all possible scenario.

Pediatric and infant basic life support

Pediatric and Infant BLS have received few modifications as listed below:[4]

Compressions – Airway – Breathing still to be a preferred sequence of cardiopulmonary resuscitation

The sequence of Compressions – Airway –Breathing is still preferred in the updated guidelines. The guidelines detail that there are gaps in the research and knowledge to identify the preferred sequence for children. It also stated that the best sequence for pediatric and infant patients is yet to be named.

Different algorithms with single and multiple rescuers

New algorithms have been introduced for the pediatric group with single and multiple rescuers whereby the multiple rescuers follow the choreographed approach.

Adolescence to follow adult-basic life support protocols

Adolescents and adults have been merged in the protocol to follow a similar sequence of events as listed in A-BLS.

Reaffirmation of compressions and ventilation in P-basic life support

Compressions and ventilation are a part of P-BLS protocol irrespective of the asphyxia being one of the prominent causes of arrest in children. The compression rate is similar to that of adult and depth is standardized to 1/3rd of an anterior-posterior diameter that stands at least 2 inches in children and at least 1.5 inches in infants.


  Chain of Survival Top


The AHA recommends a separate chain of survival for victims depending upon the settings in which cardiac arrest is reflected. A dental operatory would be considered as out of hospital setting until the same is present within the hospital premises. The sequence for chain of survival in the case of an operatory dental professional remains the same as cited in the previous guidelines. The chain starts with recognition and activation of response system – immediate high-quality CPR – rapid defibrillation – basic and advanced emergency medical services – advanced life support and postarrest care.

For more details on the subject, one can refer to AHA 2015 Guidelines highlights [5] or see the entire issue of Circulation, 2015, Volume 13, Issue 18, Suppl 2,[6] available online as web-based integrated guidelines..


  Implementation of Team Resuscitation Concept for Emergencies in Dental Settings Top


Many dental setups viz., institution, clinics, dental hospitals, multi-specialty dental clinics, etc., lack an organized infrastructure and human resource for management of medical emergencies if they occur during routine practice. Given same, it is advisable for the bodies to train their respective personals in the management of such emergency on a regular basis; to update their existing knowledge with the recent protocols that will help to avoid panic when encountered in an emergency situation. An emergency response team if designated for such cases would reduce the maximum stress that one can go through if present in such a situation, especially in life-threatening cases.


  Conclusion Top


Timely update of protocols is the need of an hour in today's professional practice. This communication was an attempt to outline the major changes in 2015 AHA guidelines for CPR and ECC. It is better that after understanding the highlighted changes, one practices the same by undergoing thorough training over the subject and that too on a routine basis to avoid sudden anxiety if the need arises. For detailed rationale over the subject, the recommendation needs a thorough read as per the reference quoted.

Recommendation

Training of BLS and its regular update is mandatory for all HCP including dental health professionals. Through this literature, a proposal is formed for those countries that have not yet mandated BLS for their countrymen dental professionals as a requirement to practice. The implementation of same can lead to better management and outcome of patients encountering life threatening emergencies in routine dental practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wikipedia the Free Encyclopedia. American Heart Association. Available from: https://www.en.wikipedia.org/wiki/American_Heart_Association. [Last accessed on 2015 Oct 17].  Back to cited text no. 1
    
2.
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: Executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132 18 Suppl 2:S315-67.  Back to cited text no. 2
    
3.
Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132 18 Suppl 2:S414-35.  Back to cited text no. 3
    
4.
Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132 18 Suppl 2:S519-25.  Back to cited text no. 4
    
5.
American Heart Association. 2015 Guidelines Highlight; 2015. Available from: http://www.eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf. [Last accessed on 2015 Oct 19].  Back to cited text no. 5
    
6.
Available from: http://www.circ.ahajournals.org/content/132/18_suppl_2.toc. [Last accessed on 2015 Oct 19].  Back to cited text no. 6
    




 

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Abstract
Introduction
Chain of Survival
Implementation o...
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Significant Chan...
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