High quality CPR is reemphasized for its primary importance in any resuscitation.
CHEST COMPRESSIONS: Compression depth of at least two inches, and adequate time to allow for complete chest recoil, are emphasized in the new ACLS guidelines.
MINIMIZATION OF INTERRUPTION of chest compressions is stressed in ACLS. It has been recognized through evidence based studies that effective CPR is based upon the minimization of interruption between shock and CPR. Because a perfusing rhythm is often not established immediately after ROSC, CPR may be necessary after ROSC.
VENTILATION should be carefully administered so that the patient is not overventilated. Overventilation can be dangerous in the patient in cardiac arrest, and after ROSC, as it can cause pneumothorax or changes in intracerebral perfusion pressures.
CPR SEQUENCE has been changed in the BLS Survey, from ABCs to CABs. For in-hospital providers, the AHA states, "It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest."
EMPHASIS ON TEAM DELEGATION is stressed, as it has been recognized that coordinated care delivery by a team of professionals results in superior outcomes. Coordination by a team of highly trained rescuers results in efficient management of multiple tasks performed during a resuscitation attempt. Training focuses heavily upon teamwork, as team member arrive and the team leader delegates roles quickly.
MAJOR BLS CHANGES encourage Hands Only (compressions) CPR for untrained lay rescuers. The CPR SEQUENCE has changed from ABC to CAB. The depth of compressions has changed, as noted above.