basic life support (BLS)

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]

Introduction

The goal of basic life support is to provide oxygen to the brain & heart until ACLS can be delivered. ABCs, Airway, Breathing, & Circulation provide the cornerstone of BLS.

Management

(guidelines)

determine responsiveness
- gently shake patient
- do not shake head or neck if head or neck trauma is suspected
activate the EMS system
position the patient supine on a firm, flat surface, try to move the patient as a unit, avoiding tension on the neck
open airway & assess pulse & respirations (5-10 seconds)
begin chest compressions immediately (100-120/min)
- untrained bystanders should begin compression-only CPR^[8]
  - compression-only CPR may also apply to BLS for healthcare providers^[6]
- pediatric recommendations differ; see pediatric basic & advanced cardiopulmonary life support
- check for pulse & breathing simultaneously to reduce time to 1st chest compression^[11]
- exception is drowning: give 2 respirations first^[13]
chest compressions
- heal of one hand on the back of another
- one inch above xiphoid
- shoulders above hands, elbows locked
- compress chest 1.5-2 inches (>= 5 cm)^[7]; 2-2.4 inches^[14]
  - survival is highest when chest compression depths are between 4.0 & 5.5 cm (adults)^[9]
- 107 compressions per minute with a depth of 4.7 centimeters is optimal^[13]
- American Heart Association guidelines recommend aiming for 80 to 100 compressions per minute with a compression depth of 4-6 cm.
- for children, chest compression to a depth of 1/3 of the anteroposterior chest wall diameter^[5]
- completely release pressure after each compression, but keep hands in contact with chest to maintain proper hand position
- rate = 100-120 compressions/minute^[11]
  - acceptable < 23 sec for 30 compressions
- assess adequacy of compressions by palpating carotid pulse (2 person CPR)
basic life support: 30 compressions (100-120/min) followed by 2 respirations (1 sec/forced inspiration)^[2]
stop basic life support at 2 minutes & each 2 minutes thereafter to assess for spontaneous pulse or respirations
- Red Cross recommends stopping CPR only for defibrillation or if the patient shows signs of life
- basic life support should not be withheld for more than 5-10 sec except for defibrillation or intubation
- attempts to intubate should not exceed 30 sec
- 2 minute cycles (about 5 cycles of 30 compressions with 2 repirations)
- change person delivering compressions every 2 minutes if feasible
8-10 breaths/min for patients with endotracheal intubation or other advanced airway
rescue breathing (lower priority than chest compressions)
- open the patient's mouth, leave dentures in (they facilitate a good mouth-to-mouth seal)
- open patient's airway
  - head tilt-chin lift; lay rescuers should use the head tilt-chin lift in all unresponsive patients regardless of injury^[4]
  - jaw thrust maneuver if neck injury suspected & rescuer is a professional proficient in this maneuver^[4]
- sweep oral airway with hand to open airway
  - the AHA no longer recommends blind finger sweeping under any circumstances, as this may push foreign objects into the airway & cause an obstruction^[10]
- evaluate patient's respirations with airway open
  - look for chest movement
  - place ear over mouth & listen for respirations
- spontaneous respirations not present
  - gently pinch the nose with the index finger & thumb
  - make a tight seal over the patient's mouth & give 2 breaths 1 sec/breath
  - continue rescue breathing if signs of circulation
- palpate patient's carotid pulse for 5-10 sec, if pulse present continue rescue breathing @ 10-12/min

More general terms

cardiopulmonary resuscitation (CPR)

More specific terms

Additional terms

References

↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170-71
↑ ^{Jump up to: 2.0} ^2.1 ECC Committee, ECC Subcommittees, and ECC Task Forces; and Authors of Final Evidence Evaluation Worksheets 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations Conference. Circulation. 2005 Dec 13;112(24_suppl):b2-b5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16344388
↑ ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
↑ ^{Jump up to: 4.0} ^4.1 ^4.2 ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 http://www.americanheart.org/cpr
↑ ^{Jump up to: 5.0} ^5.1 Braga MS et al Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 2009 Jul; 124:e69 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19564271 <Internet> http://dx.doi.org/10.1542/peds.2009-0153
↑ ^{Jump up to: 6.0} ^6.1 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317267.pdf
↑ ^{Jump up to: 7.0} ^7.1 Stiell IG et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012 Jan 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22202708
↑ ^{Jump up to: 8.0} ^8.1 Dumas F et al. Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 2013 Jan 29; 127:435. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23230313
↑ ^{Jump up to: 9.0} ^9.1 Stiell IG et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation 2014 Sep 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25252721
↑ ^{Jump up to: 10.0} ^10.1 Knowledge+ http://knowledgeplus.nejm.org/question-of-week
Link MS et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010 Oct 22; 122:S706.
American Red Cross. Step Three: Be Informed. Cardiac Arrest/AED Steps. 2007. https://www.redcross.org/flash/brr/English-html/AED.asp
↑ ^{Jump up to: 11.0} ^11.1 ^11.2 Physician's First Watch, Oct 20, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (in 15 parts, see Table of Contents) Circulation November 3, 2015, Volume 132, Issue 18 suppl 2 http://circ.ahajournals.org/content/132/18_suppl_2.toc
↑ Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2017 Nov 6. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114008 <Internet> http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000539.long
↑ ^{Jump up to: 13.0} ^13.1 ^13.2 Duval S, Pepe PE, Aufderheide TP et al Optimal Combination of Compression Rate and Depth During Cardiopulmonary Resuscitation for Functionally Favorable Survival. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411632 https://jamanetwork.com/journals/jamacardiology/fullarticle/2747606
Cone DC Push Hard, Push Fast, Do Not Stop - Optimal Chest Compression Rate and Depth. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411633 https://jamanetwork.com/journals/jamacardiology/article-abstract/2747603
↑ ^{Jump up to: 14.0} ^14.1 American Red Cross - Basic Life Support 2018

[ref1-1] Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170-71

[ref2-2] {Jump up to: 2.0} ^2.1 ECC Committee, ECC Subcommittees, and ECC Task Forces; and Authors of Final Evidence Evaluation Worksheets 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations Conference. Circulation. 2005 Dec 13;112(24_suppl):b2-b5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16344388

[ref3-3] ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2

[ref4-4] {Jump up to: 4.0} ^4.1 ^4.2 ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 http://www.americanheart.org/cpr

[ref5-5] {Jump up to: 5.0} ^5.1 Braga MS et al Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 2009 Jul; 124:e69 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19564271 <Internet> http://dx.doi.org/10.1542/peds.2009-0153

[ref6-6] {Jump up to: 6.0} ^6.1 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317267.pdf

[ref7-7] {Jump up to: 7.0} ^7.1 Stiell IG et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012 Jan 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22202708

[ref8-8] {Jump up to: 8.0} ^8.1 Dumas F et al. Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 2013 Jan 29; 127:435. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23230313

[ref9-9] {Jump up to: 9.0} ^9.1 Stiell IG et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation 2014 Sep 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25252721

[ref10-10] {Jump up to: 10.0} ^10.1 Knowledge+ http://knowledgeplus.nejm.org/question-of-week
Link MS et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010 Oct 22; 122:S706.
American Red Cross. Step Three: Be Informed. Cardiac Arrest/AED Steps. 2007. https://www.redcross.org/flash/brr/English-html/AED.asp

[ref11-11] {Jump up to: 11.0} ^11.1 ^11.2 Physician's First Watch, Oct 20, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (in 15 parts, see Table of Contents) Circulation November 3, 2015, Volume 132, Issue 18 suppl 2 http://circ.ahajournals.org/content/132/18_suppl_2.toc

[ref12-12] Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2017 Nov 6. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114008 <Internet> http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000539.long

[ref13-13] {Jump up to: 13.0} ^13.1 ^13.2 Duval S, Pepe PE, Aufderheide TP et al Optimal Combination of Compression Rate and Depth During Cardiopulmonary Resuscitation for Functionally Favorable Survival. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411632 https://jamanetwork.com/journals/jamacardiology/fullarticle/2747606
Cone DC Push Hard, Push Fast, Do Not Stop - Optimal Chest Compression Rate and Depth. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411633 https://jamanetwork.com/journals/jamacardiology/article-abstract/2747603

[ref14-14] {Jump up to: 14.0} ^14.1 American Red Cross - Basic Life Support 2018

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]