Updated guidelines: What's really new

Et wasn't long after that October 15, 2015, presentation of the new guidelines that initial assessments were made: not much happening, nothing new, only 100 to 120 compressions per minute or only 5 to 6 centimeters of compression depth - that was making the rounds among operating medics.

At first glance, this may also be true. The technical changes for the provider are indeed minor. However, a closer look reveals that while 2015 was clearly the year with the fewest technical changes published compared to previous years, the nature of the review has evolved enormously. The aim was to gain clarity about what we know and can evidence - and equally to gain an idea of the issues around resuscitation and cardiocirculatory emergencies about which we know nothing or too little

What's new?
One of the reasons why there are so few innovations is that the maxim is now to change only what can be seriously argued for scientifically. Compared to earlier detailed considerations, the system approach comes more clearly to the fore in 2015. This involves, for example, the interaction between layperson, dispatcher, rescue service and hospital as an overall system for increasing the chances of survival. It is about systemically integrating the elements of recognition, alerting, BLS-AED, A(C)LS, and post resuscitation care and recognizing that the chances of survival can only be relevantly influenced if the individual system elements interact. In short, reanimate the chain of survival. Train the system, it says for the first time - and also for the first time, the need to train non-medical skills in particular, in addition to the classic skills, is emphasized.

Accordingly, what is new in 2015 is not only what has changed - a different compression frequency, a new drug, an adapted dosage. Such changes in technical details have been implemented in past guideline editions. What is new in 2015 are particularly changes in assessment and emphasis when viewed from a more detached perspective. On the other hand, there is much confirmation that recommendations from 2010 can stand. But beware: many 2010 recommendations were not updated because they were not the subject of consideration.

The main changes are as follows:

• It is recommended that emergency medical dispatchers assist first responders by telephone in recognizing circulatory arrest and performing basic measures.
• The importance of first responder training, the establishment of PAD systems in specific settings, and the use of first responders is emphasized.
• Furthermore, a ratio of 30 chest compressions to 2 ventilations is recommended.
• CPR alone should be performed if a first responder has not learned ventilation.
• The frequency of cardiac massage should be 100 to 120 compressions per minute.
• The recommended depth of chest compression for adults is 5 to 6 cm.

Where does the new come from?
The most important documents in this context are the ILCOR Consensus on CPR to ECC Science and the guidelines of the American Heart Association AHA and the European Resuscitation Council ERC derived from it. These original English-language documents are comprehensive, freely accessible and of excellent quality. In addition, different official language versions have already been published

The ILCOR prepares recommendations for action. These recommendations are always to be understood as answers to the previously formulated questions. In the chapter Basic Life Support in Adults, 32 recommendations were developed for 23 high-priority PICO questions. PICO refers to the patient (or problem), the intervention, the comparison and the outcome. To clarify, here is the following example of a PICO question on a key BLS issue: "In adults and children in circulatory arrest of any type (P), does a given frequency of external chest compression (I) compared with a compression frequency of 100/min (C) change survival with good neurologic outcome at ROSC, discharge, 30 days (...) and 180 days (O), respectively?"