AHA Guidelines: Key Takeaways

The new American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care guidelines were released this morning. While the AHA does a major update every five years, since they went to online updates a few years back, the changes are not as momentous as they once were.

After reading the executive summary, here are the key takeaways that affect EMS.

Adult Basic and ACLS

Good CPR remains the bedrock of resuscitation.

Double sequential defibrillation is permitted but it’s usefulness if not considered established.

EMS should first attempt an intravenous access before intraosseous. While IO access has become increasingly popular, its efficacy compared to IV is considered uncertain. IO access should only be attempted if IV attempts fail or are not feasible. For me, not feasible would be in a person with no veins, including jugular.

Epinephrine should be administered as early as possible in cardiac arrest patients with non shockable rhythms.

Epinephrine should be delayed in cardiac arrest patients with shockable rhythms. It is permissible after initial defibrillation attempts have failed.

This is later clarified to mean after the third shock.

CPR should always come first in suspected opioid overdoses found in cardiac arrest.

Ultrasound should not be used prehospitally in termination of life decisions. It is permissible to use prehospital ultrasound to identify possible reversible causes of cardiac arrest as well as ROSC.

Pediatric Basic and Advanced Life Support

Pediatrics with an advanced airway should be ventilated at higher rates than previously done. One breath every 2 to 3 seconds or 20-30 breaths a minute is ideal. Be careful on the volume of each breath.

Pedis should be intubated with cuffed ET tubs where available. No longer are uncuffed tubes recommended.


Healthy newborns should be placed skin to skin on their mothers to improve breastfeeding.

Infants with meconium should be intubated if there is evidence of airway obstruction. Suction only if airway obstruction is present after positive-pressure ventilation.

The umbilical vein is the preferred vascular access for infants. IO access is an alternative if umbilical access is not feasible.

CPR Training

Short booster sessions are recommended over a period of time to keep rescuers sharps

These are the highlights that stood out to me.  Not earthshaking, but still some real change.

Go to 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care  to download the documents. I have always found them to be excellent educational material.