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2005 AHA Guidelines for CPR and ECC. with Commentary

The following pages summarize some of key information from the 2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

This summary pertains mainly to the Guidelines that impact how a Physio-Control product is used. Visit the American Heart Association Web site for the complete Guidelines.

Quick Highlights


  • EMS medical directors may implement a protocol of CPR before defibrillation for unwitnessed cardiac arrest.
  • CPR compression to ventilation ratio is now 30:2 for most victims.
  • Compress the adult chest at a rate of 100 compressions per minute, with a compression depth of 1 1/2 to 2 inches (4-5 cm). Allow the chest to completely recoil after each compression, and allow approximately equal compression and relaxation times.
  • Each shock should be followed by about 2 minutes of CPR. No more "stacked shocks," pulse checks or checks for signs of circulation.
  • Lay rescuers no longer check for signs of circulation to establish the presence of sudden cardiac arrest.

Defibrillation and Pacing

  • Defibrillation with biphasic waveforms: Start at recommended manufacturer's dose.
  • Defibrillation with monophasic waveforms: Give all shocks at 360J monophasic. Monophasic AEDs that cannot be reprogrammed can follow the existing programmed energy protocol.
  • Noninvasive pacing: Bradycardia is still a Class 1 recommendation but pacing for asystole is no longer recommended and is a Class 3 recommendation.
  • Disposable defibrillation electrodes should be used instead of hard paddles.


  • CPR and AED use is recommended for both traditional and non-traditional public safety responders - this is a Class I recommendation.
  • AEDs programs should be implemented in sites where there is a high likelihood of witnessed cardiac arrest - this is a Class 1 recommendation.
  • AEDs should be considered for the hospital setting as a way to facilitate early defibrillation (within 3 minutes of collapse).

About: AHA Classifications

Many — but not all — treatment recommendations are given class ratings. Classifications are defined as:

  • Class I is excellent (highest rating) = benefit greatly outweighs risk
  • Class IIa is good to very good = benefit is greater than risk
  • Class IIb is fair to good = benefit is equal to or greater than risk
  • Class III is unacceptable = risk is greater than or equal to benefit
  • Class Indeterminate = research just getting started. No recommendation until further research. Cannot recommend for or against