Resuscitation Council (UK) Statement on AEDs compliance with 2010 Guidelines

Automated External Defibrillators (AEDs)
and compliance with
Resuscitation Guidelines 2010

Updated guidelines for the use of AEDs were published by the Resuscitation Council (UK) in October 2010, as part of Resuscitation Guidelines 2010. These are based on an international consensus on treatment during resuscitation attempts that was published electronically in the UK, Europe and the United States on 18th October 2010.

It is recommended that users of an AED follow the voice prompts and other instructions provided by the machine. It is recognised, however, that there will often be a delay before AEDs can be reprogrammed so that the instructions are fully compliant with Guidelines 2010.

Guidance for AED manufacturers on voice prompts for AED

In Guidelines 2010 there are no major changes to the sequence of actions required for AED use. There is, however, renewed emphasis on minimising interruptions in chest compressions. The rescuer should not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness AND starts to breathe normally.

Ideally, AEDs should be programmed so that:

If rhythm analysis determines that no shock is indicated an immediate prompt to perform CPR (beginning with chest compressions) is given

No rhythm check is performed by the AED after the delivery of a shock.
(The rhythm is re-analysed 2 minutes after a shock is given)

Voice prompts instruct the rescuer to re-start CPR, beginning with chest compressions, immediately after the shock is delivered

Voice prompts do not give instructions to rescuers to perform checks for breathing, circulation or a pulse after AED rhythm analysis and/or shock
(if given)

Voice prompts do not give ambiguous instructions such as “restart CPR if indicated”

As a minimum, an AED should be programmed to:

Deliver one shock only (if indicated) before voice prompt to resume CPR
Re-analyse rhythm after 2 minutes

This flow chart provides guidance to AED manufacturers about the voice prompts for AEDs so that they comply with the 2010 guidelines.

AEDs (and training AEDs) that were programmed before 2005 may deliver three shocks in succession before a prompt to resume CPR. Some machines may also advise 3 minutes of CPR before reassessment of rhythm. If at all possible, these AEDs should be re-programmed to be compliant with Guidelines 2010. If they cannot be re-programmed, serious consideration should be given to replacing them. If, after a risk assessment, it is not considered cost effective to obtain replacements, it is better to have an older model available than to have no AED at all.

Training Issues

Instructors on AED training courses should teach trainees to follow the voice prompts given by the machine. As the transition to Guidelines 2010 is made, it is inevitable that there will be some variation in practice.

The priority in patients who suffer a cardiac arrest caused by ventricular fibrillation (VF) is the delivery of the first shock as soon as possible. Minor variations in AED practice whilst Guidelines 2010 are fully implemented are acceptable as long as they do not detract from this goal. The updated treatment recommendations in Guidelines 2010 do not define the only way that successful resuscitation may be achieved; they merely represent a widely-held view of how resuscitation can be undertaken both safely and effectively.

BLS / AED Subcommittee
October 2010

Automated External Defibrillators (AEDs) and compliance with Resuscitation Guidelines 2010

Automated External Defibrillators (AEDs)
and compliance with
Resuscitation Guidelines 2010