Part 1: Introduction / V-3 Colors of the boxes distinguish types of actions. As noted ECC Committee and subcommittees who wrote and re- above, the rose boxes indicate assessment steps. In general, viewed this document are listed online as a COI treatments that involve electrical therapy or drugs are place ment(availablethroughhttp://www.C2005.org) in blue boxes, and simple action steps are placed in tan boxes. sheet authors potential conflicts of interest are In order to emphasize the fundamental importance of good on each worksheet, which can be accessed through basicCprinallEccalgorithmsactionstepsinvolvinghttp://www.c2005.org support of airway, breathing, and circulation are placed in green boxes. In addition, all advanced cardiovascular life New Developments support(ACLS)and pediatric advanced life support(PALS) The most significant changes in these guidelines were made gorithms contain a green "reminder"box to assist the to simplify CPR instruction and increase the number of chest clinician in recalling helpful information, including funda- ns delivered per minute and reduce interruptions mentals of CPR. The algorithm box color-coding is not in chest compressions during CPR. Following are some of the absolute because some boxes contain combinations of several most significant new recommendations in these guideline types of actions. Three algorithms have unique features. In the basic life Elimination of lay rescuer assessment of signs of circula support(BLS) healthcare provider adult and pediatric algo- tion before beginning chest compressions: the lay rescuer rithms, the actions that are completed by only healthcare will be taught to begin chest compressions immediately providers are bordered with a dotted line. In the ACLs after delivering 2 rescue breaths to the unresponsive victim who is not breathing(Parts 4 and Il) screening(the text contained in screened boxes appears Simplification of instructions for rescue breaths: all breaths lighter than regular text). These screened boxes include actions that are intended to be accomplished in the in-hospi mask, or bag-to-advanced airway) should be given over 1 setting or with expert consultation readily available. Informa- second with sufficient volume to achieve visible chest rise tion in non-screened boxes is intended to apply to the (Parts 4 and 11). out-of-hospital or the in-hospital setting. In the ACLs Elimination of lay rescuer training in rescue breathin Tachycardia Algorithm, to create visual separation between without chest compressions(Parts 4 and 11) actions for wide-complex versus narrow-complex Recommendation of a single(universal) compression-to- tachycardia, boxes containing therapy for wide-complex ventilation ratio of 30: 2 for single rescuers of victims of all tachycardia are shadowed with yellow, and boxes with ages(except newborn infants). This recommendation is treatment for narrow-complex tachycardia are shadowed with designed to simplify teaching and provide longer periods of interrupted chest compressions(Parts 4 and Il) Modification of the definition of"pediatric victim"to Management of Conflict of Interest preadolescent (prepubescent) victim for application of The world's leading experts in resuscitation science have pediatric BLS guidelines for healthcare providers(Parts 3 established their expertise by undertaking and publishin and ID), but no change to lay rescuer application of child research and related scholarly work. Some investigators CPR guidelines(I to 8 activities are supported by industry, thereby creating the Increased emphasis on the importance of chest compres potential for conflicts of interest. 8.9 Grants and other support sions: rescuers will be taught to "push hard, push fast"(at for scientific research, speaker fees, and honoraria can also a rate of 100 compressions per minute), allow complete create potential financial conflicts of interest. Nonfinancial chest recoil, and minimize interruptions in chest compres conflicts of interest include in-kind support, intellectual sions(Parts 3,4, and ID) collaboration or intellectual investment in personal ideas, and Recommendation that Emergency Medical Services(EMS) long-term research as Ho endas in which investigators have providers may consider provision of about 5 cycles(or invested a substantial amount of time about 2 minutes) of CPr before defibrillation for unwit To protect the objectivity and credibility of the evidence nessed arrest, particularly when the interval from the call to evaluation and consensus development process, the AHA the ems dispatcher to response at the scene is more than 4 ECC Conflict of Interest( COI) policy was revised before the to 5 minutes(Part 5) 2005 Consensus Conference to ensure full disclosure and Recommendation for provision of about 5 cycles(or about comprehensive management of potential conflicts. A proces 2 minutes) of CPR between rhythm checks during treat was developed for managing potential conflicts of interest ment of pulseless arrest(Parts 5, 7. 2, and 12). Rescuers during the evidence evaluation process and the 2005 Consen- should not check the rhythm or a pulse immediately after sus Conference. Each speaker's COI statement was projected shock delivery--they should immediately resume CPR, on a dedicated screen during every presentation, question, beginning with chest compressions, and should check the and discussion period. The COI policy is described in detail rhythm after 5 cycles(or about 2 minutes)of CPR in an editorial in this supplement1o and the corresponding . Recommendation that all rescue efforts, including insertion editorial in the Ilcor 2005 CPr Consensus. ll potential con of an advanced airway(eg, endotracheal tube, esophageal- flicts of interest disclosed by the editors and science volunteers tracheal combitube [Combitube], or laryngeal mask airway of this document are listed in this supplement(page B4) [LMAD, administration of medications, and reassessment Potential conflicts of interest disclosed by members of the of the patient be performed in a way that minimizesColors of the boxes distinguish types of actions. As noted above, the rose boxes indicate assessment steps. In general, treatments that involve electrical therapy or drugs are placed in blue boxes, and simple action steps are placed in tan boxes. In order to emphasize the fundamental importance of good basic CPR in all ECC algorithms, action steps involving support of airway, breathing, and circulation are placed in green boxes. In addition, all advanced cardiovascular life support (ACLS) and pediatric advanced life support (PALS) algorithms contain a green “reminder” box to assist the clinician in recalling helpful information, including funda￾mentals of CPR. The algorithm box color-coding is not absolute because some boxes contain combinations of several types of actions. Three algorithms have unique features. In the basic life support (BLS) healthcare provider adult and pediatric algo￾rithms, the actions that are completed by only healthcare providers are bordered with a dotted line. In the ACLS Tachycardia Algorithm, several boxes are printed with screening (the text contained in screened boxes appears lighter than regular text). These screened boxes include actions that are intended to be accomplished in the in-hospital setting or with expert consultation readily available. Informa￾tion in non-screened boxes is intended to apply to the out-of-hospital or the in-hospital setting. In the ACLS Tachycardia Algorithm, to create visual separation between actions for wide-complex versus narrow-complex tachycardia, boxes containing therapy for wide-complex tachycardia are shadowed with yellow, and boxes with treatment for narrow-complex tachycardia are shadowed with blue. Management of Conflict of Interest The world’s leading experts in resuscitation science have established their expertise by undertaking and publishing research and related scholarly work. Some investigators’ activities are supported by industry, thereby creating the potential for conflicts of interest.8,9 Grants and other support for scientific research, speaker fees, and honoraria can also create potential financial conflicts of interest. Nonfinancial conflicts of interest include in-kind support, intellectual collaboration or intellectual investment in personal ideas, and long-term research agendas in which investigators have invested a substantial amount of time. To protect the objectivity and credibility of the evidence evaluation and consensus development process, the AHA ECC Conflict of Interest (COI) policy was revised before the 2005 Consensus Conference to ensure full disclosure and comprehensive management of potential conflicts. A process was developed for managing potential conflicts of interest during the evidence evaluation process and the 2005 Consen￾sus Conference. Each speaker’s COI statement was projected on a dedicated screen during every presentation, question, and discussion period. The COI policy is described in detail in an editorial in this supplement10 and the corresponding editorial in the ILCOR 2005 CPR Consensus. 11 Potential con￾flicts of interest disclosed by the editors and science volunteers of this document are listed in this supplement (page B4). Potential conflicts of interest disclosed by members of the ECC Committee and subcommittees who wrote and re￾viewed this document are listed online as a COI supple￾ment (available through http://www.C2005.org). Work￾sheet authors’ potential conflicts of interest are included on each worksheet, which can be accessed through http://www.C2005.org. New Developments The most significant changes in these guidelines were made to simplify CPR instruction and increase the number of chest compressions delivered per minute and reduce interruptions in chest compressions during CPR. Following are some of the most significant new recommendations in these guidelines: ● Elimination of lay rescuer assessment of signs of circula￾tion before beginning chest compressions: the lay rescuer will be taught to begin chest compressions immediately after delivering 2 rescue breaths to the unresponsive victim who is not breathing (Parts 4 and 11). ● Simplification of instructions for rescue breaths: all breaths (whether delivered mouth-to-mouth, mouth-to-mask, bag￾mask, or bag-to–advanced airway) should be given over 1 second with sufficient volume to achieve visible chest rise (Parts 4 and 11). ● Elimination of lay rescuer training in rescue breathing without chest compressions (Parts 4 and 11). ● Recommendation of a single (universal) compression-to￾ventilation ratio of 30:2 for single rescuers of victims of all ages (except newborn infants). This recommendation is designed to simplify teaching and provide longer periods of uninterrupted chest compressions (Parts 4 and 11). ● Modification of the definition of “pediatric victim” to preadolescent (prepubescent) victim for application of pediatric BLS guidelines for healthcare providers (Parts 3 and 11), but no change to lay rescuer application of child CPR guidelines (1 to 8 years). ● Increased emphasis on the importance of chest compres￾sions: rescuers will be taught to “push hard, push fast” (at a rate of 100 compressions per minute), allow complete chest recoil, and minimize interruptions in chest compres￾sions (Parts 3, 4, and 11). ● Recommendation that Emergency Medical Services (EMS) providers may consider provision of about 5 cycles (or about 2 minutes) of CPR before defibrillation for unwit￾nessed arrest, particularly when the interval from the call to the EMS dispatcher to response at the scene is more than 4 to 5 minutes (Part 5). ● Recommendation for provision of about 5 cycles (or about 2 minutes) of CPR between rhythm checks during treat￾ment of pulseless arrest (Parts 5, 7.2, and 12). Rescuers should not check the rhythm or a pulse immediately after shock delivery—they should immediately resume CPR, beginning with chest compressions, and should check the rhythm after 5 cycles (or about 2 minutes) of CPR. ● Recommendation that all rescue efforts, including insertion of an advanced airway (eg, endotracheal tube, esophageal￾tracheal combitube [Combitube], or laryngeal mask airway [LMA]), administration of medications, and reassessment of the patient be performed in a way that minimizes Part 1: Introduction IV-3