On the 50th anniversary of cardiopulmonary resuscitation (CPR), the 2010 International Guidelines for Cardiopulmonary Resuscitation and Cardiovascular Emergencies, published in the journal Circulation this October, recognize the safety and efficacy of many lifesaving approaches, dismiss others as ineffective, and recommend several new therapies based on extensive evidence and expert consensus. Changing “A-B-C” to “C-A-B” The new guidelines most recently changed the basic life support (BLS) protocol for adults and pediatric patients (including children and infants, but not neonates) from “A-B-C” to “C-A-B. C” (Airway, Breathing, ChestCompression) to “C-A-B” (chest compressions, airway, breathing). The reasons are as follows: i. Most cardiac arrests occur in adults, and the patients with the highest cardiac arrest survival rate are those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and the key starting measures for CPR in these patients are chest compressions and early defibrillation. In the “A-B-C” procedure, chest compressions are often delayed because the witness has to open the airway, give mouth-to-mouth breathing or apply barrier devices or other ventilation equipment. By changing the procedure to C-A-B, chest compressions can be started quickly. Third, starting chest compressions first will ensure that more patients are rescued by CPR, even if the rescuer is unwilling or unable to provide ventilation to the patient, but at least chest compressions can be completed. Fourth, it makes sense for the rescuer to develop resuscitation procedures for the most likely cause of cardiac arrest. ”The new guidelines extend the “life chain” from four links to five links: First, rapid recognition of cardiac arrest and activation of the emergency response system. Early CPR, with emphasis on chest compressions. Rapid defibrillation. IV. Effective advanced cardiovascular life support. V. Comprehensive post-cardiac arrest resuscitation and treatment. If these components are effectively implemented, the survival rate of patients witnessing cardiac arrest due to out-of-hospital ventricular fibrillation (VF) can be approximately 50%. However, the survival rate of patients with VF-induced cardiac arrest, whether out-of-hospital or in-hospital, is much lower than this figure and can vary widely, from 5% to 50%. This difference also suggests that in many cases, there is significant room for improving survival rates. Key changes to basic life support (BLS) Basic life support (BLS) is the foundation of lifesaving after cardiac arrest, and in adults BLS consists of immediate recognition of sudden cardiac arrest, activation of the emergency response system, early implementation of high-quality CPR, and rapid defibrillation. The new guidelines introduce several important changes, but continue to emphasize elements for which there is previous evidence of evidence-based medicine. There are five main changes: First, the BLS process has been simplified and “look, listen, sense” has been removed from the process, with immediate activation of the EMS response system for all adult patients who are unresponsive, not breathing, or not breathing normally (e.g., wheezing only). Encourage hands-only (chest compressions only) CPR for untrained passers-by. iii. Start chest compressions before giving artificial respiration. iv. Ensure that high quality CPR is completed. v. When resuscitation is performed, medical personnel perform many tasks, such as chest compressions, airway management, artificial respiration, rhythm detection, shock defibrillation, and medication, which can be done simultaneously by a team of well-trained rescuers working together. Adult Advanced Cardiovascular Life Support (ACLS) The new guidelines continue to emphasize that good BLS is the foundation for successful adult advanced cardiovascular life support (ACLS), that high-quality CPR should be initiated immediately with minimal interruptions, that in VF/pulseless VT, defibrillation should occur within minutes of the onset of defibrillation, and that the fifth link in the new chain of survival (post-resuscitation cardiac arrest) emphasizes that from recognition of The importance of comprehensive multidisciplinary salvage, critical ACLS assessment and interventions from the start of cardiac arrest to ROSC (return of autonomic circulation) to discharge, provides a crucial bridge between BLS and long-term survival with good neurological function. Aggressive post-resuscitation care is still needed After cardiac arrest, many organs are damaged, so post-resuscitation care is critical. The new guidelines state that the initial goals of post-resuscitation cardiac arrest care are: to optimize cardiopulmonary function and perfusion to living organs; to transfer out-of-hospital cardiac arrest patients to hospitals with comprehensive post-resuscitation cardiac arrest care including acute coronary syndrome, neurological care, intensive care units, and hypothermia; to transfer in-hospital cardiac arrest patients with post-resuscitation care to hospitals that provide comprehensive post-resuscitation cardiac arrest care; and to transfer in-hospital cardiac arrest patients to hospitals with comprehensive post-resuscitation cardiac care. To identify and treat the causes of cardiac arrest and prevent recurrence of the arrest. The subsequent goals of post-resuscitation cardiac arrest care are: to control temperature to an optimal state for survival and neurological recovery; to identify and treat acute coronary syndrome (ACS); to minimize pulmonary injury through appropriate use of mechanical ventilation; to reduce the risk of multi-organ injury and support organ function; to objectively assess the patient’s prognosis; and to provide a variety of rehabilitative services to surviving patients. As a stone from another mountain, the new guidelines are undoubtedly an important asset to the emergency medicine community, but they are not an unshakable Chinese standard for a considerable period of time. Our medical personnel, especially those who actually participate in on-site CPR and cardiovascular emergencies engaged in professional out-of-hospital emergencies, have a great right to speak and should be frequently summarized and improved. Such as in the past in Europe and the United States textbooks and some early guidelines, the heart squeeze site are clear for the lower 1/3 of the sternum, the fact that this site in the field is difficult to precise, the text description is also very unclear, up to more than a hundred words. Our scholars proposed squeezing the lower 1/2 of the sternum as early as the 1980s and published it several times in monograph papers. This proposal was adopted in the guidelines.