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PETER J. ZED, B.SC., B.SC.(PHARM.), PHARM.D., ACPR, FCSHP, is Clinical Coordinator, Department of Pharmacy, and Pharmacotherapeutic Specialist—Emergency Medicine, Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS, Canada, and Associate Professor, College of Pharmacy and Department of Emergency Medicine, Dalhousie University (DU), Halifax. RIYAD B. ABU-LABAN, M.D., M.H.SC., FRCPC, is Attending Physician and Research Director, Department of Emergency Medicine, Vancouver General Hospital, and Assistant Professor, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada. MICHAEL SHUSTER, M.D., FRCPC, is Attending Physician, Department of Emergency Medicine, Banff Mineral Springs Hospital, Banff, AB, Canada. ROBERT S. GREEN, M.D., FRCPC, is Attending Physician, Department of Medicine, Division of Critical Care Medicine, and Department of Emergency Medicine, QEIIHSC, and Associate Professor, Departments of Medicine and Emergency Medicine, DU. RICHARD S. SLAVIK, B.SC.(PHARM.), PHARM.D., ACPR, FCSHP, is Regional Manager—Professional Practice, Department of Pharmacy, Interior Health Authority, Kelowna, BC, Canada, and Clinical Associate Professor, Faculty of Pharmaceutical Sciences, UBC, Kelowna. ANDREW H. TRAVERS, M.D., M.SC., FRCPC, is Assistant Professor, Department of Emergency Medicine, DU, and Medical Director, Nova Scotia Emergency Health Services, Halifax.

Address correspondence to Dr. Zed at the Department of Pharmacy, Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, Room 2417, 1796 Summer Street, Halifax, NS, Canada, B3H 3A7 (peter.zed{at}dal.ca).

Purpose. The key changes included in the 2005 cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) guidelines are reviewed. Advances since publication of the current guidelines are also discussed. Summary. The 2005 CPR and ECC guidelines include several key changes from the previous version published in 2000. The new guidelines place an increased emphasis on chest compressions and recommend a compression:ventilation (C:V) ratio of 30:2. Current knowledge on defibrillation has also been incorporated by recommending that Emergency Medical Service (EMS) rescuers give two minutes of CPR before defibrillation when the response interval is greater than four to five minutes and EMS responders did not witness the arrest. Another major change is the recommendation for a single shock to be administered followed immediately by CPR with no check of the cardiac rhythm until two minutes of CPR has been performed postdefibrillation. The 2005 guidelines recommend that an automated external defibrillator should be implemented in public locations where there is a relatively high likelihood of witnessed cardiac arrest. In addition, the most recent guidelines highlight the shift from primary-rhythm-based therapies and resuscitation to a focus on neurologic outcomes. Conclusion. Several evidence-based changes were included in the 2005 CPR and ECC guidelines, including a C:V ratio of 30:2 and mitigation of hands-off time, early defibrillation, administration of a single shock versus a three-shock sequence, use of public-access defibrillators, and a shift from primary-rhythm-based therapies to a focus on neurologic outcomes. Index terms: Cardiopulmonary resuscitation; Emergencies; Heart arrest; Protocols