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Welcome to the American Heart Association 2010 Update for CPR.

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Page 1: cpr guidelines 2010

Welcome to the

American Heart Association

2010 Update for CPR.

Page 2: cpr guidelines 2010

Clinical staff – all levels

2010 AHA Update for CPR

1.0

5/24/2011

This module provides the audience with an overview of

the American Heart Association’s 2010 changes to

CPR procedures for healthcare professionals.

The module contains 45 slides and should take ~25

minutes to complete. 404-785-6767

Shannon Dunlap

[email protected]

Mark Guerrein

05/24/2011 2©2011 Children’s Healthcare of Atlanta Inc.

All Rights Reserved.

None

Page 3: cpr guidelines 2010

Children’s Healthcare of Atlanta has developed this module to

present the updated CPR protocol from the American Heart

Association (AHA) to clinicians who perform CPR.

On April 1, 2011, we will begin utilizing this new protocol when CPR is

performed in our hospitals and neighborhood locations. You will be

thoroughly instructed in this protocol during your next CPR

recertification or your initial CPR certification course. Meanwhile,

there are some important points you must know so that you and all

those performing CPR are using the same protocol.

If you have any questions about any of these points you can ask your

educator or contact Shannon Dunlap.

Note: The new guidelines are highlighted in red throughout the CBT.

05/24/2011 3©2011 Children’s Healthcare of Atlanta Inc.

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Page 4: cpr guidelines 2010

At the completion of this module you will be able to

describe the American Heart Association’s 2010 revisions

to providing basic life support (including CPR) for:

•Adult victims

•Infant and child victims

•Victims with foreign body obstructions in their airways

05/24/2011 4©2011 Children’s Healthcare of Atlanta Inc.

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Page 5: cpr guidelines 2010

In late 2010, the American Heart Association or AHA

modified its recommendations on Cardio Pulmonary

Resuscitation (CPR) procedures to improve survival

rates of adult and pediatric victims.

These recommendations were based upon empirical

studies that indicated improved survival. They include:

•Changes to the “Chain of Survival”

•Changes to the CPR sequence

In this lesson you will be presented with an overview of

these changes.

Lesson 1: CPR Overview

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Page 6: cpr guidelines 2010

CPR Overview

• Immediate recognition of cardiac

arrest and activation of the

emergency response system

• Early CPR emphasizing chest

compressions

• Rapid defibrillation

• Effective advanced life support

• Integrated post-cardiac care

Successful resuscitation following cardiac arrest requires several key actions

also know as the Chain of Survival. These are:

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Page 7: cpr guidelines 2010

Change in Sequence

The new AHA guidelines recommend a

fundamental change in CPR sequence

from A-B-C to C-A-B

C-A-B

•Compressions: Push hard and fast on

the center of the victim’s chest.

•Airway: Tilt the victim’s head back and lift

the chin to open the airway.

•Breathing: Give mouth-to-mouth or

bag/mask rescue breathing.

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Page 8: cpr guidelines 2010

Change in Sequence continued

The new AHA guidelines have also eliminated “Look, Listen, and Feel” from

the CPR sequence because performing it is inconsistent and time consuming.

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Page 9: cpr guidelines 2010

Cardiac Arrest

• Cardiac arrest in adults is usually

sudden, and the primary cause is

cardiac related. Therefore

circulation produced by chest

compressions is crucial.

• Cardiac arrest in children is

mostly asphyxial which requires

both compressions and

ventilations.

• Rescue breathing may be more

important for children than adults

in cardiac arrest.

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Page 10: cpr guidelines 2010

Lesson 1: CPR Overview

In this lesson you learned about general changes to

CPR guidelines that the AHA has recommended:

•Changes to the “Chain of Survival”

•Changes to the CPR sequence from A-B-C to C-A-B

In the next lesson you will be presented the specific

changes to the AHA CPR guidelines for adults.

05/24/2011 10©2011 Children’s Healthcare of Atlanta Inc.

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Page 11: cpr guidelines 2010

Lesson 2: Adult Basic Life

Support for Healthcare

Providers

In this lesson you will learn about changes to the CPR

procedures for adults that are provided by our

caregivers here at Children’s.

These include revisions to:

•Chest compressions

•Pulse checks

•Rescue breaths

You will also learn about revisions on using an

Automated External Defibrillator (AED) in conjunction

with CPR.

05/24/2011 11©2011 Children’s Healthcare of Atlanta Inc.

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Page 12: cpr guidelines 2010

Adults / Adolescents Basic Life Support (BLS) for

Healthcare Providers

• The rescuer recognizes that the

patient is unresponsive – no

breathing or no normal breathing.

• Activate the emergency response

system and get AED/defibrillator –

if second rescuer is available send

her or him to do this.

• Check the pulse – if definite pulse

within 10 seconds give 1 breath

every 5 to 6 seconds and re-check

carotid pulse every 2 minutes.

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Page 13: cpr guidelines 2010

Adult BLS for Healthcare Providers

• If there is no pulse, begin CPR starting with

30 compressions. Then open the airway and

give 2 breaths.

• When the AED/defibrillator arrives, check

rhythm.

• If rhythm is shockable, give 1 shock and

resume CPR immediately for 2 minutes.

• If rhythm is not shockable, resume CPR for 2

minutes; check rhythm every 2 minutes and

continue until advanced life support providers

take over or the patient starts to move.

• The AED will automatically prompt you to

perform the above actions.

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Page 14: cpr guidelines 2010

Chest Compressions in AdultsRescuers should focus on delivery of high qualityCPR – Push Hard and Push Fast

• Provide chest compressions at an adequate rate (at least 100/min)

• Provide Chest compressions to adequate depth

o Adults: Compression depth of at least 2 inches (5cm)

o Allow complete chest recoil after each compression

• Minimize interruptions in compressions

• Avoid excessive ventilations

• If multiple rescuers are available, they should rotate the task of compressions

every 2 minutes

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Page 15: cpr guidelines 2010

Pulse Checks

• Studies have shown that healthcare

providers and lay rescuers have

difficulty detecting pulses.

• To avoid delay in CPR, healthcare

providers should take no more than 10

seconds to check for a pulse.

• If a pulse is not detected within 5-10

seconds then compressions should be

started.

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Page 16: cpr guidelines 2010

Rescue Breaths

• The 2010 AHA Guidelines recommend

the initiation of compressions before

ventilations.

• Once compressions have been started,

a trained rescuer should deliver rescue

breaths by mouth-to-mouth or

bag/mask.

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Page 17: cpr guidelines 2010

Rescue Breaths

• Rescue breaths should be

delivered over 1 second.

• Give sufficient tidal volume to

produce visible chest rise.

• Use compression to ventilation

ratio of 30 compressions to 2

ventilations.

• If there is a pulse give 1 breath

every 5-6 seconds.

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Page 18: cpr guidelines 2010

AED/Defibrillation

Defibrillation sequence

• Turn on the AED.

• Follow the AED prompts.

• Resume chest compressions

immediately after the shock;

minimize interruptions.

Pad placement

• The 4 pad positions are

anterolateral, anteroposterior,

anterior-left infrascapular, and

anterior-right infrascapular. All of

these positions are equally

effective.

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Page 19: cpr guidelines 2010

Adult BLS for Healthcare Providers

The following slide displays a flow chart of the steps to follow when providing

Adult BLS.

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Page 20: cpr guidelines 2010

Victim is unresponsive. No breathing or no normal breathing (i.e., only gasping).

Activate the emergency response

system and get AED/defibrillator.

Check pulse:

DEFINITE pulse within 10 secs.?

Begin cycles of 30 compressions

and 2 breaths.Give 1 breath every 5 to 6 secs.

Re-check pulse every 2 mins.

AED/defibrillator arrives.

Shockable rhythm?

Shockable rhythm:

Give 1 shock and resume

CPR for 2 mins.

No shockable rhythm: Resume

CPR immediately for 2 mins. Check

rhythm every 2 mins. Continue until

ALS providers take over or victim

starts to move.

2

3

3a 4

5

6

7 8

1

Pulse No Pulse

No

High Quality CPR•Rate at least 100/minute

•Compression depth at least 2

inches (5cm)

•Allow complete chest recoil after

each compression.

•Minimize interruptions in chest

compressions.

•Avoid excessive ventilations.

** Indicates a

change to

AHA protocol

YES

Adult / Adolescent

BLS for

Healthcare Providers

Page 21: cpr guidelines 2010

Lesson 2: Adult Basic Life

Support for Healthcare

Providers

In this lesson you learned about revisions to CPR

procedures for adults including:

•Chest compressions

•Pulse checks

•Rescue breaths

You also learned about revisions on using an Automated

external defibrillator (AED) in conjunction with CPR.

In the next lesson information about BLS for children

and infants is presented.

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Page 22: cpr guidelines 2010

Lesson 3: Child and

Infant CPR

This lesson presents information about revisions to the

CPR procedures for infants and children.

These include:

•The differences between CPR for infants and children

•Inadequate breathing issues

•Poor Perfusion

You will also learn about revisions on using an

Automated External Defibrillator (AED) in conjunction

with CPR for children and infants.

05/24/2011 22©2011 Children’s Healthcare of Atlanta Inc.

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Page 23: cpr guidelines 2010

Child and Infant CPR

• Infant BLS guidelines apply to

infants less than approximately 1

year of age.

• Child BLS guidelines apply to

children approximately 1 year of

age until puberty.

• For teaching purposes, puberty is

defined as breast development in

females and presence of axillary

hair in males.

05/24/2011 23©2011 Children’s Healthcare of Atlanta Inc.

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Page 24: cpr guidelines 2010

Child and Infant CPRThe AHA recommends that the sequence of CPR for adults and infants/children be the same

Rationale for making the changes in

CPR sequence to C-A-B in infants

and children:

•The majority of victims who require

CPR are adults. They have a better

outcome if compressions are started

as early as possible.

•Beginning CPR with compressions

rather than ventilations leads to a

shorter delay to the first compression.

• All rescuers should be able to start

chest compressions almost

immediately. Whereas positioning

the head and making sure there is

a seal for mouth-to–mouth or bag-

mask resuscitation takes time and

delays the initiation of chest

compressions

• This also offers the advantage of

consistency in education whether

the victims are adult, children or

infants.

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Page 25: cpr guidelines 2010

Pediatric Chain of Survival

• Make sure the area is safe for you

and the infant/child

• Assess the need for CPR and

start compressions – lone

rescuers should give about 5

cycles of compressions and

ventilations before leaving the

child to activate the emergency

response

• Activate emergency response

system and get the AED

• Effective advanced life support

• Integrated post-cardiac care

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Page 26: cpr guidelines 2010

Chest Compressions in Infants and Children

Rescuers should focus on delivery of high quality CPR –

Push Hard and Push Fast.

•Provide chest compressions to adequate rate (at least 100/minute)

•Provide chest compressions of adequate depth

– Infants and children: a depth of at least one third the anterior-posterior

(AP) diameter of the chest or about 1 ½ inches (4cm) in infants and about

2 inches (5cm) in children

•Allow compete chest recoil after each compression

•Minimize interruptions in compressions

•Avoid excessive ventilation

If multiple rescuers are available they should rotate the task of compressions

every 2 minutes.

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Page 27: cpr guidelines 2010

Pediatric BLS for Healthcare Providers in Infants

and Children

• If second rescuer is available send him or her to

activate the emergency response and obtain

AED/defibrillator. – AEDs have now been

approved for use with infants.

• Check pulse – if definite pulse within 10

seconds give 1 breath every 3 seconds.

• Add compressions if pulse remains less than

60/min with poor perfusion despite adequate

oxygenation and ventilation.

• Recheck pulse every 2 minutes.

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Page 28: cpr guidelines 2010

Pediatric BLS for Healthcare Providers in Infants

and Children• If no pulse is detected, begin cycles of 30

compressions and 2 breaths for one rescuer. For

2 rescuers begin cycles of 15 compressions and 2

breaths.

• If lone rescuer, after about 2 minutes, activate the

emergency response system if not already done.

Use an AED as soon as available.

• If rhythm is shockable, give 1 shock and resume

CPR immediately for 2 minutes.

• If rhythm is not shockable, resume CPR

immediately for 2 minutes. Check rhythm every 2

minutes. Continue until Advanced Life Support

providers take over or victim starts to move.

05/24/2011 28©2011 Children’s Healthcare of Atlanta Inc.

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Page 29: cpr guidelines 2010

Pediatric BLS for Healthcare Providers

The following slide displays a flow chart of the steps to follow when providing

pediatric BLS.

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Page 30: cpr guidelines 2010

Victim is unresponsive. Not breathing or gasping. Send someone to activate

The emergency response system and get an AED/defibrillator.

One rescuer:

For SUDDEN COLLAPSE activate the

emergency response system and get

AED/defibrillator

Check pulse:

DEFINITE pulse within 10 secs.?

One rescuer: Begin cycles of 30

compressions and 2 breaths

Two rescuers: Begin cycles of 15

compressions and 2 breaths

Give 1 breath every 3 secs. Add

compressions if pulse remains

< 60/min with poor perfusion despite

adequate oxygenation and ventilation

RE-check pulse every 2 mins

After about 2 mins, activate emergency

response system and get AED (if not already

done). Use AED ASAP to check rhythm.

Shockable rhythm?

Shockable rhythm:

Give 1 shock and resume

CPR for 2 mins.

No shockable rhythm: Resume

CPR immediately for 2 mins. Check

rhythm every 2 mins. Continue until

ALS providers take over or victim

starts to move.

2

3

3a 4

5

6

7 8

1

Pulse No Pulse

No

High Quality CPR•Rate at least 100/minute

•Compression depth at

least 1/3 anterior-posterior

diameter of chest, about 1

½ inches (4cm) in infants

and 2 inches (5cm) in

children

•Allow complete chest recoil

after each compression.

•Minimize interruptions in

chest compressions.

•Avoid excessive ventilations.

*

* Indicates a

change to AHA

protocol

YES

Pediatric BLS for

Healthcare Providers

TWO rescuers:

For SUDDEN COLLAPSE send someone

to activate the emergency response

system and get AED/defibrillator

2

Page 31: cpr guidelines 2010

Chest Compressions for Healthcare Provider

of Infants• For infants, the single rescuer should

use the 2-finger chest compression

technique.

• The 2-thumb encircling hands

technique is recommended when CPR

is provided by 2 rescuers.

• To do this, encircle the infant’s chest

with both hands. Spread your fingers

around the thorax, and place your

thumbs together over the lower third of

the sternum. Forcefully compress the

sternum with your thumbs.

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Page 32: cpr guidelines 2010

Inadequate Breathing with Pulse

If there is a palpable pulse > 60 per

minute but there is inadequate

breathing:

Give rescue breaths at a rate of about

12-20 breaths per minute – 1 breath

every 3-5 seconds until spontaneous

breathing resumes.

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Page 33: cpr guidelines 2010

Bradycardia with Poor Perfusion

If the pulse is less than 60 beats per minute and there are signs of poor perfusion

( i.e., pallor, mottling, cyanosis) begin compressions.

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Page 34: cpr guidelines 2010

AED/Defibrillators in Children and Infants

• If a manual defibrillator is unavailable

then an AED that has a pediatric

dose attenuator (pediatric pads) is

preferred for infants.

• An AED with a pediatric dose

attenuator is also preferred for

children under 8 years of age.

• If neither is available an AED without

a dose attenuator may be used.

• In infants, manual defibrillators are

preferred. If a manual defibrillator is

not available then one with a

pediatric dose attenuator (pediatric

pads) is preferred.

• AED’s that do not have

pediatric dose attenuators have

been used in infants with no

clear adverse effects.

05/24/2011 34©2011 Children’s Healthcare of Atlanta Inc.

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Page 35: cpr guidelines 2010

BLS for Adults vs. Children

In this lesson we discussed Basic Life Support (BLS) for children and Infants.

In the previous lesson Adult BLS was presented. It may be helpful to compare

the differences of these groups. The next slide displays a table taken from the

AHA 2010 Guidelines summarizing these differences.

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Page 36: cpr guidelines 2010

Recommendations

Component Adults Children Infants

Recognition

Unresponsive (for all ages)

No breathing or no normal

breathing (i.e., only gasping)No breathing or only gasping

No pulse palpated within 10 seconds for all ages (HCP only)

CPR Sequence C-A-B

Compression rate At least 100/min

Compression depth At least 2 inches (5cm)At least ½ AP diameter

About 2 inches (5cm)

At least ½ AP diameter

About 1½ inches (4cm)

Chest wall recoilAllow complete recoil between compressions

HCPs rotate compressions every 2 minutes

Compression

interruptions

Minimize interruptions in chest compressions

Attempt to limit interruptions to < 10 seconds

Airway Head tilt-chin lift (HCP suspected trauma: jaw thrust)

Compression-to-

ventilation ratios

(until advanced

airway placed)

30:2

1 or 2 rescuers

30:2

Single rescuer

15:2

2 HCP rescuers

Ventilations: when

rescuer untrained or

trained and not

proficient

Compressions only

Ventilations with

advanced airway

(HCP)

1 breath every 6-8 seconds (8-10 breaths/min)

Asynchronous with chest compressions

About 1 second per breath

Visible chest rise

Defibrillation

Attach and use AED as soon as possible. Minimize interruptions in chest compressions

before and after shock;

resume CPR beginning with compressions immediately after each shock.Source: Highlights of the 2010

AHA Guidelines for CPR & ECC

Summary of Key BLS Components for Adults, Children, and Infants**Excluding the newly born, in

whom the etiology of an arrest is

nearly always asphyxiate.

Page 37: cpr guidelines 2010

Lesson 3: Child and

Infant CPR

In this lesson you learned about.

•The differences between CPR for infants and children

versus adults

•Inadequate breathing issues

•Poor perfusion

You also learned about using an Automated External

Defibrillator (AED) in conjunction with CPR for children

and infants.

05/24/2011 37©2011 Children’s Healthcare of Atlanta Inc.

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Page 38: cpr guidelines 2010

Lesson 4: Foreign Body

Obstruction (Choking)

This final lesson will present information about foreign

body obstructions in victims’ airways, including:

• Relief for responsive and unresponsive victims

•Recognizing and responding appropriately to mild and

severe obstructions

You will also learn about Hands-only CPR.

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Page 39: cpr guidelines 2010

Foreign Body Airway Obstruction (Choking)

• Greater than 90% of childhood

deaths from foreign body

aspiration occur in children under

5 years old.

• Foreign body obstruction can be

either mild or severe.

• When it is mild, the adult and children

can cough and make some sounds.

• When it is severe, the adult or child

cannot cough or make any sound.

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Page 40: cpr guidelines 2010

Relief of Foreign Body Obstruction

• If the foreign body obstruction is

mild, do not interfere. Allow the

victim to clear airway by coughing

while you observe for signs of

severe foreign body obstruction.

• If the foreign body obstruction is

severe you must act to relieve the

obstruction.

• For adults and children, perform

abdominal thrusts until the object

is expelled or the victim becomes

unresponsive.

• For infant, deliver repeated cycles

of 5 back blows followed by 5

chest compressions until the

object is expelled or the victim

becomes unresponsive.

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Page 41: cpr guidelines 2010

Relief of Foreign Body Obstruction (Unresponsive)

If the victim becomes unresponsive:

•Start CPR with chest compressions –

do not perform a pulse check.

•After 30 chest compressions open

the airway.

•If you see a foreign body, remove it

but do not perform blind finger

sweeps because they may push the

objects further into the pharynx.

• Attempt to give 2 breaths and

continue with cycles of chest

compressions and ventilations

until the object is expelled. Look

for the object after each round of

compressions and sweep if seen.

• After 2 minutes, if no one has

done so, activate the emergency

response system.

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Page 42: cpr guidelines 2010

Hands-only CPRBecause we are in a healthcare setting, this CBT has focused primarily on CPR

for Healthcare Providers. Hands-only CPR is for layperson cardiac arrest

rescue in the community or out of the hospital when unable to provide breaths

(no mask/barrier) because:

• Lay rescuers are more likely to provide CPR if they do

not have to give ventilations.

• It is easier for emergency response personnel to

instruct lay rescuers how to perform chest

compressions when they are untrained.

• Survival rates from cardiac arrest are similar for

Hands-only CPR and CPR using both compressions

and ventilations.

• If the lay rescuer is trained, it is still recommended

that the rescuer perform both compressions and

ventilations.

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Page 43: cpr guidelines 2010

Lesson 4: Foreign Body

Obstruction (Choking)

This lesson presented information about foreign body

obstructions in victims’ airways, including:

• Relief for responsive and unresponsive victims

•Recognizing and responding appropriately to mild and

severe obstructions

You also learned about Hands-only CPR used by lay-

people.

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Page 44: cpr guidelines 2010

You have completed this module. In it you learned about

the changes to the AHA’s new recommendations for

providing CPR. These changes impact providing basic

life support for:

•Adult victims

•Infant and child victims

•Victims with foreign body obstructions in their airways

05/24/2011 44©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

Page 45: cpr guidelines 2010

References

2010 American Heart Association Guidelines for CPR and ECC, Supplement to Circulation November 2,2010, Volume 122, Issue 18, Supplement 3.

www.heart.org

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