scholarly journals European Resuscitation Council guidelines 2021: Adult advanced life support changes related to the guidelines 2015

2021 ◽  
Vol 7 (18) ◽  
pp. 298-303
Author(s):  
Srđan Nikolovski ◽  
Lovćenka Čizmović
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Point Of Care ◽  
Advanced Life Support ◽  
High Heart Rate ◽  
Point Of Care Ultrasound ◽  
European Resuscitation Council ◽  
Skilled Operator ◽  
New Guidelines

Adult advanced life support guidelines 2021 provided by the European Resuscitation Council in its largest extent do not differ significantly from equivalent guidelines published six years ago. However, some important points were further emphasized, and some protocols show new additions and structural changes. According to the new guidelines, there is a greater recognition that patients with both in-hospital and out-of-hospital cardiac arrest have premonitory signs, and that many of these arrests may be preventable. High-quality chest compressions with minimal interruption, early defibrillation, and treatment of reversible causes remained high priority steps in resuscitation process. New guidelines also recommend that, if an advanced airway is required, rescuers with a high tracheal intubation success rate should use this technique. With regard to using diagnostic procedures, medications, and special methods of cardiopulmonary resuscitation, newest guidelines also made new suggestions. According to these guidelines, when adrenaline is used, it should be used as soon as possible when the cardiac arrest rhythm is non-shockable, and after three defibrillation attempts for a shockable cardiac arrest rhythm. The guidelines recognise the increasing role of point-of-care ultrasound in peri-arrest care for diagnosis, but emphasis that it requires a skilled operator, and the need to minimise interruptions during chest compression. Additionally, 2015 guidelines suggested use of point-of-care ultrasound in diagnosing several various conditions with potential of causing cardiac arrest. However, 2021 guidelines limited indications in diagnosing only cardiac causes, such as tamponade or pneumothorax. The guidelines also reflect the increasing evidence for extracorporeal cardiopulmonary resuscitation as a rescue therapy for selected patients with cardiac arrest when conventional advanced life support measures are failing or to facilitate specific interventions. Additionally, newest guidelines made significant changes in the order of steps used in the In/hospital resuscitation algorithm, as well as changes in several very important steps of treating tachycardias and high heart rate associated arrhythmias.

Nieuwe richtlijnen 2021 voor cardiopulmonale reanimatie bij volwassenen

2021 ◽  
Author(s):  
C. WYFFELS ◽  
J. KLEIN OVINK ◽  
PH. DEWOLF
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Treatment Recommendations ◽  
The Internet ◽  
European Resuscitation Council ◽  
Liaison Committee ◽  
New Guidelines ◽  
Erc Guidelines

New guidelines 2021 for cardiopulmonary resuscitation in adults. In March 2021, the new European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) were presented in Antwerp (Belgium). Every 5 years, these guidelines are renewed. They are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR). In this manuscript, the most important aspects of these guidelines are summarized. Furthermore, the changes with regard to the guidelines of 2015 are emphasized. Basic life support (BLS), advanced life support (ALS) and post-resuscitation care are discussed. The 2021 guidelines can be downloaded from the internet (http://www.erc.edu).

Resuscitation on the field: basic and advanced life support and automatic external defibrillators

2019 ◽  
pp. 403-410
Author(s):  
Mark S. Link ◽  
Mark Estes III
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Basic Life Support ◽  
Life Support ◽  
Action Plan ◽  
Advanced Life Support ◽  
Advanced Cardiac Life Support ◽  
Screening Strategy ◽  
Automated External Defibrillators ◽  
Playing Field

Resuscitation on the playing field is at least as important as screening in the prevention of death. Even if a screening strategy is largely effective, individuals will suffer sudden cardiac arrests. Timely recognition of a cardiac arrest with rapid implementation of cardiopulmonary resuscitation (CPR) and deployment and use of automated external defibrillators (AEDs) will save lives. Basic life support, including CPR and AED use, should be a requirement for all those involved in sports, including athletes. An emergency action plan is important in order to render advanced cardiac life support and arrange for transport to medical centres.

scholarly journals Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Circulation ◽  
2020 ◽  
Vol 142 (16_suppl_1) ◽  
Author(s):  
Katherine M. Berg ◽  
Jasmeet Soar ◽  
Lars W. Andersen ◽  
Bernd W. Böttiger ◽  
Sofia Cacciola ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Systematic Reviews ◽  
Life Support ◽  
Advanced Life Support ◽  
Treatment Recommendations ◽  
International Consensus ◽  
Scoping Reviews ◽  
New Evidence ◽  
Cardiovascular Care

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

2019 ◽  
Vol 36 (8) ◽  
pp. 479-484 ◽  
Author(s):  
Mark H Ebell ◽  
Akke Vellinga ◽  
Siobhan Masterson ◽  
Phillip Yun
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Meta Analysis ◽  
Advanced Life Support ◽  
Study Quality ◽  
European Resuscitation Council ◽  
Comprehensive Search ◽  
Hospital Cardiac Arrest ◽  
Low Rate

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

scholarly journals Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

2021 ◽  
Vol 17 (8) ◽  
pp. 6-19
Author(s):  
L.V. Usenko ◽  
А.V. Tsarev ◽  
Yu.Yu. Kobelatsky
Keyword(s):  
Cardiac Arrest ◽  
Healthcare Workers ◽  
Basic Life Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Advanced Life Support ◽  
European Resuscitation Council ◽  
Improved Outcomes ◽  
Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

scholarly journals Return of spontaneous circulation in patients with out-of-hospital cardiac arrest caused by pulmonary embolism using early point-of-care ultrasound and timely thrombolytic agent application: Two case reports

2020 ◽  
pp. 102490792096413
Author(s):  
Su Yeong Pyo ◽  
Gwan Jin Park ◽  
Sang Chul Kim ◽  
Hoon Kim ◽  
Suk Woo Lee ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Acute Pulmonary Embolism ◽  
Thrombolytic Agent ◽  
Point Of Care ◽  
Fibrinolytic Therapy ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Hospital Cardiac Arrest

Introduction: Acute pulmonary embolism is a confirmed cause of up to 5% of out-of-hospital cardiac arrest and 5%–13% of unexplained cardiac arrest in patients. However, the true incidence may be much higher, as pulmonary embolism is often clinically underdiagnosed. Thrombolytic therapy is a recognized therapy for pulmonary embolism–associated cardiac arrest but is not routinely recommended during cardiopulmonary resuscitation. Therefore, clinicians should attempt to identify patients with suspected pulmonary embolism. Many point-of care ultrasound protocols suggest diagnosis of pulmonary embolism for cardiac arrest patients. Case presentation: We describe two male patients (60 years and 66 years, respectively) who presented to the emergency department with cardiac arrest within a period of 1 week. With administration of point-of care ultrasound during the ongoing cardiopulmonary resuscitation in both patients, fibrinolytic therapy was initiated under suspicion of cardiac arrest caused by pulmonary embolism. Both patients had return of spontaneous circulation; however, only the second patient, who received fibrinolytic therapy relatively early, was discharged with a good outcome. In this report, we discussed how to diagnose and manage patients with cardiac arrest–associated pulmonary embolism with the help of point-of care ultrasound. We also discuss the different clinical outcomes of the two patients based on the experience of the clinicians and the timing of thrombolytic agent application. Conclusions: If acute pulmonary embolism is suspected in patients with out-of-hospital cardiac arrest, we recommend prompt point-of care ultrasound examination. Point-of care ultrasound may help identify patients with pulmonary embolism during cardiopulmonary resuscitation, leading to immediate treatment, although the clinical outcomes may vary.

scholarly journals New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

Medicina ◽  
2010 ◽  
Vol 46 (9) ◽  
pp. 571 ◽  
Author(s):  
Andrius Pranskūnas ◽  
Paulius Dobožinskas ◽  
Vidas Pilvinis ◽  
Živilė Petkevičiūtė ◽  
Nedas Jasinskas ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Current Trends ◽  
Resuscitation Guidelines ◽  
Chain Of Survival ◽  
Meta Analyses

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

scholarly journals Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

2014 ◽  
Vol 22 (4) ◽  
pp. 562-568 ◽  
Author(s):  
Daniela Aparecida Morais ◽  
Daclé Vilma Carvalho ◽  
Allana dos Reis Correa
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Services ◽  
Determinant Factors ◽  
Emergency Medical ◽  
Advanced Support

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%).CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

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