So following on from our recent blog on the European Resuscitation Council’s 2015 guidelines on traumatic cardiac arrest (which are just a part of the new ERC guidelines), we thought we’d just run through some of the changes that caught our eye in the rest of the guideline. When you’ve got a free hour or two, make sure you take a look at the rest of the guidelines yourself here.
Concentrating on the Advanced Life Support section
The emphasis remains on high quality uninterrupted chest compressions with extremely small interruptions for necessary interventions and they state that defibrillation should lead to a pause in chest compressions for less than 5 seconds.
There is a new section on waveform capnography which is mentioned extensively throughout the the new guidelines. They highlight it’s utility in a number of respects;
- Ensuring ET placement in the trachea
- Monitoring ventilatory rate during CPR and avoiding hyperventilation and hypocarbia which is associated with worse neurological outcomes
- Monitoring the quality of chest compressions during CPR
- Identifying ROSC during CPR and potentially avoiding unnecessary adrenaline administration
- Prognostication during CPR; that lower values are associated with poor prognosis and specifically that the inability to achieve 1.33kPa after 20 minutes of CPR has been proven to be associated with poor outcomes in some observational studies. But they also warn that the cessation of CPR should not be made on the ETCO2 alone.
There have been no changes in the recommendations involving drug therapy but there has been an acknowledgement regarding the relative lack of evidence in the role of drugs for improving outcomes from cardiac arrests.
Following some recent trials of mechanical chest compression devices the guideline comment that these are not recommended for routine use but that there may be situations in which sustained high-quality chest compressions are impractical without their use.
Ultrasound gets a mentioned as having a role in identifying reversible causes of cardiac arrest as does extracorporeal CPR (ECPR) for those patients in whom initial ALS measures are unsuccessful. ECPR could be considered to facilitate specific interventions such as PCI or pulmonary thrombectomy for massive PE.
The guideline also mentions that transport with continuing CPR may help selected patients when there’s immediate access to the cath lab that’s experienced in PCI with patients in arrest.
The traumatic cardiac arrest guideline is also a new feature, check out the accompanying blog and podcast on this.
Coming onto the peri-arrest patients……
There’s a new algorithm providing clinical guidance of the treatment of a life-threatening hyperkalaemia.
There’s also a really useful table on the presentation and management of those tricky electrolyte disturbances and their management which can be so easy to forget.
Post Resuscitation Care…….
The new guidelines place greater emphasis on the need urgent PCI following out-of-hospital cardiac arrest if the cause is likely to be cardiac.
Rather than necessitating therapeutic hypothermia the guideline also gives the option of a targeted temperature management strategy to maintain the temperature a 36° C, acknowledging that the most important part of temperature management post ROSC is to prevent fever.
And finally it’s warned that prognostication following ROSC should be done considering multiple factors and there is an emphasis on allowing enough time to neurological recovery to ensure this is done appropriately.
No ground breaking changes but a few tweaks and improvements that it’s worth knowing about and that’s pretty much the ones we wanted to run through. There are other small changes contained within the guidelines and it is worth running through them when you get a chance.
Again a podcast will be out to sum this up really soon!