The new Australian Resuscitation Guidelines are out. We were waiting to see if they took on the form of the Americal Heart Association or the European version. We tend to follow the European version. Here they are.
The new guidelines recognise the need for continuous chest compressions as well as the need to minimise time away from CPR.
For a 14 minute summary lecture this week on adult resuscitation, go to the free lecture on the home page of Resus TV. Paediatric guidelines coming in the next week.
In summary, the adult guidelines are:
They stress the importance of good, CONTINUOUS cardiac compressions, with minimal interruption.
-Remember that CPR gives about 25-30% of the normal cardiac output, so it really is a bandaid measure
-Remember to start CPR immediately after defibrillation
They acknowledge the importance of defibrillation as perhaps the only thing that makes a definitive difference.
Airway is important but should not interrupt cardiac compressions by at most 20 seconds.
-It is probably important to not intubate immediately but to oxygenate and ventilate with bag valve mask or laryngeal mask
-End tidal CO2 is recommended to monitor potential return of spontaneous circulation
What about drugs?
-It is emphasised that drugs do not make any great difference
-Certainly adrenaline increases the chance of return of circulation, but makes no difference in terms of intact patient to hospital discharge
-Adrenaline is given following the second shock
-Amiodarone is the anti-arrhythmic used
-The anti-arrhythmic is given following the third shock
What about cooling?
-Yes it’s still cool to cool. Use normal saline at 4 degrees Celcius and give 30mL/kg
For my approach, watch the video. To practice, come along to one of the Cardiac Courses where we discuss all the evidence, what there is for it, and practice the best approaches.
In an arrested patient:
- Start CPR immediately 30:2
- Get the defibrillator there and attach the paddles
- Airway at this point is bag valve mask
- Assess the rhythm – is it VF or VT (pulseless)? If yes, SHOCK 200J with biphasic. If not, is it PEA or asystole? If yes, give adrenaline
- Following shock, restart chest compressions immediately – go for 5 cycles of 30:2 ie., 2 minutes
- Get IV access (NO LONGER APPROPRIATE TO PUT DRUGS DOWN THE ENDOTRACHEAL TUBE)
- If cannot get IV access i.e. within 1 – 1.5 minutes (i.e. until the next shock) use intraosseous
- After 2 minutes, assess rhythm if shockable do so and start compressions
- Give 1mg of adrenaline
- In 2 minutes, re-assess rhythm – if organised rhythm, only at this time check the pulse. If not SHOCK again and restart CPR
- Give anti-arrhythmic – Amiodarone 5mg/kg
- Continue with cycles – adrenaline next and then amiodarone
- If spontaneous circulation returns:
- I then will intubate the patient
- I give approximately 2-3L of cooled normal saline
Having your own approach is essential.
Go to Resus TV to watch the free 14 minute lecture.