Nurses' knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana.

Changes to the European Resuscitation Council guidelines for adult resuscitation

resuscitation ◼ defibrillators ◼ delivery of health care ◼ echocardiography ◼ electric countershock ◼ epinephrine ◼ extracorporeal membrane oxygenation ◼ heart arrest ◼ infusions, intraosseous ◼ intubation, intratracheal

Annual resuscitation competency assessments: A review of the evidence

A survey of Advanced Life Support practices in countries implementing the European Resuscitation Council guidelines

Despite several advances in resuscitation care over the last decade, in-hospital cardiac arrest (IHCA) remains common and is linked to poor survival. Approximately 200 000 hospitalized patients suffer IHCA and undergo cardiopulmonary resuscitation in the United States annually, with fewer than 20%

Cardiac arrest is a common and treatable cause of death and disability. Each year ≈424 000 people experience emergency medical services (EMS)-assessed out-of-hospital cardiac arrest (OHCA) in the United States.1 The actual burden of OHCA is likely significantly higher because a substantial number go unassessed. In a prospective analysis of deaths in a US county, 5.6% of annual mortality was attributable to cardiac arrest.2 Many patients who suffer OHCA do not receive prompt cardiopulmonary resuscitation (CPR). Among those who receive CPR, a large number do not survive because of an inability to restore spontaneous circulation, or anoxic cerebral injury even after restoration of circulation. Nevertheless, when timely interventions are provided, a small proportion of patients (10.4% of all EMS-treated OHCA) recover to resume normal lives. The key therapeutic interventions that make the difference between life and death, metaphorically characterized as the 5 links in a chain of survival by the American Heart Association, include: (1) immediate recognition of cardiac arrest and activation of the EMS, (2) early CPR with emphasis on chest compression, (3) rapid defibrillation, (4) effective advanced life support, and (5) integrated postcardiac arrest care.3 Resuscitation science has undergone major advances since the origins of modern CPR >50 years ago.4 The field continues to be dynamic with emergence of new therapies such as therapeutic hypothermia5 and improvements in systems of care. However, many questions remain on issues such as optimum compression rate, efficacy of chest compression only CPR (CCCPR), dispatcher-assisted CPR, and benefits of postresuscitation measures such as hypothermia. A critical challenge also lies in the translation of resuscitation science into practice. To improve outcomes, each of the links in the chain of survival needs to be executed promptly and effectively. There remain several lacunae, which need to be overcome to develop an …

To evaluate cardiac arrest outcomes following the introduction of the Australian Resuscitation Council (ARC) 2006 amended guidelines for basic and advanced life support. A retrospective study of all consecutive cardiac arrests during a 3-year phase pre-implementation (2004-06) and a 3-year phase post-implementation (2007-09) of the ARC 2006 guidelines was conducted at a tertiary referral hospital in Brisbane, Australia. Over the 6-year study phase 690 cardiac arrests were reported. Resuscitation was attempted in 248 patients pre-implementation and 271 patients post-implementation of the ARC 2006 guidelines. After adjusting for significant prognostic factors we found no significant change in return of spontaneous circulation (ROSC) (odds ratio 1.21, 95% confidence interval 0.80-1.85, P=0.37) or survival to discharge (odds ratio 1.49, 95% confidence interval 0.94-2.37, P=0.09) after the implementation of the ARC 2006 guidelines. Factors that remained significant in the final model for both outcomes included having an initial shockable rhythm, a shorter length of time from collapse to arrival of cardiac arrest team, location of the patient in a critical-care area, shorter length of resuscitation and a day-time arrest (0700-2259 hours). In addition the arrest being witnessed was significant for ROSC and younger age was significant for survival to discharge. There are multiple factors that influence clinical outcomes following an in-hospital cardiac arrest and further research to refine these significant variables will assist in the future management of cardiac arrests. WHAT IS KNOWN ABOUT THIS TOPIC? The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. WHAT DOES THIS PAPER ADD? This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines, which included a refocus on providing quality cardiopulmonary resuscitation with minimal interruptions. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding cardiopulmonary resuscitation is essential to improve outcomes.

Children and Adults in Cardiopulmonary Arrest: Are Advanced Life Support Guidelines Followed in the Prehospital Setting?

Of late there has been a debate on whether green revolution has reduced absolute poverty among farm families in India. Most of the studies examining the issue relate to the all-India rural sector. But since the green revolution has not spread evenly in all the regions, the changes in the level of poverty reported in these istudies do not strictly relate to the phenomenon. Haryana is one of those few regions where new agricultural technology has spread more widely than others and therefore the experience of its farmers should provide us a better picture of how poverty among farmers changes with the spread of new farming technology.

Cardiopulmonary Resuscitation in Coronavirus Disease 2019: Rebalancing Risk, Reward, and Autonomy.

Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Cardiopulmonary Resuscitation During the Coronavirus Crisis: Important Updates for the Cardiothoracic and Vascular Anesthesia Community

The contributors to this statement were selected to ensure expertise in all the disciplines relevant to post–cardiac arrest care. In an attempt to make this document universally applicable and generalizable, the authorship comprised clinicians and scientists who represent many specialties in many regions of the world. Several major professional groups whose practice is relevant to post–cardiac arrest care were asked and agreed to provide representative contributors. Planning and invitations took place initially by e-mail, followed a series of telephone conferences and face-to-face meetings of the cochairs and writing group members. International writing teams were formed to generate the content of each section, which corresponded to the major subheadings of the final document. Two team leaders from different countries led each writing team. Individual contributors were assigned by the writing group cochairs to work on 1 or more writing teams, which generally reflected their areas of expertise. Relevant articles were identified with PubMed, EMBASE, and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Drafts of each section were written and agreed on by the writing team authors and then sent to the cochairs for editing and amalgamation into a single document. The first draft of the complete document was circulated among writing team leaders for initial comment and editing. A revised version of the document was circulated among all contributors, and consensus was achieved before submission of the final version for independent peer review and approval for publication. This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after cardiac arrest. The purpose is to provide a resource for optimization of post–cardiac arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes …

Thank you for the opportunity to respond to the letter by Dr Hogan concerning resuscitation for cardiac arrest caused by anaphylaxis during anaesthesia. First, Dr Hogan questions the use of a pulse check to diagnose cardiac arrest with pulseless electrical activity (PEA). Second, Dr Hogan suggests that external chest compressions are potentially harmful in PEA caused by anaphylaxis and other states where there is a profound decrease in systemic vascular resistance because loss of a palpable pulse can occur in the presence of a cardiac output and low systemic vascular resistance. Cardiac arrest secondary to anaphylaxis can occur rapidly following a rapid decrease in the patient’s blood pressure [1]. The precise moment when PEA cardiac arrest occurs is difficult to diagnose clinically. Palpation of the pulse as the sole indicator of the presence or absence of cardiac arrest is unreliable [2]. A pulse check alone to diagnose cardiac arrest has not been part of advanced life support guidelines for many years [3]. Dr Hogan is therefore correct that the absence of a palpable pulse alone should not indicate the need for chest compressions if there are other reliable indicators of the presence of an adequate cardiac output. During anaesthesia, continuous monitoring of vital signs in addition to clinical signs will help make the diagnosis. The most recent guidelines for advanced life support reinforce the important diagnostic role of waveform capnography to indicate the return of a spontaneous circulation [4]. Current guidance for the treatment of anaphylaxis from both the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the Resuscitation Council UK suggests using an ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach with adrenaline and intravenous fluids as key treatments [5, 6]. Adrenaline should be given in small intravenous increments (e.g. 50 μg in adults) or an infusion, if necessary, to treat anaphylaxis during anaesthesia. These treatments may have already started before cardiac arrest occurs and may be useful in the scenario Dr Hogan describes. If cardiac arrest does occur, standard advanced life support guidelines should be followed [7]. These include high quality chest compressions combined with adrenaline and fluid resuscitation. The recommended doses of adrenaline used during cardiac arrest are much higher (1 mg intravenously in adults). Care therefore needs to be taken to confirm cardiac arrest before giving this significantly higher dose of adrenaline. Although chest compressions are undoubtedly less effective in the presence of hypovolaemia, we are not aware of any evidence that chest compressions reduce cardiac output in the presence of a low blood pressure, regardless of whether this has been caused by a low cardiac output or a vasodilatory state. There are few data to provide a basis for specific guidance on the treatment of cardiac arrest from anaphylaxis during anaesthesia. The current guidance may prevent cardiac arrest in many circumstances, and ensures that cardiopulmonary resuscitation with advanced life support measures is started early if cardiac arrest occurs. Following standard guidelines for advanced life support importantly acknowledges the fact that there may be clinical uncertainty about the cause of cardiac arrest during anaesthesia. If the anaesthetist is unable to feel a pulse, chest compressions should be started unless there are other convincing and reliable indicators of the presence of an adequate cardiac output. JS chairs the anaphylaxis working group of the Resuscitation Council UK and contributed to the AAGBI anaphylaxis guidance. He is an editor of Resuscitation. JPN is a member of the anaphylaxis working group of the Resuscitation Council UK and is Editor-in-Chief of Resuscitation. No external funding declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

Part 1: Introduction