Australian Resuscitation Council Research Articles

Part 9: Pediatric Basic Life Support

The epidemiology and outcome of pediatric cardiopulmonary arrest and the priorities, techniques, and sequence of pediatric resuscitation assessments and intervention differ from those of adults. Current guidelines have been updated after extensive multinational evidence-based review and discussion over several years. Areas of controversy in current guidelines and recommendations made by consensus are detailed. A large degree of uniformity exists in the current guidelines advocated by the AHA, Council on Latin American Resuscitation, Heart and Stroke Foundation of Canada, European Resuscitation Council, Australian Resuscitation Council, and Resuscitation Council of Southern Africa. Differences are currently based on local and regional preferences, training networks, and customs rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted.

Simply add oxygen: Why isn’t oxygen administration taught in all resuscitation training?

Resuscitation training is all about procedures, yet the overwhelming need is to get sufficient oxygen to hypoxic and endangered tissues. Neither the Australian Resuscitation Council nor the American Heart Association make mention in any basic courses of the need to add oxygen as soon as possible. The Australian Resuscitation Council has a separate policy on oxygen, and the American Heart Association mentions the need, but not until page 2274 of the 1992 ‘Guidelines’. Major first aid training organisations do not mention the use of oxygen resuscitation in basic courses. There seems to be a belief in first aid training that oxygen administration is potentially dangerous and is an ‘Advanced’ skill. Oxygen should be used as soon as possible, in as near 100% as possible in all resuscitation situations, and for the early management of injury and illness. Its use will never disadvantage a patient under these circumstances. This skill should be added into all resuscitation training. In these days of high technology for all, we can easily add the simple skill of administration of oxygen, as soon as available, to basic life support and first aid. An oxygen supply should be as easily available as a fire extinguisher, and as simply used.

Adult resuscitation guidelines

In April of this year at the international meeting in Brighton, the Resuscitation Council of the United Kingdom presented changes to its guidelines for resuscitation. The original guidelines, published in 1992 by the European Resuscitation Council ( ERC ), were the result of a consensus view from international groups of experts based on the most up to date information. The International Liaison Committee on Resuscitation (ILCOR) comprises the ERC, the American Heart Association (AHA), the Australian Resuscitation Council (ARC), the Resuscitation Council of Southern Africa (RCSA), the Heart and Stroke Foundation of Canada (HSFC). and the Cosejo Latinoamericano de Resuscitation (CLAR).

Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’: A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa

This scientific statement is the product of the Utstein ’95 Symposium held June 23-24, 1995, at Utstein Abbey, Island of Mosteroy, Rogaland County, Norway. Draft versions were circulated for comment to participants of the Utstein ’95 Symposium; the European Resuscitation Council Executive Committee; the Emergency Cardiac Care Committee of the American Heart Association; the Executive Committees of the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa; and several outside reviewers. The development of this statement was authorized by the Science Advisory and Coordinating Committee of the AHA and the Executive Committee of the European Resuscitation Council. We do not know the true effectiveness of in-hospital resuscitation. Observed results of the many published studies vary greatly. Studies originate from different settings and have different patient populations. Reports suffer from nonuniform nomenclature and variable inclusion definitions. Patients differ in the extent of comorbid conditions and interventions in place at the time of cardiac arrest. These differences prevent valid interhospital and intrahospital comparisons and make determining the effectiveness of current resuscitation techniques impossible. To develop these guidelines the task force used a consensus development process that originated with the “Utstein style” for reporting outcome data from out-of-hospital resuscitation events. Task force members performed an integrated review of published studies. An initial draft was prepared, discussed, and revised at a 2-day conference. Further drafts were revised and circulated among task force members and discussed face-to-face at three subsequent meetings. The task force defined a set of data elements that are essential or desirable for documenting in-hospital cardiac arrest. Data categories are hospital variables, patient variables, arrest variables, and outcome variables. The “In-Hospital Utstein-Style Template” was developed to summarize these data and recommendations for reporting a specific set of survival rates and outcomes. The task force …

Single rescuer adult basic life support: An advisory statement from the Basic Life Support Working Group of the International Liaison Committee on Resuscitation (ILCOR)

This document presents the consensus view of the Basic Life Support (BLS) Working Group of the International Liaison Committee on Resuscitation (ILCOR), which represents the world’s major resuscitation organizations (including the American Heart Association [AHA], the Australian Resuscitation Council, the European Resuscitation Council [ERC], the Heart and Stroke Foundation of Canada, and the Resuscitation Councils of Southern Africa). These advisory statements have evolved during 10 meetings of ILCOR from 1991 to the present. The scientific basis for the treatment of cardiac arrest has an active international literature.1 The purpose of creating these advisory statements is to take full advantage of international perspective and experience in the basic management of cardiac arrest. It is hoped that the “Sequence of Action” can be used as a template by individual national resuscitation organizations. This template should not, however, be considered a rigid standard. It is intended primarily to remove the many minor international differences in BLS education that have developed over the last 30 years, often without any basis in science. For example, if the current BLS guidelines of the ERC and the AHA are compared, most of the differences exist without any particular rationale and are based simply on quirks of historical practice. It is hoped that by removing these, BLS training can become as uniform as possible throughout the world. The process for the development of the advisory statements involved 1. Identification of major and minor differences between existing BLS guidelines.2 3 Minor differences mostly involved the use of words rather than any real differences of opinion about scientific content. They were resolved by arriving at a consensus. 2. Presentation of formal position papers on areas of major difference with an emphasis on available scientific evidence. The group attempted to reach consensus on items of controversy, but sometimes the …

Paediatric life support: An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation

This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3–17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.

Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.

Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.

Australian Resuscitation Council

Australian Resuscitation Council

Cardiopulmonary Resuscitation — The Need for National Surveys

At the Second World Congress on Emergency and Disaster Medicine in Pittsburgh in 1981, Professor Negovsky talked about the Science of Resuscitation. Science is defined as systematic and formulated knowledge. Therefore, to be a science, resuscitation must be presented in accurate and concise terms. The introduction of Standards in the methodology of Resuscitation has achieved this. In 1977, the American Heart Association published Standards for Cardiopulmonary Resuscitation and Emergency Cardiac Care (1) and revised them in 1980 as Standards and Guidelines (2). Organizations in other countries have also introduced such standards: the Canadian Heart Foundation, the Heart Foundation of New Zealand, the Australian Resuscitation Council, and the Resuscitation Advisory Council in the United Kingdom; they all have systematic and formulated methodologies. The value of these standards and guidelines in Resuscitation methods can only be gauged by the results of various individual surveys. The definition of Resuscitation as a science runs into problems when one begins to examine these results. This paper will illustrate the difficulties of evaluating Resuscitation results.Figure 1 shows a comparison of survival rates in5 centers (3-7) when Cardiopulmonary Resuscitation (CPR) was initiated by a rescue team or a bystander. It would appear that Seattle had the best overall survival rate, followed by Oslo. But Thompson and colleagues (5) from Seattle studied survival from cardiac arrest only when ventricular fibrillation was present when the paramedical personnel arrived. Lund and Skulberg (7) from Oslo did not state their type of victim, whereas Cobb and his colleagues (4) in suburban Seattle, with the lowest survival rates, looked at all forms of cardiac arrests.