Emergency Cardiovascular Care Guidelines Research Articles

Educational Perspectives

In the fall of 2005, the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR) as well as the American Heart Association’s Guidelines for Emergency Cardiovascular Care (ECC) were published in Circulation . The guidelines were prepared by the American Heart Association Pediatric Subcommittee and American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee based on an extensive review of the existing literature on neonatal resuscitation. The guidelines were used to develop and revise the Textbook of Neonatal Resuscitation , 5th edition, and accompanying Neonatal Resuscitation Program (NRP) education materials. Based on their findings, various changes have been made to the NRP, including new recommendations for the use of supplemental oxygen and endotracheal epinephrine. These changes have the potential for a profound impact on medical practice around the world. Newborns who do not require resuscitation generally can be identified by a rapid assessment of the following four characteristics: Of note, a fifth question, “Is the baby pink?” no longer appears as part of the rapid assessment immediately after birth. The sequential approach to a newborn in the delivery room remains the same (Figure⇓). NRP providers should continue to adhere to the ABCs of resuscitation: airway before breathing before circulation. The four categories of action in sequence are: Figure. Neonatal flow algorithm. Reprinted with permission from American Heart Association, American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal …

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support

The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support

The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support

2005 emergency cardiovascular care guidelines

Creating the 2005 ECC guidelines The comprehensive guidelines creation process followed in 2005 has evolved significantly beyond the process used to create previous guidelines. In 1992, the Heart and Stroke Foundation of Canada (HSFC) participated in the American Heart Association’s (AHA) guideline process and then adapted the AHA guidelines for Canada. In 2000, the HSFC partnered with the AHA and other members of the International Liaison Committee on Resuscitation (ILCOR)* to develop the first international ECC guidelines. Consensus on some issues was difficult or impossible to reach because of differences in resources and medical practice in different parts of the world. Even after the guidelines were agreed upon, each of the international participants then altered the guidelines for their home countries. In 2005, rather than try to reach an international consensus on guidelines, ILCOR agreed to develop an international consensus on science and also on treatment recommendations where possible, but to leave the establishment of guidelines to each of its members. The HSFC decided that, rather than “Canadianize” the AHA guidelines as it had done before 2000, HSFC would work with the AHA to develop a single set of guidelines that would be acceptable in both Canada and the United States. This 2005 guideline revision is the result of a process that began 5 years ago, immediately following the completion of the 2000 guidelines. The process has involved thousands of volunteer hours by hundreds of resuscitation experts and researchers from around the world, who reviewed 276 topics and completed more than 400 worksheets. In January 2005, 380 experts from around the world met in Dallas under the auspices of ILCOR to examine the evidence on resuscitation and to develop a consensus on science and on treatment recommendations. This international consensus forms the basis for the new guidelines. The guidelines themselves are a result of a collaboration between the AHA and the HSFC. Previous guidelines have been criticized for reflecting the influence of pharmaceutical companies and other special interests. For the 2005 guidelines, ILCOR and the AHA went to great lengths to ensure full disclosure of potential conflicts and to manage conflict of interest when it existed. Details of the conflict of interest policy have been published along with the consensus document.

Major Changes in the 2005 AHA Guidelines for CPR and ECC

The emergency cardiovascular care (ECC) scientists involved in the 2005 evidence evaluation process and the revision of the 2005 AHA Guidelines for CPR and ECC began and ended the process aware of the limitations of the resuscitation scientific evidence, optimistic about emerging data that documents the benefits of high-quality cardiopulmonary resuscitation (CPR), and determined to make recommendations that would increase survival from cardiac arrest and life-threatening emergencies. This editorial summarizes the factors that contributed to the tipping point, the point at which information and discussion either triggered support for major changes in the guidelines or reaffirmed existing recommendations. The scientists critically reviewed the sequence and priorities of the steps of CPR to identify those factors with the greatest potential impact on survival. They then developed recommendations to support those interventions that should be performed frequently and well. There was unanimous support for increased emphasis on ensuring that rescuers deliver high-quality CPR: rescuers need to provide an adequate number and depth of compressions, allow complete chest recoil after each compression, and minimize interruptions in chest compressions. The 2005 AHA Guidelines for CPR and ECC are based on the most comprehensive review of resuscitation literature ever published.1 The evidence evaluation process incorporated the input of 281 international resuscitation experts who evaluated research, topics, and hypotheses over a 36-month period before the 2005 Consensus Conference. The process included structured evidence evaluation, analysis, and documentation of the literature.2 It also included rigorous disclosure and management of potential conflicts of interest, a process summarized in two editorials.3,4 Cardiopulmonary resuscitation and emergency cardiovascular care is a relatively new field. The epidemiologic data is incomplete, and high-level evidence is insufficient to support many recommendations. Although sudden cardiac arrest (SCA) is responsible for an estimated 250 000 deaths out of the hospital in the United …

Part 10.2: Toxicology in ECC

Poisoning is an infrequent cause of cardiac arrest in older patients, but it is a leading cause of cardiac arrest in victims <40 years of age.1–4 When a patient with poisoning is in cardiac arrest or near-arrest, immediate support of airway, breathing, and circulation is essential. Urgent consultation with a medical toxicologist or certified regional poison center is recommended5,6 because standard guidelines for emergency cardiovascular care may not be optimal in the management of acute poisoning and overdose. This section presents recommendations for the care of the patient with a toxicologic problem. Some recommendations are evidence-based, but most toxicology research in this area consists primarily of small case series (LOE 5), case reports, and animal studies (LOE 6). Hence many of these recommendations are based on expert consensus, and further research is needed to validate them. Clinicians may see a patient with a history of ingestion of an unknown substance. In such cases the clinician must be familiar with common toxidromes and their therapies. To assist during such encounters, Table 1 lists drug-induced cardiovascular emergencies or altered vital signs, potential therapies to consider, and interventions that should be used with caution. View this table: TABLE 1. Drug-Induced Cardiovascular Emergencies or Altered Vital Signs * :Therapies to Consider † and Contraindicated Interventions Clinicians may also encounter patients with a history of known ingestion. Then the clinician must anticipate the complications from that substance and be prepared to treat them. Table 2 lists potentially cardiotoxic drugs, signs of toxicity, and therapy to consider. View this table: TABLE 2. Potentially Cardiotoxic Drugs: Cardiopulmonary Signs * of Toxicity and Therapy to Consider † ### Airway and Respiratory Management Poisoned patients may deteriorate rapidly. Providers must assess and frequently reassess airway, breathing, and circulation and support them as needed. Although consultation with a poison control center or toxicologist may be needed to identify a …

Cardiopulmonary Resuscitation in the Real World: When Will the Guidelines Get the Message?

THE GUIDELINES FOR CARDIOPULMONARY RESUSCITAtion (CPR) and Emergency Cardiovascular Care (ECC) are probably the most widely implemented and best-known guidelines in medicine. In the setting of cardiac arrest, health care professionals want and need simple, practical, and effective guidelines. As the American Heart Association (AHA) and International Liaison Committee on Resuscitation (ILCOR) revise their Consensus on Science and Treatment Guidelines in 2005, it is imperative to assess how these guidelines are developed. Despite the major reassessment and publication of new CPR and ECC guidelines every 5 to 8 years for the past 3 decades, survival from cardiac arrest remains dismal. Have the guidelines and guideline development process improved or compromised the treatment of patients in cardiac arrest? Do they reflect the reality of cardiac arrest treatment? Are they responsive, or impenetrable, to new ideas and concepts in ECC? Are there ways to improve the guidelines process and, therefore, the guidelines themselves? The studies by Wik et al and Abella et al in this issue of JAMA document a major problem in the treatment of patients in cardiac arrest. Using a sternal pad to monitor chest compressions and ventilations, Wik et al obtained data from paramedics and nurse anesthetists performing CPR on 176 adult patients with out-of-hospital cardiac arrest in 3 cities in Europe. They found that chest compressions were not provided 48% of the time with patients in cardiac arrest. Despite using a compression rate of 121/min, these rescue personnel, with the documented interruptions, delivered only 64 chest compressions per minute. Abella et al, using the same monitoring device to observe 67 in-hospital cardiac arrests, found that patients did not receive chest compressions 24% of the time during the resuscitation. Other problems identified in the CPR segments analyzed included ventilations of 20/min or more (61%), compression rates less than 90/min (28%), and inadequate compression depth (37%). Although neither of these studies was powered to assess patient survival, Abella et al found a trend showing that patients who had longer periods without chest compression had worse resuscitation outcome. These reports are consistent with previous studies documenting low chest compression rates and high ventilation rates when CPR is performed by health care professionals. They also complement studies looking at how laypersons and health professionals deliver CPR in cardiac arrest simulations. Assar et al demonstrated that laypersons taught single-rescuer CPR take an average of 16 seconds for each ventilatory pause. A recent study from our CPR Research Group showed that medical students needed 14 seconds to deliver 2 breaths during CPR and delivered only 43 chest compressions per minute after AHA standard CPR training because of pauses for ventilations. Students taught a simplified chest-compression-only CPR delivered 113 compressions per minute immediately after training and 91 compressions per minute when tested 6 months later. Thus, laypersons, medics, physicians, nurses, medical students, and other health care professionals do not perform CPR according to published guidelines. However, this conclusion is not surprising. Indeed, studies demonstrating poor retention of CPR skills have documented the poor performance of CPR for more than 3 decades. Does the quality of CPR make a difference in patient outcomes? Although there are no randomized controlled trials (RCTs) to answer this question, observational studies in both experimental models and humans indicate that the quality of CPR is likely to affect patient outcome. Kern et al demonstrated that when animals received realistic 16-second pauses for ventilations, 24-hour neurologically intact survival was 13% compared with 80% in the group receiving continuous chest compressions. Yu et al showed that 100% of animals receiving more than 80 compressions per minute were resuscitated whereas only 10% of those receiving fewer than 80 compressions per minute survived.

Family Member Presence During Cardiopulmonary Resuscitation: A Survey of US and International Critical Care Professionals

Recent international emergency cardiovascular care (ECC) and cardiopulmonary resuscitation (CPR) guidelines have recommended that health-care professionals allow family members to be present during resuscitation attempts. To assess whether critical care professionals support these recommendations, we surveyed health-care professionals for their opinions regarding family-witnessed resuscitation (FWR). We surveyed health-care professionals attending the International Meeting of the American College of Chest Physicians in San Francisco, CA, from October 23 to 26, 2000, about their CPR experience, their opinions on FWR, and demographic characteristics. The opinions of physicians, nurses, and other allied health professionals were compared, and differences in opinions based on demographics were examined. Five hundred ninety-two professionals were surveyed. Fewer physicians (20%) than nurses and allied health-care workers combined (39%) would allow family member presence during adult CPR (p = 0.0037 [chi(2) test]). Fourteen percent of physicians and 17% of nurses would allow a family presence during pediatric CPR. There was a significant difference among the opinions of US professionals, based on regional location. Professionals practicing in the northeastern states were less likely than other US professionals to allow FWR during adult or pediatric resuscitations (p = 0.016 and p < 0.001, respectively [chi(2) test]). Midwestern professionals were more likely than others to allow family members to be present during an adult resuscitation, when compared to professional in the rest of the nation (p = 0.002 [chi(2) test]). Health-care professionals disapproving of family member presence during CPR did so because of the fear of psychological trauma to family members, performance anxiety affecting the CPR team, medicolegal concerns, and a fear of distraction to the resuscitation team. Our evaluation indicated that the majority of critical care professionals surveyed do not support the current recommendations provided by the ECC and CPR guidelines of 2000.

Changes to CPR and emergency cardiovascular care guidelines

Changes to CPR and emergency cardiovascular care guidelines

Changes to CPR and emergency cardiovascular care guidelines

Changes to CPR and emergency cardiovascular care guidelines

Part 6: Advanced Cardiovascular Life Support

Part 6: Advanced Cardiovascular Life Support

Low-energy biphasic waveform defibrillation: evidence-based review applied to emergency cardiovascular care guidelines: a statement for healthcare professionals from the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation.

Researchers have only recently conducted out-of-hospital human studies that document outcomes of transthoracic defibrillation using a low-energy biphasic waveform shock. The American Heart Association Committee on Emergency Cardiovascular Care (ECC) and its subcommittees included prepublication reports of these studies in this review of transthoracic biphasic waveform defibrillation. The writing group and a panel of invited experts have diligently attempted to assess the quality of the studies reviewed here by using a formal evidence-based template, which is summarized in this statement. The experts most familiar with defibrillation technology and assessment are often recipients of research support from manufacturers of automated external defibrillators (AEDs). Several of the authors and expert reviewers of this report have signed disclosure statements acknowledging training or research support from one or more AED manufacturers. However, in every case, support was administered through the academic institutions employing those individuals. No one has disclosed receiving personal salary support or consultant’s fees from any AED manufacturer, nor has anyone disclosed that they are or were a shareholder, paid advisor, or member of an advisory board of an AED manufacturer. The same is true of ECC Committee members with one exception, an employee of an AED manufacturer who abstained from discussions of the reviewed material and this statement. The final statement was reviewed and approved by the AHA Science Advisory and Coordinating Committee, 2 ECC science advisors, and 2 AHA vice presidents. These reviewers were familiar with the comments and recommendations of the expert reviewers and their disclosure statements. It was the opinion of the final reviewers that statements by the writing group and reviewers were objective, balanced, and based on known scientific facts and did not appear influenced by the disclosed possible conflicts of interest. This report addresses important clinical questions regarding newly developed AEDs that deliver impedance-compensating, fixed, low-energy …