References

Aufderheide TP, Frascone RJ, Wayne MA Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet. 2011; 377:(9762)301-1

Baker PW, Conway J, Cotton C Defibrillation or cardiopulmonary resuscitation first for patients with out-of-hospital cardiac arrests found by paramedics to be in ventricular fibrillation? A randomised control trial. Resuscitation. 2008; 79:(3)424-31

Berdowski J, Schmohl A, Tijssen JG Time needed for a regional emergency medical system to implement resuscitation Guidelines 2005--The Netherlands experience. Resuscitation. 2009; 80:(12)1336-41

Breitkreutz R, Price S, Steiger HV Focused echocardiographic evaluation in life support and periresuscitation of emergency patients: a prospective trial. Resuscitation. 2010; 81:(11)1527-33

Cave DM, Aufderheide TP, Beeson A Importance and Implementation of Training in Cardiopulmonary Resuscitation and Automated External Defibrillation in Schools: A Science Advisory From the American Heart Association. Circulation. 2011; 123:(6)691-706

Christenson J, Andrusiek D, Everson-Stewart S Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009; 120:(13)1241-7

Edelson DP, Abella BS, Kramer-Johansen J Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006; 71:(2)137-45

Hostler D, Everson-Stewart S, Dea T Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ. 2011; 342:(d512)

Jacobs IG, Finn JC, Oxer HF CPR before defibrillation in out-of-hospital cardiac arrest: a randomized trial. Emerg Med Australas. 2005; 17:(1)39-45

Kilgannon JH, Jones AE, Shapiro NI Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010; 303:(21)2165-71

Kouwenhoven WB, Jude JR, Knickerbocker GG Closed-chest cardiac massage. JAMA. 1960; 173:1064-7

Lerner EB, Persse D, Souders CM Design of the Circulation Improving Resuscitation Care (CIRC) Trial: A new state of the art design for out-of-hospital cardiac arrest research. Resuscitation. 2011; 82:(3)294-9

Morrison LJ, Bigham BL, Kiss A Termination of resuscitation: a guide to interpreting the literature. Resuscitation. 2008; 79:(3)387-90

Nichol G, Thomas E, Callaway CW Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008; 300:(12)1423-31

Nolan J, Soar J, Eikeland H The chain of survival. Resuscitation. 2006; 71:(3)270-1

Nolan J, Hazinski MF, Billi JE Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2010; 81:(Suppl 1)e1-25

Nolan JP, Soar J Airway techniques and ventilation strategies. Curr Opin Crit Care. 2008; 14:(3)279-86

Nolan J, Soar PJ, Zideman DA European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010; 81:(10)1219-76

Ogawa TA, Akahane M, Koike S Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ. 2011;

Olasveengen TM, Sunde K, Brunborg C Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA. 2009; 302:(20)2222-9

Perkins GD, Woollard M, Cooke MW Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial protocol. Scand J Trauma Resusc Emerg Med. 2010; 18:(1)

Pokorna M, Necas N, Kratochvil J A sudden increase in partial pressure end-tidal carbon dioxide (PETCO2) at the moment of return of spontaneous circulation. J Emerg Med. 2010; 38:(5)614-21

The Resuscitation Council (UK) in collaboration with the Intensive Care National Audit and Research Centre (ICNARC). 2010. http//tinyurl.com/6eva6ts (accessed 23 March 2011)

Soar J, Packham S Cardiac arrest centres make sense. Resuscitation. 2010; 81:(5)507-8

Wang HE, Simeone SJ, Weaver MD Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med. 2009; 54:(5)645-52

Zoll. 2011. http//tinyurl.com/6zr9oog ( accessed 23 March 2011)

New cardiac arrest guidelines: implications for paramedic practice

04 April 2011
Features
02 April 2011
Volume 3 · Issue 5

Abstract

New UK, European and international guidelines for cardiopulmonary resuscitation (CPR) were published in October 2010 (Nolan et al, 2010). These guidelines marked the 50th anniversary of modern CPR (Kouwenhoven et al, 1960). The new guidelines give greater emphasis on early bystander CPR, high quality chest compressions with minimal interruption, early effective defibrillation and good quality post cardiac arrest care for achieving neurological survival in cardiac arrest victims. Guidelines 2010 recommendations also attempt to make it easier for rescuers to achieve this in any setting. The full UK guidelines can be accessed from the Resuscitation Council (UK) website (www.resus.org.uk). In this article, the authors discuss issues relating to the new guidelines that they feel are relevant for paramedic practice.

Recognition of cardiac arrest, calling for help and starting bystander cardiopulmonary resuscitation (CPR) are the first and second links in the chain of survival (Nolan et al, 2006). Guidelines 2010 recommend deeper chest compressions (5–6 cm) at a faster rate (100–120 per minute), ensuring full recoil, with minimum interruption and with the same 30:2 compression to ventilation ratio. Studies show that the quality of CPR is a key determinant of outcome (Edelson et al, 2006; Christenson et al, 2009).

Despite much media hype, compression-only CPR is only effective for short periods in individuals who suffer a sudden primary cardiac arrest. Recent studies suggest conventional CPR has better overall outcomes (Ogawa et al, 2011). Ideally, laypeople should be trained to do both chest compressions and ventilations. Instruction in compression-only CPR should however be used by emergency telephone dispatchers to improve bystander CPR rates. Compression-only CPR is better than no CPR and individuals should be encouraged to do chest compressions if they cannot do ventilations. To improve bystander CPR rates, everybody should know CPR, so when training is opportunistic or time limited, even training in compression-only CPR is better than no training at all.

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Adrenaline
Defibrillation
Cardiac arrest
Cardiopulmonary resuscitation