Saturday, 24 October 2015

2015 UPDATE- AHA CPR GUIDELINES

2015 UPDATE- AHA CPR GUIDELINES:
By Dr. Deepak Marwah

CHANGES FROM 2010:

●BASIC LIFE SUPPORT (BLS):

Compression rate is modified to a range of 100 to 120/min. (Should not exceed 120/min).

Compression depth for adults is modified to at least 2 inches (5 cm). (Should not exceed 2.4 inches (6 cm).

To allow full chest wall recoil after each compression, rescuers must avoid leaning on the chest between compressions.

Criteria for minimizing interruptions is clarified with a goal of chest compression fraction as high as possible, with a target of at least 60%.

For patients with ongoing CPR and an advanced airway in place, a simplified ventilation rate of 1 breath every 6 seconds (10 breaths per minute) is recommended.

For witnessed OHCA with a shockable rhythm, it may be reasonable to delay positive-pressure ventilation (PPV) by using a strategy of up to 3 cycles of 200 continuous compressions with passive oxygen insufflation and airway adjuncts.

●ADVANCE CARDIAC LIFE SUPPORT (ACLS):

Vasopressin has been removed from the Adult Cardiac Arrest Algorithm.

In intubated patients, failure to achieve an ETCO2 of greater than 10 mm Hg by waveform capnography after 20 minutes of CPR may be considered as one component of a multimodal approach to decide when to end resuscitation efforts, but should not be used in isolation.

Steroids as part of bundle with vasopressin and epinephrine may be administered in IHCA. Though routine use in not recommonded. 
(Steroids may provide some benefit when bundled with vasopressin and epinephrine in treating IHCA).

Initiation or continuation of lidocaine may be considered immediately after ROSC from VF/pulseless ventricular tachycardia (pVT) cardiac arrest.

Initiation or continuation of an oral or intravenous (IV) ß-blocker may be considered early after hospitalization from cardiac arrest due to VF/pVT.

●POST CARDIAC ARREST CARE:

Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected.

All comatose adults patients with ROSC should have TTM (target temperature management), with a target temperature between 32 to 36 C selected and achieved, then maintained constantly for at least 24 hours. 
Actively preventing fever in comatose patients after TTM is reasonable.

Routine prehospital cooling of OHCA patients with rapid infusion of cold IV fluids after ROSC is not recommonded.

Avoid and immediately correct (systolic BP less than 90 mmHg, mean arterial pressure less than 65) during post cardiac arrest care.

Prognostication is now recommended no sooner than 72 hours after the completion of TTM; for those who do not have TTM, prognostication is not recommended any sooner than 72 hours after ROSC.

All patients who progress to brain death or circulatory death after initial cardiac arrest should be considered potential organ donors.

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