Recently, AHA has published a 2015 Updated Guideline for CPR and ECC. Here I will be sharing some updates for ACLS part.
In a nutshell, there are no major changes compared to the last (2010) guideline.
- Main changes are in CPR compression rate, depth and ventilation rate.
- Manual compression without any adjunctive device is still preferred over the use of devices eg ITC.
- Vasopressin is removed. Early epinephrine is recommended in non-shockable rhythm..
- Use of ETCO2 as 1 of the factors to discontinue resus efforts.
- Lidocaine and BB should not be used routinely after ROSC.
- EMERGENT angiography for those suspected to have cardiac ischemia .
- Temperature range for TTM is widened.
- Wait for AT LEAST 72 hours before accessing patient for poor neurological outcome, regardless of whether they receive TTM or not.
For those who do not know impedance threshold device, please watch this:
Compression-decompression CPR using suction device placed on chest
** One thing that I have missed
- If supplemental O2 is available, the maximal oxygen should be provided to the patients receiving CPR.
- Unlike in STEMI or post ROSC in which hyperoxia maybe detrimental, CPR is a low flow state. O2 demand is always higher during a cardiac arrest.