Anthony J. Handley

European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators.

Basic life support (BLS) refers to maintaining airway patency and supporting breathing and the circulation, without the use of equipment other than a protective device.(1) This section contains the guidelines for adult BLS by lay rescuers and for the use of an automated external defibrillator (AED). It also includes recognition of sudden cardiac arrest, the recovery position and management of choking (foreign-body airway obstruction). Guidelines for in-hospital BLS and the use of manual defibrillators may be found in Sections 3 and 4b.

European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances

uropean Resuscitation Council Guidelines for Resuscitation 2015 ection 4. Cardiac arrest in special circumstances natolij Truhlář a,b,∗, Charles D. Deakinc, Jasmeet Soard, Gamal Eldin Abbas Khalifae, nnette Alfonzof, Joost J.L.M. Bierensg, Guttorm Brattebøh, Hermann Brugger i, oel Dunningj, Silvija Hunyadi-Antičević k, Rudolph W. Koster l, David J. Lockeym,w, arsten Lottn, Peter Paalo,p, Gavin D. Perkinsq,r, Claudio Sandroni s, Karl-Christian Thies t, avid A. Zidemanu, Jerry P. Nolanv,w, on behalf of the Cardiac arrest in special ircumstances section Collaborators1

European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.

uropean Resuscitation Council Guidelines for Resuscitation 2010 ection 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, oisoning, drowning, accidental hypothermia, hyperthermia, asthma, naphylaxis, cardiac surgery, trauma, pregnancy, electrocution asmeet Soara,∗, Gavin D. Perkinsb, Gamal Abbasc, Annette Alfonzod, Alessandro Barelli e, oost J.L.M. Bierens f, Hermann Bruggerg, Charles D. Deakinh, Joel Dunning i, Marios Georgiouj, nthony J. Handleyk, David J. Lockey l, Peter Paalm, Claudio Sandronin, Karl-Christian Thieso, avid A. Zidemanp, Jerry P. Nolanq

European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation

Southmead Hospital, North Bristol NHS Trust, Bristol, UK Emergency Department, Ghent University Hospital, Ghent, Belgium Woolhope, Herefordshire, UK Department of Clinical Toxicology – Poison Centre and Emergency Department, Catholic University School of Medicine, Rome, Italy Paediatric Intensive Care and Emergency Medicine, Universite Libre de Bruxelles, Queen Fabiola Children’s University Hospital, Brussels, Belgium Department Anesthesiology and Pain Therapy, University Hospital Bern, Inselspital, Bern, Switzerland Honorary Consultant Physician, Colchester, UK Calderdale and Huddersfield NHS Trust, Salterhebble, Halifax, UK Sunderland Royal Hospital, Sunderland, UK University of Copenhagen and Capital Region, Rigshospitalet, Copenhagen, Denmark James Cook University Hospital, Middlesbrough, UK Royal United Hospital, Bath, UK University of Warwick, Warwick Medical School, Warwick, UK

Four-step CPR—improving skill retention

This study is an attempt to see if simplifying the teaching of basic life support leads to better skill acquisition and retention. Forty-eight lay volunteers received instruction in CPR; 24 were taught the standard 8-step sequence whereas 24 were taught a simplified 4-step sequence. Tests of performance were carried out on a manikin before and after training. Those in the 4-step group were significantly better than those in the 8-step group at remembering the sequence of skills immediately after training (P = 0.04), 1 week later (P < 0.001) and at 6 weeks (P < 0.001). Twenty-three out of the 24 volunteers in the 4-step group got the sequence completely correct each time they were tested, in contrast to only 2 out of the 24 in the 8-step group. There was no difference, however, in the quality of performance of the skills between the two groups. In addition, it was shown that use of the 4-step sequence should result in a useful reduction in the time taken before a rescuer calls for the emergency services and commences CPR. Whether such a radical change in teaching should be introduced is a matter for further discussion and research.

Heparin in the Prevention of Deep Vein Thrombosis after Myocardial Infarction

A trial of continuous intravenous heparin in the prevention of deep vein thrombosis was undertaken in 48 patients who had suffered a myocardial infarction. Of the 24 control patients who did not receive heparin seven (29%) developed calf vein thrombosis as detected by the radioactive fibrinogen technique. None of the 24 heparinized patients had any evidence of venous thrombosis. This difference is significant at the 1% level.

Teaching hand placement for chest compression—a simpler technique

BACKGROUND Simplification of the techniques and teaching of resuscitation are advocated as ways of improving skill acquisition and retention. A simple method for teaching hand placement for chest compression has been described but not validated. OBJECTIVE The objective of this study was to determine if instructing trainees simply to place their hands in the centre of the chest results in better initial and retained accuracy of hand placement than the usual method of first identifying anatomical landmarks. METHODS Volunteers received instruction in basic CPR, being taught hand placement either by the standard method (33 subjects) or the simplified method (32 subjects). They were tested for accuracy of hand position before training, immediately afterwards and 6 weeks later. RESULTS After training both groups showed an improvement in accuracy of hand placement but there was no significant difference in the degree of improvement between the groups (P=0.345), nor in the level of accuracy achieved (P=0.178). Six weeks after training, the Standard Group demonstrated a statistically significant deterioration in accuracy (P=0.001), whereas the Simple Group did not (P=0.561). By this time, however, there was no longer any difference in accuracy of hand placement for either group compared with before training (Standard Group P=0.912; Simple Group P=0.140). On the positive side, the Simple Group took significantly less time (2.90 s) than the Standard Group (4.43 s) to change from ventilation to chest compression (P=0.000003). CONCLUSIONS Simplifying the teaching of correct hand placement for chest compression does not appear to lead to improvement in acquisition or retention of the skill. However, it does result in a significant reduction in the length of the pauses between ventilation and chest compression.

Single rescuer adult basic life support

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 …

The relationship between rate of chest compression and compression:relaxation ratio

One of the arguments put forward in support of a relatively fast rate of chest compression during CPR, is that it facilitates the achievement of a high compression:relaxation ratio. This has been shown to increase blood flow. In this study a group of volunteers carried out chest compression at the rate that each felt was correct and comfortable. There was no significant relationship between compression rate and compression:relaxation ratio. In a second study volunteers carried out chest compression on a manikin at rates of 40/min; 60/min; 80/min and 100/min. There was no significant rate related difference in the compression:relaxation ratios recorded. The ability to achieve a high compression duration is not related to compression rate, and should not be a consideration when guidelines on CPR are revised.

European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid

Imperial College Healthcare NHS Trust, London, UK Centre for Evidence-Based Practice, Belgian Red Cross-Flanders, Mechelen, Belgium Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA Global First Aid Reference Centre, International Federation of Red Cross and Red Crescent Societies, Paris, France National and Kapodistrian University of Athens, Medical School, MSc “Cardiopulmonary Resuscitation”, Athens, Greece Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece Wellington Hospital, Wellington Place, London, UK Department of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria Colchester University Hospitals NHS Foundation Trust, Colchester, UK French Red-Cross, Paris, France Austrian Red Cross, National Training Center, Vienna, Austria Belgian Red Cross-Flanders, Mechelen, Belgium Department of Public Health and Primary Care, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium Faculty of Medicine, University of Ghent, Ghent, Belgium