Gavin D. Perkins

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support

Cardiothoracic Anaesthesia, Southampton General Hospital, Southampton, UK Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Surgical Intensive Care Unit, Oslo University Hospital Ulleval, Oslo, Norway Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Critical Care and Resuscitation, University of Warwick, Warwick Medical School, Warwick, UK

European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary.

This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2010. Detailed guidance is provided in each of the ten sections, which are published as individual papers within this issue of Resuscitation. The sections of the ERC Guidelines 2015 are:

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.

Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

CONTEXT Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic. OBJECTIVE To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO. DESIGN, SETTING, AND PATIENTS A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching). MAIN OUTCOME MEASURE Survival to hospital discharge analyzed according to the intention-to-treat principle. RESULTS Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P = .006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P = .008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P = .001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated. CONCLUSION For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients.

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 2015: Section 3. Adult advanced life support

Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany Warwick Medical School, University of Warwick, Coventry, UK Heart of England NHS Foundation Trust, Birmingham, UK Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, elsinki, Finland Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway edical Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biom outhampton, UK

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

Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library). By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6 GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9 These evidence profile tables were then used to create a …

Effect of intravenous β-2 agonist treatment on clinical outcomes in acute respiratory distress syndrome (BALTI-2): a multicentre, randomised controlled trial

Summary Background In a previous randomised controlled phase 2 trial, intravenous infusion of salbutamol for up to 7 days in patients with acute respiratory distress syndrome (ARDS) reduced extravascular lung water and plateau airway pressure. We assessed the effects of this intervention on mortality in patients with ARDS. Methods We did a multicentre, placebo-controlled, parallel-group, randomised trial at 46 UK intensive-care units between December, 2006, and March, 2010. Intubated and mechanically ventilated patients (aged ≥16 years) within 72 h of ARDS onset were randomly assigned to receive either salbutamol (15 μg/kg ideal bodyweight per h) or placebo for up to 7 days. Randomisation was done by a central telephone or web-based randomisation service with minmisation by centre, pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) ratio, and age. All participants, caregivers, and investigators were masked to group allocation. The primary outcome was death within 28 days of randomisation. Analysis was by intention-to-treat. This trial is registered, ISRCTN38366450 and EudraCT number 2006-002647-86. Findings We randomly assigned 162 patients to the salbutamol group and 164 to the placebo group. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality (55 [34%] of 161 patients died in the salbutamol group vs 38 (23%) of 163 in the placebo group; risk ratio [RR] 1·47, 95% CI 1·03–2·08). Interpretation Treatment with intravenous salbutamol early in the course of ARDS was poorly tolerated. Treatment is unlikely to be beneficial, and could worsen outcomes. Routine use of β-2 agonist treatment in ventilated patients with this disorder cannot be recommended. Funding UK Medical Research Council, UK Department of Health, UK Intensive Care Foundation.

Part 12: Education, Implementation, and Teams 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Cardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post–cardiac arrest care. The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest. The use of evidence-based education and implementation strategies can optimize the links of that chain. Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based Chain of Survival. Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community- and hospital-based resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feedback, …