Kjetil Sunde

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

Part 8: Advanced Life Support 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Part 8 : Advanced life support : 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Post–Cardiac Arrest Syndrome

The contributors to this statement were selected to ensure expertise in all the disciplines relevant to post–cardiac arrest care. In an attempt to make this document universally applicable and generalizable, the authorship comprised clinicians and scientists who represent many specialties in many regions of the world. Several major professional groups whose practice is relevant to post–cardiac arrest care were asked and agreed to provide representative contributors. Planning and invitations took place initially by e-mail, followed a series of telephone conferences and face-to-face meetings of the cochairs and writing group members. International writing teams were formed to generate the content of each section, which corresponded to the major subheadings of the final document. Two team leaders from different countries led each writing team. Individual contributors were assigned by the writing group cochairs to work on 1 or more writing teams, which generally reflected their areas of expertise. Relevant articles were identified with PubMed, EMBASE, and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Drafts of each section were written and agreed on by the writing team authors and then sent to the cochairs for editing and amalgamation into a single document. The first draft of the complete document was circulated among writing team leaders for initial comment and editing. A revised version of the document was circulated among all contributors, and consensus was achieved before submission of the final version for independent peer review and approval for publication. This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after cardiac arrest. The purpose is to provide a resource for optimization of post–cardiac arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes …

Part 1: Executive Summary 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation (ILCOR) was founded on November 22, 1992, and currently includes representatives from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Council of Southern Africa (RCSA), the InterAmerican Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Its mission is to identify and review international science and knowledge relevant to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and when there is consensus to offer treatment recommendations. Emergency cardiovascular care includes all responses necessary to treat sudden life-threatening events affecting the cardiovascular and respiratory systems, with a particular focus on sudden cardiac arrest. In 1999, the AHA hosted the first ILCOR conference to evaluate resuscitation science and develop common resuscitation guidelines. The conference recommendations were published in the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care .1 Since 2000, researchers from the ILCOR member councils have evaluated resuscitation science in 5-year cycles. The conclusions and recommendations of the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations were published at the end of 2005.2,3 The most recent International Consensus Conference was held in Dallas in February 2010, and this publication contains the consensus science statements and treatment recommendations developed with input from the invited participants. The goal of every resuscitation organization and resuscitation expert is to prevent premature cardiovascular death. When cardiac arrest or life-threatening emergencies occur, prompt and skillful response can make the difference between life and death and between intact survival and debilitation. This document summarizes the 2010 evidence evaluation of published science about the recognition and response to sudden life-threatening events, particularly sudden cardiac arrest and periarrest events in …

Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest

Background: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH.

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

Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial

CONTEXT Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration. OBJECTIVE To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest. DESIGN, SETTING, AND PATIENTS Prospective, randomized controlled trial of consecutive adult patients with out-of-hospital nontraumatic cardiac arrest treated within the emergency medical service system in Oslo, Norway, between May 1, 2003, and April 28, 2008. INTERVENTIONS Advanced cardiac life support with intravenous drug administration or ACLS without access to intravenous drug administration. MAIN OUTCOME MEASURES The primary outcome was survival to hospital discharge. The secondary outcomes were 1-year survival, survival with favorable neurological outcome, hospital admission with return of spontaneous circulation, and quality of CPR (chest compression rate, pauses, and ventilation rate). RESULTS Of 1183 patients for whom resuscitation was attempted, 851 were included; 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no access to intravenous drug administration group. The rate of survival to hospital discharge was 10.5% for the intravenous drug administration group and 9.2% for the no intravenous drug administration group (P = .61), 32% vs 21%, respectively, (P<.001) for hospital admission with return of spontaneous circulation, 9.8% vs 8.1% (P = .45) for survival with favorable neurological outcome, and 10% vs 8% (P = .53) for survival at 1 year. The quality of CPR was comparable and within guideline recommendations for both groups. After adjustment for ventricular fibrillation, response interval, witnessed arrest, or arrest in a public location, there was no significant difference in survival to hospital discharge for the intravenous group vs the no intravenous group (adjusted odds ratio, 1.15; 95% confidence interval, 0.69-1.91). CONCLUSION Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long-term survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00121524.

In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway

INTRODUCTION While pre-hospital factors related to outcome after out-of-hospital cardiac arrest (OHCA) are well known, little is known about possible in-hospitals factors related to outcome. HYPOTHESIS Some in-hospital factors are associated with outcome in terms of survival. MATERIAL AND METHODS An historical cohort observational study of all patients admitted to hospital with a spontaneous circulation after OHCA due to a cardiac cause in four different regions in Norway 1995-1999: Oslo, Akershus, Østfold and Stavanger. RESULTS In Oslo, Akershus, Østfold and Stavanger 98, 84, 91 and 186 patients were included, respectively. Hospital mortality was higher in Oslo (66%) and Akershus (64%) than in Østfold (56%) and Stavanger (44%), P=0.002. By multivariate analysis the following pre-arrest and pre-hospital factors were associated with in-hospital survival: age <or=71 years, better pre-arrest overall performance, a call-receipt-start CPR interval <or=1 min, and no use of adrenaline (epinephrine). The in-hospital factors associated with survival were: no seizures, base excess >-3.5 mmol l(-1), body temperature <or=37.8 degrees C, and serum glucose <or=10.6 mmol l(-1) 1-24 h after admittance with OR (95% CI) 2.72 (1.09-8.82, P=0.033), 1.12 (1.02-1.23, P=0.016), 2.67 (1.17-6.20, P=0.019) and 2.50 (1.11-5.65, P=0.028), respectively. Pre-arrest overall function, whether adrenaline was used, body temperature, the occurrence of hypotensive episodes, and the degree of metabolic acidosis differed between the four regions in parallel with the in-hospital survival rates. CONCLUSION Both pre-arrest, pre- and in-hospital factors were associated with in-hospital survival after OCHA. It seems important also to report in-hospital factors in outcome studies of OCHA. The design of the study precludes a conclusion on causability.

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015

Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Cochin University Hospital (APHP) and Paris Descartes University, Paris, France Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, slo, Norway Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy

European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing.

The importance of early, uninterrupted chest compressions is emphasised throughout these guidelines. Much greater emphasis on minimising the duration of the preshock and post-shock pauses. The continuation of compressions during charging of the defibrillator is recommended. Immediate resumption of chest compressions following defibrillation is also emphasised; in combination with continuation of compressions during defibrillator charging, the delivery of defibrillation should be achievable with an interruption in chest compressions of no more than 5 s. Safety of the rescuer remains paramount, but there is recognition in these guidelines that the risk of harm to a rescuer from a defibrillator is very small, particularly if the rescuer is wearing gloves. The focus is now on a rapid safety check to minimise the pre-shock pause. When treating out-of-hospital cardiac arrest, emergency medical services (EMS) personnel should provide good-quality CPR while a defibrillator is retrieved, applied and charged, but routine delivery of a pre-specified period of CPR (e.g., 2 or 3min) before rhythm analysis and a shock is delivered is no longer recommended. For some emergency medical services that have already fully implemented a pre-specified period of chest compressions before defibrillation, given the lack of convincing data either supporting or refuting this strategy, it is reasonable for them to continue this practice. The use of up to three-stacked shocks may be considered if ventricular fibrillation/pulseless ventricular tachycardia (VF/VT)