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European Resuscitation Council Guidelines for Resuscitation 2015

Summary of changes since 2010 Guidelines The main changes in the ERC Guidelines 2015 in comparison with the Guidelines 20101are summarised below:Special causes•Survival after an asphyxia-induced cardiac arrest is rare and survivors often have severe neurological impairment. During CPR, early effective ventilation of the lungs with supplementary oxy-gen is essential.•A high degree of clinical suspicion and aggressive treatment can prevent cardiac arrest from electrolyte abnormalities. The new algorithm provides clinical guidance to emergency treatment of life-threatening hyperkalaemia.•Hypothermic patients without signs of cardiac instability(systolic blood pressure ≥90 mmHg, absence of ventricular arrhythmias or core temperature ≥28◦C) can be rewarmed externally using minimally invasive techniques (e.g. with warm forced air and warm intravenous fluid). Patients with signs of cardiac instability should be transferred directly to a centre capable of extracorporeal life support (ECLS).•Early recognition and immediate treatment with intramuscular adrenaline remains the mainstay of emergency treatment for anaphylaxis.•The mortality from traumatic cardiac arrest (TCA) is very high.The most common cause of death is haemorrhage. It is recognised that most survivors do not have hypovolaemia, but instead have other reversible causes (hypoxia, tension pneumothorax, cardiac tamponade) that must be immediately treated. The new treatment algorithm for TCA was developed to prioritise the sequence of life- saving measures. Chest compressions should not delay the treatment of reversible causes. Cardiac arrests of non-traumatic origin leading to a secondary traumatic event should be recog- nised and treated with standard algorithms.•There is limited evidence for recommending the routine trans-port of patients with continuing CPR after out-of-hospital cardiac arrest (OHCA) of suspected cardiac origin. Transport may be beneficial in selected patients where there is immediate hospital access to the catheterisation laboratory and an infrastructure providing prehospital and in- hospital teams experienced in mechanical or haemodynamic support and percutaneous coronary intervention (PCI) with ongoing CPR.•Recommendations for administration of fibrinolytics when pulmonary embolism is the suspected cause of cardiac arrest remain unchanged. Routine use of surgical embolectomy or mechanical thrombectomy when pulmonary embolism is the suspected cause of cardiac arrest is not recommended. Consider these methods only when there is a known diagnosis of pulmonary embolism.•Routine use of gastric lavage for gastrointestinal decontamination in poisoning is no longer recommended. Reduced emphasis is placed on hyperbaric oxygen therapy in carbon monoxide poisoning.Special environments•The special environments section includes recommendations for treatment of cardiac arrest occurring in specific locations. These locations are specialised healthcare facilities (e.g. operating theatre, cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery), commercial airplanes or air ambulances, field of play, outside environment (e.g. drowning, difficult terrain, high altitude, avalanche burial, lightning strike and electrical injuries)or the scene of a mass casualty incident.•Patients undergoing surgical procedures involving general anaes- thesia, particularly in emergencies, are at risk from perioperative cardiac arrest. A new section covers the common causes and relevant modification to resuscitative procedures in this group of patients.•Cardiac arrest following major cardiac surgery is relatively common in the immediate post-operative phase. Key to successful resuscitation is recognition of the need to perform emergency resternotomy, especially in the context of tamponade or hae- morrhage, where external chest compressions may be ineffective. Resternotomy should be performed within 5 min if other interventions have failed.•Cardiac arrest from shockable rhythms (Ventricular Fibrillation(VF) or pulseless Ventricular Tachycardia (pVT)) during cardiac catheterisation should immediately be treated with up to three stacked shocks before starting chest compressions. Use of mechanical chest compression devices during angiography is recommended to ensure high-quality chest compressions and reduce the radiation burden to personnel during angiography with ongoing CPR.•In dental surgery, do not move the patient from the dental chair in order to start CPR. Quickly recline the dental chair into a hor- izontal position and place a stool under the head of the chair to increase its stability during CPR.•The in-flight use of AEDs aboard commercial airplanes can result in up to 50% survival to hospital discharge. AEDs and appropriate CPR equipment should be mandatory on board of all commercial aircraft in Europe, including regional and low-cost carriers.Consider an over-the-head technique of CPR if restricted access precludes a conventional method, e.g. in the aisle.•The incidence of cardiac arrest on board helicopter emergency medical services (HEMS) and air ambulances is low. Importance of preflight preparation and use of mechanical chest compression devices are emphasised.•Sudden and unexpected collapse of an athlete on the field of play is likely to be cardiac in origin and requires rapid recognition and early defibrillation.•The duration of submersion is a key determinant of outcome from drowning. Submersion exceeding 10 min is associated with poor outcome. Bystanders play a critical role in early rescue and resuscitation. Resuscitation strategies for those in respiratory or cardiac arrest continue to prioritise oxygenation and ventilation.•The chances of good outcome from cardiac arrest in difficult terrain or mountains may be reduced because of delayed access and prolonged transport. There is a recognised role of air rescue and availability of AEDs in remote but often-visited locations.•The cut-off criteria for prolonged CPR and extracorporeal rewarming of avalanche victims in cardiac arrest are more stringent to reduce the number of futile cases treated with extra-corpoereal life support (ECLS). ECLS is indicated if the duration of burial is >60 min (instead of >35 min), core temperature at extrication is <30◦C (instead of <32◦C), and serum potassium at hospital admission is ≤8 mmol L−1(instead of ≤12 mmol L−1) ; otherwise standard guidelines apply.•Safety measures are emphasised when providing CPR to the vic-tim of an electrical injury.•Recommendations for management of multiple victims should prevent delay of treatment available for salvageable victims during mass casualty incidents (MCIs). Safety at scene is paramount.A triage system should be used to prioritise treatment and, if the number of casualties overwhelms healthcare resources, withhold CPR for those without signs of life.Special patients•The section on special patients gives guidance for CPR inpatients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease, obesity) and those with specific physiological conditions (pregnancy, elderly people).•The first line treatment for acute asthma is inhaled beta-2 agonists while intravenous beta-2 agonists are suggested only for those patients in whom inhaled therapy cannot be used reliably.Inhaled magnesium is no longer recommended.•In patients with ventricular assist devices (VADs), confirmation of cardiac arrest may be difficult. If during the first 10 days after surgery, cardiac arrest does not respond to defibrillation, perform resternotomy immediately.•Patients with subarachnoid haemorrhage may have ECG changes that suggest an acute coronary syndrome (ACS). Whether a computed tomography (CT) brain scan is done before or after coronary angiography will depend on clinical judgement regarding the likelihood of a subarachnoid haemorrhage versus acute coronary syndrome.•No changes to the sequence of actions are recommended in resus- citation of obese patients, although delivery of effective CPR maybe challenging. Consider changing rescuers more frequently than the standard 2-min interval. Early tracheal intubation by an experienced provider is recommended.•For the pregnant woman in cardiac arrest, high-quality CPR with manual uterine displacement, early ALS and delivery of the fetus if early return of spontaneous circulation (ROSC) is not achieved remain key interventions.

Cardiac arrest, Special Circumstances, Resuscitation

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