Elsevier

Resuscitation

Volume 67, Issues 2–3, November–December 2005, Pages 213-247
Resuscitation

Part 4: Advanced life support

https://doi.org/10.1016/j.resuscitation.2005.09.018Get rights and content

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Causes and prevention

Rescuers may be able to identify some noncardiac causes of arrest and tailor the sequence of attempted resuscitation. Most patients sustaining in-hospital cardiac arrest display signs of deterioration for several hours before the arrest. Early identification of these high-risk patients and the immediate arrival of a MET (also known as Rapid Response Team in the United States) to care for them may help prevent cardiac arrest. Hospitals in many countries are introducing early warning systems such

Airway and ventilation

Consensus conference topics related to the management of airway and ventilation are categorised as (1) basic airway devices, (2) advanced airway devices, (3) confirmation of advanced airway placement, (4) strategies to secure advanced airways, and (5) strategies for ventilation.

Drugs and fluids for cardiac arrest

Questions related to the use of drugs during cardiac arrest that were discussed during the 2005 Consensus Conference are categorised as (1) vasopressors, (2) antiarrhythmics, (3) other drugs and fluids, and (4) alternative routes of delivery.

Monitoring and assisting the circulation

Specific questions related to the use of techniques and devices to (1) monitor the performance of CPR during cardiac arrest or (2) assist the circulation (alternatives to standard CPR) during cardiac arrest were discussed during the 2005 Consensus Conference. They are listed below.

Narrow-complex tachycardia

There are four options for the treatment of narrow-complex tachycardia in the periarrest setting: electrical conversion, physical manoeuvers, pharmacological conversion, or rate control. The choice depends on the stability of the patient and the rhythm. In a haemodynamically unstable patient, narrow-complex tachycardia is best treated with electrical cardioversion.

Cardiac arrest in special circumstances

In some circumstances modification of the standard resuscitation technique is required to maximize the victim's chance of survival. In many of these special circumstances recognition of the critically ill patient may enable early treatment to prevent cardiac arrest. The special circumstances reviewed during the consensus process can be categorised as environmental (hypothermia, submersion, electrocution), pregnancy, asthma, and drug overdose/poisoning.

Postresuscitation care

ROSC is just the first step toward the goal of complete recovery from cardiac arrest. Interventions in the postresuscitation period are likely to significantly influence the final outcome, yet there are relatively few data relating to this phase. In the absence of firm guidelines, approaches to postresuscitation care are heterogeneous. Postresuscitation interventions are categorised into the following areas: (1) ventilation, (2) temperature control (therapeutic hypothermia and prevention and

Consensus on science

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Five studies (LOE 4532, 533; LOE 5534, 535, 536) documented some ability to predict outcome in adults when neurological examination is undertaken during cardiac arrest, but there is insufficient negative predictive value for this assessment to be used clinically.

Treatment recommendation

Relying on the neurological exam during cardiac arrest to predict outcome is not recommended and should not be used.

Consensus on science

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In eight human prospective studies (LOE 3537, 538; LOE 4241, 539, 540, 541, 542, 543) of the value of biomarkers in

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    • Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review

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      During the initial care of patients in cardiac arrest by healthcare personnel, bag-valve-mask (BVM) ventilation with devices to open the airway (oropharyngeal or nasopharyngeal cannulas) is often the technique used until the establishment of advanced devices.2 There has been controversy about the ideal, definitive device for airway management during cardiopulmonary resuscitation (CPR); orotracheal intubation (OTI) has been the recommended standard.3,4 The International Liaison Committee on Resuscitation (ILCOR), in the latest recommendations (2015),5 raised reasonable doubts about the superiority of advanced airway management (by means of OTI or extraglottic airway devices [EADs]) in comparison with ventilation with BVMs, referring to the improvement of results obtained after cardiac arrest in various published observational studies.

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