RxPG - Important Changes in European Resuscitation Guidelines: A Must for PLAB takers

New guidelines for the resuscitation of adults and children have been published today in November Issue of the international journal Resuscitation. It is important for all the doctors to update themselves about these guidelines as they herald a change in the existing chest compression algorithm. It is almost absolutely necessary for every PLAB Part 2 exam taker to familiarise themselves with these changes as Cardio-Pulmonary resuscitation is a compulsory OSCE station and doing it in a wrong way will lead to a definite fail. We at RxPG have summarised the important changes in guidelines for you in this article.

The guidelines are aimed at all healthcare workers and a section on basic life support also provides information for laypeople and first responders.

BACKGROUND
The recommendations made by the ERC (European Resuscitation Council) are based on a comprehensive, evidence-based review of resuscitation science that was undertaken over the last two years by experts from all over the world. The last CPR guidelines were published in 2000; since then, science has moved forward and our understanding of the evidence has improved. The new CPR guidelines focus on a back-to-basics approach and are easier for laypeople and healthcare professionals to learn. Early recognition of the patient who is very ill will enable medical assistance to be called immediately, providing an opportunity for early treatment and the prevention of cardiac arrest.

IMPORTANCE OF CHEST COMPRESSIONS
In the event of cardiac arrest, early chest compressions and breathing may keep enough blood going to the heart and brain to buy time until the heart can be restarted by an electric shock (defibrillation). Once the heart has been restarted new treatments aim to improve the chances of the patient making a full recovery.

COMPARISON
In comparison with the 2000 guidelines, the 2005 guidelines recommend giving more chest compressions (30 compressions for every 2 breaths instead of the traditional 15 compressions for every 2 breaths). The ratio of 30:2 applies to all adults and children (except for newborn babies). This should make it easier for everyone to learn and remember. Advances in defibrillator technology enable healthcare workers and trained laypeople to give an electric shock earlier and more effectively to a person in cardiac arrest.

INTRODUCTION OF THERAPEUTIC HYPOTHERMIA
It is known that hypothermia provides temporary protection for the brain when the heart stops beating. Recent evidence indicates that mild cooling of a person, whose heart has been restarted after cardiac arrest, may increase the chance of a full recovery. The new guidelines recommend that therapeutic hypothermia is used for some patients admitted to intensive care units after cardiac arrest.

SUMMARY OF CHANGES
The following changes in the BLS guidelines have been made to reflect the greater importance placed on chest compression, and to attempt to reduce the number and duration of pauses:

1) Make a diagnosis of cardiac arrest if a victim is unresponsive and not breathing normally.

2) Teach rescuers to place their hands in the centre of the chest, rather than to spend more time using the ‘rib margin’ method.

3) Give each rescue breath over 1 sec rather than 2 sec.

4) Use a ratio of compressions to ventilations of 30:2 for all adult victims of sudden cardiac arrest. Use this same ratio for children when attended by a lay rescuer.

5) For an adult victim, omit the initial 2 rescue breaths and give 30 compressions immediately after cardiac arrest is established.

References: European Resuscitation Society and British Resuscitation Council.