European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary
Introduction
The publication of these European Resuscitation Council (ERC) Guidelines for cardiopulmonary resuscitation (CPR) updates those that were published in 2005 and maintains the established 5-yearly cycle of guideline changes.1 Like the previous guidelines, these 2010 guidelines are based on the most recent International Consensus on CPR Science with Treatment Recommendations (CoSTR),2 which incorporated the results of systematic reviews of a wide range of topics relating to CPR. Resuscitation science continues to advance, and clinical guidelines must be updated regularly to reflect these developments and advise healthcare providers on best practice. In between the 5-yearly guideline updates, interim scientific statements can inform the healthcare provider about new therapies that might influence outcome significantly.3
This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2005. Detailed guidance is provided in each of the remaining nine sections, which are published as individual papers within this issue of Resuscitation. The sections of the 2010 guidelines are:
- 1.
Executive summary;
- 2.
Adult basic life support and use of automated external defibrillators;4
- 3.
Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing;5
- 4.
Adult advanced life support;6
- 5.
Initial management of acute coronary syndromes;7
- 6.
Paediatric life support;8
- 7.
Resuscitation of babies at birth;9
- 8.
Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution;10
- 9.
Principles of education in resuscitation;11
- 10.
The ethics of resuscitation and end-of-life decisions.12
The guidelines that follow do not define the only way that resuscitation can be delivered; they merely represent a widely accepted view of how resuscitation should be undertaken both safely and effectively. The publication of new and revised treatment recommendations does not imply that current clinical care is either unsafe or ineffective.
Section snippets
Basic life support
Changes in basic life support (BLS) since the 2005 guidelines include:4, 13
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Dispatchers should be trained to interrogate callers with strict protocols to elicit information. This information should focus on the recognition of unresponsiveness and the quality of breathing. In combination with unresponsiveness, absence of breathing or any abnormality of breathing should start a dispatch protocol for suspected cardiac arrest. The importance of gasping as sign of cardiac arrest is emphasised.
- •
All
Epidemiology and outcome of cardiac arrest
Ischaemic heart disease is the leading cause of death in the world.20 In Europe, cardiovascular disease accounts for around 40% of all deaths under the age of 75 years.21 Sudden cardiac arrest is responsible for more than 60% of adult deaths from coronary heart disease.22 Summary data from 37 communities in Europe indicate that the annual incidence of EMS-treated out-of-hospital cardiopulmonary arrests (OHCAs) for all rhythms is 38 per 100,000 population.22a Based on these data, the annual
The International Consensus on Cardiopulmonary Science
The International Liaison Committee on Resuscitation (ILCOR) 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 Inter-American Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Since 2000, researchers from the ILCOR member councils have evaluated
From science to guidelines
As in 2005, the resuscitation organisations forming ILCOR will publish individual resuscitation guidelines that are consistent with the science in the consensus document, but will also consider geographic, economic and system differences in practice, and the availability of medical devices and drugs. These 2010 ERC Resuscitation Guidelines are derived from the 2010 CoSTR document but represent consensus among members of the ERC Executive Committee. The ERC Executive Committee considers these
Conflict of interest policy for the 2010 ERC Guidelines
All authors of these 2010 ERC Resuscitation Guidelines have signed COI declarations (Appendix B).
The Chain of Survival
The actions linking the victim of sudden cardiac arrest with survival are called the Chain of Survival (Fig. 1.1). The first link of this chain indicates the importance of recognising those at risk of cardiac arrest and calling for help in the hope that early treatment can prevent arrest. The central links depict the integration of CPR and defibrillation as the fundamental components of early resuscitation in an attempt to restore life. Immediate CPR can double or triple survival from VF OHCA.42
Adult BLS sequence
Throughout this section, the male gender implies both males and females.
Basic life support comprises the following sequence of actions (Fig. 1.2).
1. Make sure you, the victim and any bystanders are safe.
2. Check the victim for a response:
- •
gently shake his shoulders and ask loudly: “Are you all right?“
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3a. If he responds:
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leave him in the position in which you find him, provided there is no further danger;
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try to find out what is wrong with him and get help if needed;
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reassess him regularly.
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3b. If he
Automated external defibrillators
Automated external defibrillators (AEDs) are safe and effective when used by either laypeople or healthcare professionals (in- or out-of-hospital). Use of an AED by a layperson makes it possible to defibrillate many minutes before professional help arrives.
Prevention of in-hospital cardiac arrest
Early recognition of the deteriorating patient and prevention of cardiac arrest is the first link in the Chain of Survival.180 Once cardiac arrest occurs, fewer than 20% of patients having an in-hospital cardiac arrest will survive to go home.36, 181, 182 Prevention of in-hospital cardiac arrest requires staff education, monitoring of patients, recognition of patient deterioration, a system to call for help and an effective response.183
Sequence of actions
Rescuers who have been taught adult BLS and have no specific knowledge of paediatric resuscitation may use the adult sequence, as outcome is worse if they do nothing. Non-specialists who wish to learn paediatric resuscitation because they have responsibility for children (e.g., teachers, school nurses, lifeguards), should be taught that it is preferable to modify adult BLS and perform five initial breaths followed by approximately one minute of CPR before they go for help (see adult BLS
Preparation
Relatively few babies need any resuscitation at birth. Of those that do need help, the overwhelming majority will require only assisted lung aeration. A small minority may need a brief period of chest compressions in addition to lung aeration. Of 100,000 babies born in Sweden in one year, only 10 per 1000 (1%) babies of 2.5 kg or more appeared to need resuscitation at delivery.571 Of those babies receiving resuscitation, 8 per 1000 responded to mask inflation and only 2 per 1000 appeared to need
Electrolyte abnormalities
Life-threatening arrhythmias are associated most commonly with potassium disorders, particularly hyperkalaemia, and less commonly with disorders of serum calcium and magnesium. In some cases therapy for life-threatening electrolyte disorders should start before laboratory results become available. There is little or no evidence for the treatment of electrolyte abnormalities during cardiac arrest. Guidance during cardiac arrest is based on the strategies used in the non-arrest patient. There are
Principles of education in resuscitation
Survival from cardiac arrest is determined by the quality of the scientific evidence behind the guidelines, the effectiveness of education and the resources for implementation of the guidelines.687 An additional factor is how readily guidelines can be applied in clinical practice and the effect of human factors on putting the theory into practice.688 Implementation of Guidelines 2010 is likely to be more successful with a carefully planned, comprehensive implementation strategy that includes
The ethics of resuscitation and end-of-life decisions
Several considerations are required to ensure that the decisions to attempt or withhold resuscitation attempts are appropriate, and that patients are treated with dignity. These decisions are complex and may be influenced by individual, international and local cultural, legal, traditional, religious, social and economic factors.766
The 2010 ERC Guidelines include the following topics relating to ethics and end-of-life decisions.
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Key principles of ethics.
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Sudden cardiac arrest in a global
Acknowledgements
Many individuals have supported the authors in the preparation of these guidelines. We would particularly like to thank Annelies Pické and Christophe Bostyn for their administrative support and for co-ordinating much of the work on the algorithms, and Bart Vissers for his role as administrative lead and member of the ERC Guidelines Steering Group. The algorithms were created by Het Geel Punt bvba, Melkouwen 42a, 2590 Berlaar, Belgium ([email protected]).
ERC Guidelines Writing Group: Gamal
References (767)
European Resuscitation Council Guidelines for resuscitation 2005. Section 1. Introduction
Resuscitation
(2005)- et al.
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 1. Executive Summary
Resuscitation
(2010) - et al.
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke
Resuscitation
(2008) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators
Resuscitation
(2010) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing
Resuscitation
(2010) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 4. Adult advanced life support
Resuscitation
(2010) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 5. Initial management of acute coronary syndromes
Resuscitation
(2010) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 6. Paediatric life support
Resuscitation
(2010) - et al.
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
Resuscitation
(2010) - et al.
European Resuscitation Council Guidelines for Resuscitation. Section 9. Principles of education in resuscitation
Resuscitation
(2010)
European Resuscitation Council Guidelines for Resuscitation 2010. Section 10. The ethics of resuscitation and end-of-life decisions
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 5. Adult basic life support
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6. Defibrillation
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 8. Advanced life support
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 9. Acute coronary syndromes
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 10. Pediatric basic and advanced life support
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 11. Neonatal resuscitation
Resuscitation
Mortality by cause for eight regions of the world: global burden of disease study
Lancet
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe
Resuscitation
Incidence of out-of-hospital cardiac arrest
Am J Cardiol
Ventricular fibrillation in Rochester, Minnesota: experience over 18 years
Resuscitation
Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest
Resuscitation
Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million
J Am Coll Cardiol
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 3. Evidence evaluation process
Resuscitation
Conflict of interest management before, during, and after the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Resuscitation
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4. Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Resuscitation
Survival after cardiac arrest outside hospital in Sweden. Swedish Cardiac Arrest Registry
Resuscitation
Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARREST)
Resuscitation
Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support
Ann Emerg Med
Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic
Resuscitation
Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Goteborg
Resuscitation
In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway
Resuscitation
Inter-hospital variability in post-cardiac arrest mortality
Resuscitation
Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest
Resuscitation
Skills of lay people in checking the carotid pulse
Resuscitation
Cardiopulmonary resuscitation skills in nurses and nursing students
Resuscitation
Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest
Resuscitation
Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons
Ann Emerg Med
Birmingham assessment of breathing study (BABS)
Resuscitation
A model for regional blood flow measurements during cardiopulmonary resuscitation in a swine model
Resuscitation
Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression–decompression techniques
Resuscitation
Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest
Resuscitation
Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic
Ann Emerg Med
Reluctance of paramedics and emergency medical technicians to perform mouth-to-mouth resuscitation
J Emerg Med
Does the compression to ventilation ratio affect the quality of CPR: a simulation study
Resuscitation
Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs
Resuscitation
Adverse events associated with lay emergency response programs: the public access defibrillation trial experience
Resuscitation
Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study
Resuscitation
Is external defibrillation an electric threat for bystanders?
Resuscitation
Accidental shock to rescuer during successful defibrillation of ventricular fibrillation—a case of human involuntary automaticity
Resuscitation
Cited by (0)
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Appendix A (the list of the writing group members).