European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support
Section snippets
Summary of changes since 2005 Guidelines
The most important changes in the 2010 European Resuscitation Council Advanced Life Support (ALS) Guidelines include:
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Increased emphasis on the importance of minimally interrupted high-quality chest compressions throughout any ALS intervention: chest compressions are paused briefly only to enable specific interventions.
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Increased emphasis on the use of ‘track and trigger systems’ to detect the deteriorating patient and enable treatment to prevent in-hospital cardiac arrest.
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Increased awareness of
4a 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.1 Once cardiac arrest occurs, fewer than 20% of patients suffering an in-hospital cardiac arrest will survive to go home.2, 3, 4 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.5
Prevention of sudden cardiac death (SCD) out-of-hospital
Coronary artery disease is the commonest cause of SCD. Non-ischaemic cardiomyopathy and valvular disease account for most other SCD events. A small percentage of SCDs are caused by inherited abnormalities (e.g., Brugada syndrome, hypertrophic cardiomyopathy) or congenital heart disease.
Most SCD victims have a history of cardiac disease and warning signs, most commonly chest pain, in the hour before cardiac arrest.150 In patients with a known diagnosis of cardiac disease, syncope (with or
EMS personnel
There is considerable variation across Europe in the structure and process of EMS systems. Some countries have adopted almost exclusively paramedic/emergency medical technician (EMT)-based systems while other incorporate prehospital physicians to a greater or lesser extent. In adult cardiac arrest, physician presence during resuscitation, compared with paramedics alone, has been reported to increase compliance with guidelines183, 184 and physicians in some systems can perform advanced
4c In-hospital resuscitation
After in-hospital cardiac arrest, the division between basic life support and advanced life support is arbitrary; in practice, the resuscitation process is a continuum and is based on common sense. The public expect that clinical staff can undertake cardiopulmonary resuscitation (CPR). For all in-hospital cardiac arrests, ensure that:
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cardiorespiratory arrest is recognised immediately;
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help is summoned using a standard telephone number;
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CPR is started immediately using airway adjuncts, e.g., a
Drugs and fluids for cardiac arrest
This topic is divided into: drugs used during the management of a cardiac arrest; anti-arrhythmic drugs used in the peri-arrest period; other drugs used in the peri-arrest period; fluids; and routes for drug delivery. Every effort has been made to provide accurate information on the drugs in these guidelines, but literature from the relevant pharmaceutical companies will provide the most up-to-date data.
Drugs used during the treatment of cardiac arrest
Only a few drugs are indicated during the immediate management of a cardiac arrest, and
4g Peri-arrest arrhythmias
The correct identification and treatment of arrhythmias in the critically ill patient may prevent cardiac arrest from occurring or from reoccurring after successful initial resuscitation. The treatment algorithms described in this section have been designed to enable the non-specialist ALS provider to treat the patient effectively and safely in an emergency; for this reason, they have been kept as simple as possible. If patients are not acutely ill there may be several other treatment options,
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These individuals contributed equally to this manuscript and are equal first co-authors.