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New Resuscitation Guidelines to Emphasize Compression


 

MONTREAL — Although the content of new resuscitation guidelines will not be released until December, the elimination of interruptions to chest compression during CPR is likely to be one of the major issues that is addressed.

The International Liaison Committee on Resuscitation (ILCOR) plans to publish an international consensus on the science for CPR and emergency cardiovascular care (ECC) in November, on which its member countries will base their resuscitation guidelines, said Marc Gay, who serves on the resuscitation policy advisory committee for the Heart and Stroke Foundation of Canada.

Although he would not hint at how the new guidelines will differ from current ones, he did suggest that CPR priorities need to change.

“There are certain things we need to do better,” he said in an interview at the International Interdisciplinary Conference on Emergencies.

“There have been recent studies showing that both in-hospital and out-of-hospital resuscitation attempts by paramedics are not good because there are too many distractions and interruptions.”

The last guideline update, in 2000, eliminated the recommendation of pulse checks for laypeople performing CPR in an attempt to improve efficiency, and cut down on their division of time, he said.

“Certainly, common sense says that even for health care professionals, there is a similar time limit,” he said.

Because 90% of all cardiac arrests are of cardiac etiology only, there is growing support for the idea that chest compression should take precedence over almost everything else in CPR, Mr. Gay said.

To that end, the fire department in Tucson, Ariz., working with the University of Arizona's Sarver Heart Center, recently abandoned current resuscitation guidelines in favor of a new CPR protocol that de-emphasizes many of the interruptions (rhythm analysis, defibrillation, tracheal intubation, and placement of intravenous catheters) and focuses on chest compressions (Resuscitation 2005;64:261–8).

Using data from their own controlled animal experiments, published clinical studies, and data from the 17-year-old fire department database, the researchers identified four main issues contributing to stagnant out-of-hospital cardiac arrest survival rates: lack of bystander CPR efforts; the complexity of CPR education for lay rescuers; an emphasis on defibrillation first, regardless of the duration of ventricular fibrillation; and frequent interruptions of chest compressions resulting in a marked compromise in circulatory support during resuscitation efforts.

An evaluation of the outcome of their protocol changes has not yet been done, but there is no doubt of the authors' political intent.

“A formalized, evidence-based process has been adopted by the International Liaison Committee on Resuscitation in formulating [its] guidelines,” the investigators wrote. “Currently, randomized clinical trials are considered optimal evidence, and very few major changes in the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are made without such. An alternative approach is to allow externally controlled clinical trials more weight in Guideline formulation and resuscitation protocol adoption.”

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