First publication on Guidelines onCardiopulmonary
Resuscitation (CPR) and Emergency Cardiac Care(ECC) was in
There is strong scientific evidence behind each
1980 and more definitively in 1986,
guidelines were developed for resuscitation of infants, children, and
neonates in the delivery room.
The resuscitation councils that developed
the International Guidelines 2000 used a “class of recommendations” scheme
to indicate the evidence supporting each recommendation .
The new Resuscitation Guidelines are now
Internationally developed, Science-Based, and Evidence-Based.
This document was pilot-tested multiple
times with appropriate revisions and modifications after each of 3
evaluation meetings: the Mini Evidence Evaluation Conference, March 1999;
the Evidence Evaluation Conference, September 1999; and the Guidelines 2000
Conference, February 2000.
Cardiac compression allows the heart to maintain
pump functionby sequential filling
and emptying of its chambers with competant valves maintaining the forward
direction of flow.Palm of one hand placed over lower sternum; heel of the
other rests on dorsum of the lower hand.
the right speed and rhythm, count out loud as you do the compressions,
saying "1 and 2 and 3 and 4 and 5!" Rest on each "and,"
then compress on each number. Each series of 5 should take about 3 seconds.
Force sufficient to depress sternum by 3-5cms;relaxation is abrupt.
Amiodarone (Class IIb) and procainamide (Class
IIb) arerecommended ahead of
lidocaine and adenosine for theinitial treatment of hemodynamically stable wide-complextachycardia, especially in patients
with Compromisedcardiac function.
Amiodarone and sotalol (a drug that awaits Food andDrug Administration approval for US use)
are new agentsrecommended as Class
IIa agents for the treatment of stablemonomorphic and polymorphic ventricular tachycardia(VT).
Magnesium has shown effectiveness only in the
treatment of known hypomagnesemic statesand torsades de pointes, for which it still has a Class IIb
Vasopressin (arginine vasopressin) may be a more
effective pressor agent thanepinephrine for promoting the return of spontaneous circulation in
cardiac arrest. Theevidence from
prospective clinical trials in humans is limited but consistently
positive(Class IIb). Vasopressin
(40 U IV, not repeated) may be substituted for epinephrine as analternative Class IIb agent. The lower
adverse effects profile may be the major indicationfor vasopressin.
Research on high-dose epinephrine has not yet
shown that routine use of initial andrepeated or escalating doses of epinephrine can improve survival in
cardiac arrest Nor has high-dose epinephrine (0.1 mg/kg) in adults been
shown toimprove survival or
Cardiac arrest survivors who received high-dose
epinephrine have more postresuscitationcomplications than survivors who received the standard dose.
Because of the potential forharm, high-dose epinephrine (0.1 mg/kg)
is not recommended
Tracheal intubation in unconscious patients
should be attempted only by healthcareproviders experienced in performing this skill.
Emergency responders must confirm tracheal
tubeposition by using nonphysical
examination techniques. These include esophageal detectordevices, qualitative end-tidal CO2 indicators,
and capnographic and capnometric devices.
Growing evidence suggests that tracheal tube
dislodgments after a successful trachealtube insertion may be occurring at much higher rates than previously
placed on securing the tube carefully with a tie or tape.Monitors for
oxygensaturation and end-tidal
CO2 levels can detect tube dislodgments.
The best technique,however, to prevent, detect, and correct tube dislodgment is
the constant vigilance of careproviders.
Once the trachea has been intubated, chest
compressions, at a rate of 100 a minute, should continue uninterrupted
(except for defibrillation or pulse checks when indicated), and ventilation
should be continued at roughly 12 breaths/min..
chest compressions without interruption for
ventilation result in a substantially higher mean coronary perfusion
guidelines include the option to use biphasic shocks. In defibrillation,
success rates of repeated biphasic shocks at £ 200J are the same as or
higher than success rates of monophasic waveforms of escalating energy (200
J, 200 J, 360 J).
An intravenous bolus of amiodarone 300 mg should
be considered when the patient has ventricular fibrillation or when
pulseless ventricular tachycardia does not respond to three shocks (2300 J,
200 J, 360 J).
Atropine 3 mg is now indicated for pulseless
electrical activity (electromechanical dissociation) with a ventricular
rate of less than 60 a minute, as well as for asystole.
The international guidelines recommend a single
intravenous dose of 40 units of vasopressin as an alternative to adrenaline
in cases of ventricular fibrillation or pulseless ventricular tachycardia
refractory to three initial shocks.
The European Resuscitation Council and the
Resuscitation Council (UK) continue to recommend epinephrine (adrenaline) 1
mg every three minutes during cardiopulmonary resuscitation.
A recent study of cardiac arrests occurring in
hospital failed to detect any advantage for survival of vasopressin over
The administration of "high dose”
epinephrine (5 mg) and bretylium is no longer recommended.