Cardio pulmonary cerebral resuscitation 2010 guidelines.

Sir,

I read with keen interest the editorial column on ‘Cardio Pulmonary Resuscitation (CPCR) 2010: Improve the quality of care’.[1] The science of resuscitation is evolving rapidly. The 2010 CPCR Guidelines have been laid down. The recommendations of the 2010 International Consensus Conference confirm the safety and effectiveness of current approaches, acknowledge other approaches as ineffective, and introduce new treatments resulting from evidence-based evaluation. In the busy schedule of professional and personal life, doctors have to strain to keep themselves updated. Clinicians are requested to read the complete guidelines published in ‘Nov 2nd, 2010’, issue of AHA Journal Circulation which may be accessed at http://www.circulationaha.org

Hereby I have tried to summarize for brief reference the major changes/developments in 2010 from 2005 CPCR guidelines.[2-4]

Recommendation of C–A–B (Compression–Airway–Breathing) sequence for adult BLS instead of A–B–C (Airway–Breathing–Compression) is the most significant change in 2010 guidelines.

Lay rescuer should begin cardio pulmonary resuscitation (CPR), if adult victim is unresponsive (single question ‘are you chocking’) and breathing is ‘not normal’ (do not waste time in ‘look, listen and feel’), without assessing the pulse; with chest compressions rather than opening airway and delivering rescue breaths.

EMS dispatchers should provide telephonic instructions in chest compressions—only CPR for untrained rescuer.

A trained rescuer should provide CPR with compression–ventilation ratio of 30:2. With advanced airway devices, compression at rate 100/min and ventilation at independent rate 8-10/min without interrupting compressions.

2010 Guidelines sustain its earlier stress on delivering high-quality chest compressions. Push hard to a depth of at least 2 inches (5 cm), at rate 100/min, with full chest recoil and minimal interruptions (e.g. hands off time).

Recommendations unchanged from 2005:

Compression:Ventilation ratio (30:2) [single rescuer]

Optimal frequency (compression 100/min, ventilation 10-12/min), with advanced airway devices and ≥2 rescuer

Tidal volume for artificial ventilation (500-600 mL)

Use of capnography to confirm and monitor tracheal tube placement and quality of CPR

Defibrillation of shockable rhythm as soon as possible. Resumption of CPR with chest compression immediately after shock to minimise ‘no flow’ time.

The CPR techniques and devices reviewed during the 2010 International Consensus Conference: Interposed abdominal compression CPR, active compression–decompression CPR, open-chest CPR, load-distributing band CPR, mechanical piston (thumper) CPR, Lund University Cardiac Arrest System (LUCAS) CPR and the impedance threshold device. There are insufficient data to support or refute their routine use. Load-distributing band or LUCAS CPR may be used to maintain continuous chest compressions while the patient undergoes percutaneous coronary intervention or computed tomography or similar diagnostic studies when provision of manual CPR would be difficult.

Neonatal: The following are the major new recommendations:

The initial evaluation is now directed by the simultaneous assessment of 2 vital characteristics: Heart rate and respiration. The third assessment—of colour is now replaced by oximetry assessment of oxyhaemoglobin saturation.

For babies born at term, it is best to begin resuscitation with air rather than 100% oxygen.

Administration of supplementary oxygen should be regulated by blending oxygen and air (mixture ratio guided by oximetry).

The compression–ventilation ratio should remain at 3:1 for neonates unless arrest is known to be of cardiac aetiology, in which case a higher ratio should be considered.

Infants born at term or near term with evolving moderate to severe hypoxic–ischaemic encephalopathy should be offered therapeutic hypothermia at multi-disciplinary unit.

It is appropriate to consider discontinuance of resuscitation if there has been no detectable heart rate for 10 min (subjected to case-specific variation).

Basic and advanced life support knowledge and skills can deteriorate in as little as 3–6 months. Quality of education, frequent assessments and, when needed, refresher training are recommended to maintain resuscitation knowledge and skills.