Wednesday, November 4, 2015

2015 ERC Guidelines: Cardiac Arrest in Special Situations

Article: European Resuscitation Council Guidelines for Resuscitation 2015 Section 4. Cardiac arrest in special circumstances (click for link)

Authors: Truhlar A, et al.

Journal: Resuscitation, October 2015

Drowning has traditionally received a back seat in cardiac arrest guidelines; the topic is tucked way in the back under "special circumstances", often leaving instructors and responders unaware of the differences in treatment when compared with primary cardiac events.  While the new ERC guidelines move the drowning content from Section 8 to Section 4 (moving on up!), the largest impact is in quality of the content and the focus on simplification of resuscitation with a primary focus on providing early and adequate ventilations.

Here are the important points from the 2015 ERC guidelines:
  • Includes discussion on the Drowning Chain of Survival (click for link)
  • Updates the evidence on prognostic indicators
    • Submersion duration of less than 10 minutes associated with good outcome
    • Submersion time of more than 25 minutes associated with bad outcome
    • Age, EMS time, water salinity, water temp, and witness status not useful in prognosis
  • Provides simplified approach to initial resuscitation
    • Prioritizes ventilations and leaves out pulse check

  • Discusses the high prevalence of foam in the airway, and that clearing this foam should not delay ventilations.  If ventilations are not possible, then the patient should be turned on side.
While "guidelines" can be looked down on at times for being out of date by the time they are published and often complicating what should be simple messages, the drowning sections in the 2015 ERC guidelines are a useful update to previous versions, developed by individuals currently on the forefront drowning resuscitation.  They should be used to help guide protocol development for front-line responders associated with water safety and drowning resuscitation.