Basic Life Support: Early Access

Public Access Defibrillation Programs for Adults

• Public access defibrillation programs should be an essential part of the management of out-of-hospital cardiac arrest.
• Community leaders may consider determining the locations that have a high incidence of cardiac arrest in the local area and develop methods to have public access defibrillators available at these locations at the time of arrests.

 

 

Basic Life Support: Early Access

Public Access Defibrillation Programs for Infants, Children and Adolescents

• Public access defibrillation may be used in infants, children, and adolescents, for out-of-hospital cardiac arrest. If available, pediatric-specific automated external defibrillator pads or electrical settings should be used for infants and children 8 years of age or younger or weighing 25 kilograms or less.

 

 

Basic Life Support: CPR Techniques and Sequence

CPR Prior to Defibrillation

• Cardiopulmonary resuscitation should be performed prior to the availability of an automated external defibrillator and analysis of rhythm.

 

 

Basic Life Support: CPR Techniques and Sequence

Optimal Surface for Performing CPR

• It is suggested that a person in cardiac arrest in the hospital setting not be moved from their bed to the floor to improve chest compression depth.
• If a person in cardiac arrest is in a bed with cardiopulmonary resuscitation mode to increase mattress stiffness, it is reasonable to activate this mode.

 

 

Basic Life Support: CPR Techniques and Sequence

Real Time Feedback for CPR Quality

• Healthcare professionals may consider using feedback devices during real-time cardiopulmonary resuscitation (CPR) performance.
• Instructors may choose to incorporate feedback devices during CPR training to improve CPR performance.

 

 

Basic Life Support: CPR Techniques and Sequence

Hand Positioning During Chest Compressions

• For adults, chest compressions should be performed on the lower half of the sternum.

 

 

Basic Life Support: CPR Techniques and Sequence

CPR Compression-to-Ventilation Ratio for Adults: Healthcare Professionals

• A compression-to-ventilation (CV) ratio of 30:2 should be used for adults with cardiac arrest without an advanced airway.

 

 

Basic Life Support: CPR Techniques and Sequence

CPR Compression-to-Ventilation Ratio: Lay Responders

• Cardiopulmonary resuscitation (CPR) should be performed with ventilations, in a compression-to-ventilation ratio of 30:2.

 

 

Advanced Life Support: CPR Techniques and Sequence

Mechanical Chest Compression Devices

• The routine use of mechanical CPR (mCPR) devices is not recommended.

 

 

Advanced Life Support: CPR Techniques and Sequence

Head-Up CPR

• Head-up cardiopulmonary resuscitation should not be routinely used for cardiac arrest.

 

 

Advanced Life Support: CPR Techniques and Process

CPR-Induced Consciousness

• Sedatives and/or analgesics used in critical care may be considered in small doses for patients with possible consciousness during CPR. (Good practice statement)

 

 

Advanced Life Support: Special Circumstances

Interventions for Cardiac Arrest from Pulmonary Embolism

• Fibrinolytic therapy, surgical embolectomy or percutaneous mechanical thrombectomy may be considered for cardiac arrest due to known or suspected pulmonary embolism.

 

 

Advanced Life Support: Special Circumstances

Management of Cardiac Arrest During Pregnancy

• Resuscitative cesarean delivery of the fetus is suggested for women in cardiac arrest in the second half of pregnancy (e.g., with a uterus at or above the umbilicus or 20 weeks’ gestation by point-of-care ultrasound).
• Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered as a rescue therapy for selected cardiac arrest patients during pregnancy or in the postpartum period when conventional CPR fails, and in settings where capability and defined protocols exist. (Good practice statement)

 

 

Advanced Life Support: Post-Cardiac Arrest Care

Oxygen and Carbon Dioxide Target Levels in Adults

• Both hypoxemia and hyperoxemia should be avoided.
• Use capnography, pulse oximetry and, as available, a measured partial pressure of oxygen and PaCO₂ to ensure that ventilation and oxygenation levels are in the physiological range.
• When relying on pulse oximetry, be aware that in patients with darker skin pigmentations, there is an increased risk of inaccuracy that may conceal hypoxemia.

 

 

Advanced Life Support: Post-Cardiac Arrest Care

Temperature Control

• For patients who remain unconscious after return of spontaneous circulation (ROSC) from out-of-hospital or in-hospital cardiac arrest, it is reasonable to actively prevent fever by maintaining a core temperature of 37.5° C or less.

• Hypothermic temperature control (e.g., 32° C to 34^o C) may be considered in certain subpopulations of cardiac arrest patients who remain unconscious after ROSC.

• Patients with mild hypothermia who remain unconscious after ROSC should not be actively warmed to achieve normothermia. (Good practice statement)

• Rapid infusion of large volumes of cold intravenous fluid immediately after ROSC should not be routinely used for prehospital cooling of post-cardiac arrest patients.

• Surface or endovascular temperature control techniques may be considered for temperature control in patients who remain unconscious after ROSC.
• Temperature control devices that include a feedback system based on continuous temperature monitoring are preferred to maintain a target temperature in post-cardiac arrest patients who remain unconscious after ROSC. (Good practice statement)

 

 

Advanced Life Support: Post-Cardiac Arrest Care

Seizure Prophylaxis or Treatment

• Prophylactic anti-seizure medications are not indicated in adults following cardiac arrest with return of spontaneous circulation (ROSC).
• Healthcare professionals may consider continuous EEG monitoring in comatose adults with ROSC post-cardiac arrest. (Good practice statement)

 

 

Pediatric Advanced Life Support: CPR: Techniques and Process

Advanced Airway Interventions in Pediatric Cardiac Arrest

• Bag-mask ventilation (BMV) should be used over advanced airway placement for the initial resuscitation of children and infants with out-of-hospital cardiac arrest.

 

 

Pediatric Advanced Life Support Post-Cardiac Arrest Care

Seizure Prophylaxis or Treatment

• Prophylactic anti-seizure medication is not routinely indicated in children with return of circulation (ROSC) following cardiac arrest. (Good practice statement)
• It is reasonable to treat seizures in children with ROSC following cardiac arrest. (Good practice statement)

 

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Preterm Infant Cord Management at Birth

• For preterm infants born at 28+0 to 36+6 weeks’ gestation who do not receive deferred cord clamping, umbilical cord milking may be considered as an alternative to immediate cord clamping to improve infant hematological outcomes.
• For preterm infants born at less than 28 weeks’ gestation, intact-cord milking is not recommended. There is insufficient evidence to make a recommendation regarding cut-cord milking in this gestational age group.

 

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Therapeutic Hypothermia With Limited Resources

• Therapeutic hypothermia (cooling) should only be conducted under clearly defined protocols.

• Consider therapeutic hypothermia only in neonatal care facilities that provide multidisciplinary care and have adequate resources available to support this treatment.

• Treatment with therapeutic hypothermia should be consistent with standard protocols, usually including commencement of cooling within 6 hours after birth, strict temperature control (typically 33° C to 34° C) and for a duration of 72 hours with rewarming over at least 4 hours.

 

 

Resuscitation Education Science: Training and Education

CPR Feedback Devices in Training

• Prompt/feedback devices should be used during training for cardiopulmonary resuscitation (CPR) to enable immediate feedback to students and improve the quality of CPR performance.

 

 

Resuscitation Education Science: Training and Education

Blended Learning for Basic, Advanced and Trauma Life Support Education

• Basic life support course content and skills may be offered to adults and high school-aged children through:
  • Instructor-led training, including manikin practice.
  • Blended learning as:
    • A self-directed online session to gain knowledge and understanding of the information and an in-person or virtual automated manikin skill practice session with feedback.
    • A self-directed online session to gain knowledge and understanding of the information and an in-person, instructor-led session skill practice session with manikin practice and feedback.
  • Blended learning may be considered for advanced life support education and training where resources and accessibility permit.

 

 

Resuscitation Education Science: Training and Education

Resuscitation Performance: Debriefing

• Debriefing should be performed after resuscitation of adults, children, and infants. The debriefing should be focused on performance improvement and at a minimum include:
• Review of the resuscitation etiology, assessment, and interventions.
• Reinforcing correct assessment, decisions, actions, and communication.
• Discussion of areas for improvement and to whom to communicate these.
• Allowing all participants in the resuscitation to participate and have an opportunity to provide input.

 

 

Resuscitation Education Science: Patient-Centered Outcomes

Patient Outcome and Resuscitation Team Members Attending Advanced Life Support Courses

• Healthcare professionals who provide resuscitation and life support for adults, adolescents, children, infants or neonates should receive accredited training in resuscitation and life support for their respective discipline(s)

 

 

Resuscitation Education Science: Cognitive Aids and Technology

Cognitive Aids During Resuscitation Education

• Healthcare professionals may consider using cognitive aids during resuscitation.