Basic Life Support: Dispatcher/Telecommunicator-Assisted CPR

Optimization of Dispatcher-Assisted Recognition of Out-of-Hospital Cardiac Arrest

• Dispatch centers should employ standardized and evidence-based protocols for recognition of cardiac arrest.
• Dispatch centers should monitor the diagnostic accuracy of recognizing cardiac arrest from the use of any specific dispatch criteria or algorithms.

 

Basic Life Support: Dispatcher/Telecommunicator-Assisted CPR

Optimization of Dispatcher-Assisted CPR Instructions

• Dispatchers should provide instructions to perform compression-only cardiopulmonary resuscitation (CPR) for suspected out-of-hospital cardiac arrest to those untrained in CPR or who are unable to recall CPR performance steps.
• Dispatchers should provide support, as needed, for the performance of compression-ventilation CPR to those trained in standard CPR who are able to recall CPR performance steps.

 

Basic Life Support: CPR Techniques and Process

Minimizing Pauses in Chest Compressions

• Pauses during cardiopulmonary resuscitation, including peri-shock pauses, changing roles, and moving between ventilations and compressions for a single rescuer, should be as short as possible.
• Chest compression fraction (CCF) should be as high as possible and at least 60%.
• Where system resources permit, monitoring of peri-shock pauses and CCF may be considered as part of a comprehensive quality improvement program.

 

Basic Life Support: CPR Techniques and Process

Impact of Wearing Personal Protective Equipment on Quality of CPR

• During cardiopulmonary resuscitation (CPR), the team leader should monitor team members providing CPR for signs of fatigue.
• Team members should switch off giving compressions every 2 minutes, or sooner as the team member giving compressions may be fatigued.

 

Basic Life Support: CPR Techniques and Process

CPR Quality During Transport

• The decision to transport a patient following out-of-hospital cardiac arrest and while cardiopulmonary resuscitation (CPR) is in progress should be made based on emergency medical services protocols and/or in consultation with on-line medical control.
• Protocols to determine care on-scene versus during transport for out-of-hospital cardiac arrest should be evidence-based, and at a minimum, consider local resources, competency of providers and distances to hospital care.
• There should be separate protocols for adults and for infants and children.
• When transporting an out-of-hospital cardiac arrest care patient to a hospital, prehospital healthcare professionals should strive to deliver high-quality CPR.

 

Basic Life Support: CPR Techniques and Process

Passive Ventilation Techniques During CPR

• There is insufficient evidence to support the routine use of passive ventilation techniques during conventional CPR.
• The use of passive ventilation techniques may be considered by prehospital healthcare professionals as part of a bundle of care to include minimally interrupted cardiac resuscitation.

 

Basic Life Support: CPR Techniques and Process

Unintentional injury from CPR to Persons Not in Cardiac Arrest

• Lay responders and healthcare professionals should begin cardiopulmonary resuscitation (CPR) based on their assessment and without concern for causing unintentional physical injury to persons not in cardiac arrest.

 

Opioid-Associated Emergencies

Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use remain the first interventions for cardiac arrest in opioid-associated overdose and should not be delayed or interrupted.

 

Basic Life Support: Drowning Process Resuscitation

CPR Start Sequence for Drowning

• For infants, children, adolescents and adults with the drowning process and after determining the presence of cardiac arrest, resuscitation should start by opening the airway, providing 2 rescue breaths/manual ventilations, and then continuing cardiopulmonary resuscitation (CPR) by providing cycles of 30 compressions followed by 2 rescue breaths/manual ventilations.
• A CPR compression-to-ventilation ratio of 15:2 should be used for children and infants with the drowning process and cardiac arrest when two healthcare professionals or trained lay responders are available.
• For lay persons, if compression-ventilation CPR is not possible or someone is unwilling to provide compression-ventilation CPR, compression-only CPR should be performed.

 

Basic Life Support: Drowning Process Resuscitation

Compression-Only and Compression-Ventilation CPR for Drowning Process Resuscitation

• Initiate compression-ventilation cardiopulmonary resuscitation (CV-CPR) for cardiac arrest following drowning in adults, children and infants. If CV-CPR is not possible, compression-only CPR should be performed.
• For adults, children and infants with the drowning process and after determining the presence of cardiac arrest, resuscitation should start by opening the airway, providing two rescue breaths or manual ventilations and then continuing CPR by providing cycles of 30 compressions followed by two rescue breaths or manual ventilations.
• A CPR compression-to-ventilation ratio of 15:2 should be used for children and infants with the drowning process and cardiac arrest when two healthcare professionals or trained lay responders are available.

 

Basic Life Support: Drowning Process Resuscitation

Automated External Defibrillator Use in Drowning Resuscitation

• For adults, children or infants in cardiac arrest following a drowning event, begin cardiopulmonary resuscitation and initiate automated external defibrillator use as soon as one is available and where feasible and safe.

 

Basic Life Support: Drowning Process Resuscitation

Prehospital Oxygen Following Drowning

• If available, supplemental oxygen may be provided empirically by responders trained in its use to adults and children who are conscious and with respiratory symptoms following a drowning event. Once pulse oximetry is available, supplemental oxygen therapy should be appropriately titrated.
• For adults and children in cardiopulmonary arrest following drowning, supplemental high-flow and high-concentration oxygen should be provided, if available, with ventilations by responders trained in its use.

 

Basic Life Support: Drowning Process Resuscitation

Special Considerations in Drowning Process Resuscitation

• In-water resuscitation can be considered in cases where a responder has proper training in the in-water resuscitation technique and is comfortable performing it without causing an unsafe environment for the responder or the drowning victim.
• Though in-water resuscitation can be performed without the aid of additional equipment, floating and propelling equipment should be considered.
• If an adult, child or infant is in cardiac arrest following a drowning event, begin cardiopulmonary resuscitation and initiate automated external defibrillator use as soon as one is available and where feasible and safe.

 

Basic Life Support: Drowning Process Resuscitation

Resuscitation on a Boat Following Drowning

• Resuscitation from drowning may be performed on a boat if conditions are safe and there are adequately trained responders to assist.

 

Basic Life Support: Early Access

Drone Delivery of Automated External Defibrillators

• No recommendation. Drone delivery of automated external defibrillators is an emerging technology in need of further study.

 

Advanced Life Support: CPR Techniques and Process

Mechanical Chest Compression Devices

• Application of mCPR devices should not delay initiation of manual chest compressions.

 

Advanced Life Support: CPR Techniques and Process

Head-Up CPR

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

 

Advanced Life Support: CPR Techniques and Process

CPR and Defibrillation in the Prone Patient

• For patients in a prone position who develop cardiac arrest:
• If an advanced airway is not in place, the patient should be turned to a supine position as quickly as possible, and cardiopulmonary resuscitation (CPR) initiated.
• If an advanced airway is in place and immediate supination is not feasible or poses a risk to the patient, CPR should begin while the patient is prone.
• If the patient cannot be immediately supinated, defibrillation should be attempted in the prone position.
• For patients with an advanced airway in place in the prone position while receiving CPR, the quality of CPR should be assessed with end-tidal carbon dioxide and arterial blood pressure monitoring, if feasible.

 

Advanced Life Support: Intra-arrest Prognostication

Prognostication with Point-of-Care Echocardiography During CPR

• Point-of-care ultrasonography may be considered for assessment of reversible etiologies of cardiac arrest.
• Point-of-care ultrasonography should not have a role in prognostication for cardiac arrest.

 

Advanced Life Support: Neuroprognostication After Cardiac Arrest and ROSC: Prediction of Poor Neurological Outcome

Biomarkers

• The biomarker neuron-specific enolase may be considered in adults who are comatose after cardiac arrest within 72 hours after return of spontaneous circulation (ROSC), in combination with other tests, for predicting neurological outcome.
• The biomarkers S-100B protein, serum levels of glial fibrillary acidic protein, serum tau protein, or neurofilament light chain should not be used after ROSC for predicting neurological outcome.

 

Advanced Life Support: Neuroprognostication After Cardiac Arrest and ROSC: Prediction of Poor Neurological Outcome

Electrophysiology Tests

• In the post-cardiac arrest adult patient, neither background reactivity alone nor seizures on electroencephalogram (EEG) or status epilepticus should be used to predict poor outcome.
• In the post-arrest adult patient, any of the following can be used to predict poor outcome:
  • Presence of epileptiform activity on EEG
  • Burst suppression on EEG in patients who are off sedation after cardiac arrest and comatose
  • Highly malignant EEG patterns
• In the post-arrest adult, healthcare professionals can consider using a bilaterally absent N20 somatosensory evoked potential wave in combination with other indices to predict poor outcome.

 

Advanced Life Support: Neuroprognostication After Cardiac Arrest and ROSC: Prediction of Poor Neurological Outcome

Clinical Examination

• In the comatose adult post-cardiac arrest patient, healthcare professionals can consider using the following clinical examination findings to predict neurological outcome:
  • Pupillary light reflex at 72 hours or later after return of spontaneous circulation (ROSC)
  • Quantitative pupillometry at 72 hours or later after ROSC
  • Bilateral absence of corneal reflex at 72 hours or later after ROSC
  • Presence of myoclonus or status myoclonus within 96 hours after ROSC (One should correlate these findings with electroencephalogram.)

 

Advanced Life Support: Neuroprognostication After Cardiac Arrest and ROSC: Prediction of Poor Neurological Outcome

Brain Imaging

• In adult post-cardiac arrest patients who are comatose, healthcare professionals can consider using grey matter/white matter ratio on brain computerized tomography scan for predicting neurological outcome.

 

Advanced Life Support: Post-Cardiac Arrest Care

Post-Cardiac Arrest Coronary Angiography

• An early or a delayed approach is reasonable for unresponsive post-cardiac arrest patients without ST-elevation when coronary angiography is being considered.
• Early coronary angiography should be considered in comatose post-cardiac arrest patients with ST-elevation.

 

Advanced Life Support: Post-Cardiac Arrest Care

Post-Cardiac Arrest Prophylactic Antibiotics

• Prophylactic antibiotics should not be used in the management of the post-cardiac arrest patient.

 

Pediatric Advanced 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.

 

Pediatric Advanced Life Support: Pediatric CPR: Techniques and Process

Pediatric Advanced Airway Interventions in Cardiac Arrest

• Bag-mask ventilation should be used over advanced airway placement for the initial resuscitation of children and infants with out-of-hospital cardiac arrest.
• Technically proficient healthcare professionals may consider transitioning to an advanced airway (supraglottic or tracheal tube) when feasible and with minimal interruptions to chest compressions, or when bag-mask ventilations are ineffective and/or not providing adequate oxygenation. (Good practice statement)

 

Pediatric Advanced Life Support: Pediatric CPR: Techniques and Process

Management of Pulmonary Hypertension with In-Hospital Cardiac Arrest

• In children and neonates with pulmonary hypertension who are hospitalized for a clinical worsening event, it is reasonable to avoid factors that may increase pulmonary vascular resistance while treating the aggravating condition to decrease the risk of cardiac arrest. (Good practice statement)
• Pulmonary hypertension specific treatments, such as inhaled nitric oxide, L-Arginine, phosphodiesterase inhibitors or endothelin-1 inhibitors, may be considered for treatment of children and neonates with pulmonary hypertension hospitalized for a clinical worsening event. Other management strategies include avoiding hypoxia, hypercapnia, acidosis, and stressors such as pain, agitation, dehydration or fluid overload, anemia or infection. (Good practice statement)
• In children who develop signs of pulmonary hypertensive crisis, low cardiac output or right ventricular failure despite optimal medical therapy, extracorporeal membrane oxygenation (ECMO) may be considered before cardiac arrest or for refractory cardiac arrest as a bridge to recovery. In very select cases, ECMO can be used as a bridge to evaluate for organ replacement and transplantation. (Good practice statement)

 

Pediatric Advanced Life Support: Pediatric CPR: Techniques and Process

Ventilation Rates with an Advanced Airway During Pediatric CPR

• For children and infants in cardiac arrest and with an advanced airway in place, consider the use of ventilatory rates close to age-appropriate respiratory rates with avoidance of hypoventilation and hyperventilation. (Good practice statement)
• A ventilation rate between 20 to 30 breaths per minute may be considered for the initial rate in pediatric cardiopulmonary resuscitation with an advanced airway present, with the higher end of the range for infants and young children, and the lower end for school-age or adolescent children. Further adjustment of ventilation parameters should be guided by capnography, oximetry and blood gas analysis. (Good practice statement)

 

Pediatric Advanced Life Support: Pediatric CPR: Techniques and Process

Extracorporeal CPR for Pediatric Cardiac Arrest

• Extracorporeal cardiopulmonary resuscitation, or cardiopulmonary resuscitation with extracorporeal membrane oxygenation, may be considered on a case-by-case basis for selected infants and children (e.g., pediatric cardiac populations) with in-hospital cardiac arrest refractory to conventional resuscitation and where capability and defined protocols exist.

 

Pediatric Advanced Life Support: Drug Therapy and Vascular Access

Intravenous Versus Intraosseous Administration of Drugs During Cardiac Arrest

• Intraosseous access may be considered as an alternative to intravenous (IV) access in emergency situations when IV access is unsuccessful or not feasible.

 

Pediatric Advanced Life Support: Defibrillation

Pad Size and Placement in Infants and Children

• If pediatric-specific AED pads are unavailable, adult pads may be used for infants and children, provided the pads do not touch each other.

 

Pediatric Advanced Life Support: Post-Cardiac Arrest Care

Oxygen and Carbon Dioxide Target Levels

• Post-cardiac arrest oxygen and carbon dioxide levels should target normal physiological levels. Hyperoxia, hypoxia, hypercarbia, and hypocarbia should all be avoided.
• Post-cardiac arrest oxygenation may be guided by oxygen saturation targeting levels of 94% to 99%.

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Term Infant Cord Management at Birth

• t is reasonable to delay clamping of the cord for 60 or more seconds for term and late preterm infants born at 34+0 week’s or more gestation and who are vigorous or considered to not require immediate resuscitation at birth.

Neonatal Advanced Life Support: Neonatal Resuscitation

Cord Management for Nonvigorous Term and Late-Preterm Newborns

• For term and late preterm infants (34 weeks’ gestation or more) who remain non-vigorous at birth despite stimulation, intact cord milking is suggested in preference to early cord clamping.

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Preterm Infant Cord Management at Birth

• For preterm infants born at less than 37 weeks’ gestation who do not require immediate resuscitation at birth, clamping of the umbilical cord should be deferred for at least 60 seconds.
• 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.
• For preterm infants born at less than 37 weeks’ gestation who require immediate resuscitation at birth (i.e., nonvigorous), there is insufficient evidence to make a recommendation with respect to cord management.
• Individualized decisions for cord management in conditions such as monochorionic (multiple) fetuses, congenital anomalies, placental abnormalities, alloimmunization and/or fetal anemia, fetal compromise and maternal illness should be based on the severity of the condition and assessment of maternal and neonatal risk.
• It is reasonable to discuss the plan for umbilical cord management between maternity and neonatal providers and parents before the birth, whenever circumstances allow. (Good practice statement)

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Family Presence During Neonatal Resuscitation

• It is reasonable for parents and caregivers to be present, if they desire, during the resuscitation of neonates and where resources permit.

 

Neonatal Advanced Life Support: Neonatal Resuscitation

Duration of Resuscitation at Birth

• Healthcare professionals should consider a discussion with the clinical team and family regarding discontinuation of resuscitative efforts after 20 minutes of CPR and all the indicated resuscitative actions following birth.

 

Neonatal Advanced Life Support: Monitoring at Birth

Maintenance of Normal Body Temperature Immediately After Birth: Term and Late Preterm Newborns

• Where feasible, a room temperature of 23° C is suggested compared with 20° C at birth for late preterm and term newborn infants (34 week’s gestation or more) to maintain normothermia.
• Skin-to-skin care with a parent is encouraged immediately after birth to maintain normothermia in late preterm and term newborn infants (34 week’s gestation or more) who are at low risk of needing resuscitation. Skin-to-skin care can be done with initial care (i.e., drying and stimulation).
• The use of a plastic bag or wrap and other measures may be considered in situations where skin-to-skin care, maintaining temperature under a radiant warmer or a room temperature at 23° C is not feasible.

 

Neonatal Advanced Life Support: Monitoring at Birth

Maintenance Of Normal Body Temperature Immediately After Birth: Preterm Newborns

• For preterm infants (born at less than 34 week’s gestation) immediately after birth:
  • A room temperature of 23.0° C or higher is suggested to maintain normal body temperature.
  • It is reasonable to consider the addition of a thermal mattress in settings where hypothermia on admission is identified as an issue.
  • The use of a plastic (e.g., polyethylene) bag or wrap to maintain normal temperature should be considered, with monitoring and management of the infants’ temperature to prevent hyperthermia.
  • A head covering should be used to maintain normal temperature.
  • The use of heated and humidified gases for respiratory support in the delivery room may be used where it is documented that admission hypothermia is a problem and resources allow.
  • Skin-to-skin contact may be considered for maintaining normal temperature where alternative measures are unavailable. (Good practice statement)
  • A combination of approaches for maintaining a normal temperature may be considered. (Good practice statement)
  • When using strategies to maintain normal body temperature in newborns, hyperthermia of 38.0° C or higher should be avoided. Early measurement and regular monitoring of temperature are required to achieve and maintain normothermia in newborns. (Good practice statement)

 

Neonatal Advanced Life Support: Monitoring at Birth

Respiratory Function Monitoring During Neonatal Resuscitation at Birth

• No recommendation: Additional research is needed to determine if there is a clinical benefit from use of a respiratory function monitor in newborn infants receiving respiratory support at birth.

 

Neonatal Advanced Life Support: Monitoring at Birth in the Delivery Room

Methods to Assess Heart Rate in Newborns

• Where feasible, an electrocardiogram (ECG) is suggested for accurate and rapid heart rate assessment of a newborn in the delivery room.
• Auscultation and/or pulse oximetry are reasonable alternative methods to assess the heart rate of a newborn when an ECG is unavailable or is not functioning or when pulseless electrical activity is suspected. When auscultation and pulse oximetry are used for heart rate assessment of a newborn, the limitations of these modalities should be taken into consideration. (Good practice statement)

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Tactile Stimulation for Resuscitation Immediately After Birth

• For newborn infants greater than 32 week’s gestation with absent, intermittent or shallow respirations immediately after birth, it is reasonable to use tactile stimulation in addition to initial care including drying, stimulation and additional care to maintain temperature.
• Tactile stimulation should not delay the initiation of positive pressure ventilations for newborn infants who continue to have inadequate respiratory effort after birth despite initial care.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Suctioning Clear Amniotic Fluid at Birth

• The routine suctioning of clear amniotic fluid from the mouth and nose of newborn infants immediately after birth is not indicated.
• For suspected airway obstruction, immediate airway repositioning is indicated, and suctioning should be considered. Suctioning should be brief and begin with the mouth before the nose.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Exhaled Carbon Dioxide Detection to Guide Noninvasive Ventilation

• There is insufficient evidence to suggest for the use of exhaled carbon dioxide to guide intermittent positive-pressure ventilation with noninvasive interfaces, such as facemasks, in newborns immediately after birth.
• The routine use of colorimetric end-tidal carbon dioxide detectors with noninvasive ventilation devices (facemasks, supraglottic airways) is not recommended during newborn resuscitation.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Supraglottic Airways for Neonatal Resuscitation

• Supraglottic airways (i.e., air-filled or gel cuff laryngeal masks) may be considered for newborn infants with a gestational age of 34 weeks or more receiving intermittent positive pressure ventilation during resuscitation immediately after birth if unable to ventilate effectively with a face mask and when healthcare professionals are present who are competent in their use.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Laryngoscopy and Suctioning of Meconium at Birth for Non-Vigorous Newborns

• For non-vigorous newborns delivered with meconium-stained amniotic fluid, healthcare professionals should not routinely perform immediate laryngoscopy after birth with or without tracheal suctioning.
• For non-vigorous newborns delivered with meconium-stained amniotic fluid, healthcare professionals should perform immediate resuscitation.
• In the presence of airway obstruction, healthcare professionals may consider laryngoscopy and suctioning for newborns delivered with meconium-stained amniotic fluid and requiring resuscitation.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Initial Oxygen Concentration for Term and Late Preterm Neonatal Resuscitation

• When resuscitating a preterm newborn (less than 35 week’s gestation), healthcare professionals should start with an oxygen concentration between 21% and 30% (close to atmospheric concentration) and titrate oxygen concentration using pulse oximetry.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Supplemental Oxygen During Chest Compressions

• Once chest compressions are initiated, the oxygen concentration should be increased to 100% and continued until the newborn’s heart rate reaches 60 or more beats per minute.
• Once compressions are no longer indicated for a newborn, the oxygen concentration should be adjusted to meet target oxygen saturation levels.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Positive Pressure Ventilations at Birth

• For newborns requiring positive pressure ventilation at birth, a T-piece resuscitator should be used.
• If a T-piece resuscitator is unavailable or staff are untrained/not competent in its use, a self-inflating bag, with or without a positive end-expiratory pressure valve, can be used.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Continuous Positive Airway Pressure for Term Infant Respiratory Distress in the Delivery Room

• There is insufficient evidence to suggest for or against the routine use of continuous positive airway pressure (CPAP) compared with no CPAP for spontaneously breathing late preterm and term newborn infants in the delivery room with respiratory distress.

 

Neonatal Advanced Life Support: Airway and Ventilation Management

Sustained Inflation at Birth

• For preterm newborn infants receiving positive pressure ventilation due to either bradycardia or ineffective respirations at birth, healthcare professionals should not use initial sustained inflation(s) greater than 5 seconds.

 

Neonatal Advanced Life Support: Drug Therapy and Vascular Access

Intraosseous Versus Umbilical Vein Routes of Fluid and Drug Administration During Newborn Resuscitation

• Umbilical venous catheterization is a reasonable primary method of vascular access during newborn resuscitation in the delivery room. If umbilical venous access is not feasible, healthcare professionals may consider the intraosseous route for vascular access during newborn resuscitation.
• Healthcare professionals should use either umbilical venous access or the intraosseous route depending on their training, equipment availability and/or local protocols outside of the delivery room to administer fluids and medications during newborn resuscitation.

 

Neonatal Advanced Life Support: Drug Therapy and Vascular Access

Dose, Route, and Interval of Epinephrine (Adrenaline) for Neonatal Resuscitation

• For resuscitation of the newborn if the heart rate has not increased to more than 60 beats per minute after optimizing ventilation and chest compressions, intravascular epinephrine should be administered at 0.01 to 0.03 milligrams per kilogram (mg/kg). If intravascular access is not available, healthcare professionals may consider endotracheal epinephrine at a dose of 0.05 to 0.1 mg/kg. While epinephrine can be given via endotracheal tube, healthcare professionals should not delay attempts to establish vascular access to give epinephrine via the endotracheal tube.
• Healthcare professionals should administer repeat doses of epinephrine every 3 to 5 minutes, preferably intravascularly, if the heart rate remains less than 60 beats per minute.
• If epinephrine has been administered via the endotracheal route with inadequate response, an intravascular dose may be considered as soon as vascular access is obtained, regardless of the interval.

 

Neonatal Advanced Life Support: CPR Techniques and Process

Heart Rate to Initiate Neonatal Chest Compressions

• Chest compressions should be initiated if a newborn’s heart rate is less than 60 beats per minute after at least 30 seconds of effective positive pressure ventilations, ideally through an endotracheal tube, as evidenced by chest movement.

 

Neonatal Advanced Life Support: CPR Techniques and Process

Neonatal Chest Compression Technique

• For newborns, the two-thumb/encircling hands technique should be used for providing chest compressions.

 

Neonatal Advanced Life Support: CPR Techniques and Process

Compression-to-Ventilation Ratio for Neonatal CPR

• A 3:1 compression-to-ventilation ratio should be used for neonatal cardiopulmonary resuscitation (CPR).
• Each cycle of compressions and ventilations for neonatal CPR should be performed at a rate of 90 compressions and 30 ventilations per minute.

 

Neonatal Advanced Life Support: CPR Techniques and Process

Feedback Devices During CPR of Newborn Infants

• For newborns requiring cardiopulmonary resuscitation, the routine reliance on a single feedback device for the detection of return of spontaneous circulation is not recommended.

 

Resuscitation Education Science: Cognitive Aids and Technology

Cognitive Aids During Resuscitation Education

• Healthcare professionals may consider using cognitive aids during resuscitation.
• In the absence of dispatcher-/telecommunicator-assisted cardiopulmonary resuscitation (CPR) instructions, it may be reasonable for cognitive aids to be used by lay responders in need of immediate access to CPR instructions and guidance to provide CPR and improve performance.
• Lay responders in need of cognitive aids to perform CPR should strive to minimize any delay in activating emergency medical services and starting CPR. (Conditional recommendation)

 

Resuscitation Education Science: Cognitive Aids and Technology

Scripted Debriefing in Resuscitation Training

• Debriefing scripts may be considered by instructors during debriefing in resuscitation training programs. (Good practice statement)

 

Resuscitation Education Science: Cognitive Aids and Technology

First Responder Engaged by Technology

• Medical and disaster event notification systems via mobile positioning system or text message alerts should be used for individuals.
• Individuals who are in close proximity to a suspected out-of-hospital cardiac arrest and are willing to be notified by a smartphone app with mobile positioning system or text message alert system should be notified.

 

Resuscitation Education Science: Cognitive Aids and Technology

Augmented and Virtual Reality for Resuscitation Training

• Augmented reality or traditional methods may be used for basic life support (BLS) training of laypersons and healthcare professionals.
• The use of virtual reality as a single tool or strategy for training of BLS and advanced life support in laypersons and healthcare professionals is not recommended.

 

Resuscitation Education Science: Cognitive Aids and Technology

Gamified Learning

• Gamified learning may be considered as a component of resuscitation training for basic life support and advanced life support courses.

 

Resuscitation Education Science: Cognitive Aids and Technology

Rapid Cycle Deliberate Practice Design

• Rapid Cycle Deliberate Practice may be considered as an instructional technique for basic life support and advanced life support training.

 

Resuscitation Education Science: Training and Education

Basic Life Support Training for High-Risk Populations

• Family and caregivers of patients at high risk for out-of-hospital cardiac arrest should be trained in, or encouraged to be trained in, basic life support.

 

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

Team and Leadership Competency Training

• It is reasonable to include team competencies in life support training.

 

Resuscitation Education Science: Training and Education

Cardiac Arrest Centers

• Patients in cardiac arrest should be transported by emergency medical services (EMS) to the most appropriate facility, based on local and regional EMS protocols.

 

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: Patient-Centered Outcomes

Family Presence in Adult Resuscitation

• It is reasonable for family members to be given the option to be present, if they so desire, during in-hospital and out-of-hospital adult resuscitation from cardiac arrest, and when resources permit.