response. An RCT published in 2019 compared TTM at 33C to 37C for patients who were not following commands after ROSC from cardiac arrest with initial nonshockable rhythm. This recommendation is based on expert consensus and pathophysiologic rationale. The effectiveness of active compression-decompression CPR is uncertain. It is reasonable to immediately resume chest compressions after shock delivery for adults in cardiac arrest in any setting. Step 4. How is cpr performed when advanced airway is in place | CupSix Airway and ventilation management during cardiopulmonary resuscitation It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance. More uniform definitions for status epilepticus, malignant EEG patterns, and other EEG patterns are In these situations, the mainstay of care remains the early recognition of an emergency followed by the activation of the emergency response systems (Figures 13 and 14). Observational studies of fibrinolytic therapy for suspected PE were found to have substantial bias and showed mixed results in terms of improvement in outcomes. 3. 2. Finally, case reports and case series using ECMO in maternal cardiac arrest patients report good maternal survival.16 The treatment of cardiac arrest in late pregnancy represents a major scientific gap. Recommendations 1, 2, 3, and 5 are supported by the 2020 CoSTRs for BLS and ALS.13,14 Recommendations 4 and 6 last received formal evidence review in 2015.15. Some recommendations are directly relevant to lay rescuers who may or may not have received CPR training and who have little or no access to resuscitation equipment. Conversely, when VF/ VT is more protracted, depletion of the hearts energy reserves can compromise the efficacy of defibrillation unless replenished by a prescribed period of CPR before the rhythm analysis. On MRI, cytotoxic injury can be measured as restricted diffusion on diffusion-weighted imaging (DWI) and can be quantified by the ADC. It may be reasonable to administer IV lipid emulsion, concomitant with standard resuscitative care, to patients with local anesthetic systemic toxicity (LAST), and particularly to patients who have premonitory neurotoxicity or cardiac arrest due to bupivacaine toxicity. needed to be able to compare prognostic values across studies. Give 2 breaths. This approach recognizes that most sudden cardiac arrest in adults is of cardiac cause, particularly myocardial infarction and electric disturbances. Lifesaving procedures, including standard BLS and ACLS, are therefore important to continue until a patient is rewarmed unless the victim is obviously dead (eg, rigor mortis or nonsurvivable traumatic injury). In addition, 15 recommendations are designated Class 3: No Benefit, and 11 recommendations are Class 3: Harm. 2. These effects can also precipitate acute coronary syndrome and stroke. Other testing of serum biomarkers, including testing levels over serial time points after arrest, was not evaluated. Existing evidence suggests that the potential harm from CPR in a patient who has been incorrectly identified as having cardiac arrest is low.1 Overall, the benefits of initiation of CPR in cardiac arrest outweigh the relatively low risk of injury for patients not in cardiac arrest. As more and more centers and EMS systems are using feedback devices and collecting data on CPR measures such as compression depth and chest compression fraction, these data will enable ongoing updates to these recommendations. When the second rescuer arrives, provide 2-rescuer CPR and use the AED/defibrillator. The administration of flumazenil to patients with undifferentiated coma confers risk and is not recommended. Acknowledging these data, the use of mechanical CPR devices by trained personnel may be beneficial in settings where reliable, high-quality manual compressions are not possible or may cause risk to personnel (ie, limited personnel, moving ambulance, angiography suite, prolonged resuscitation, or with concerns for infectious disease exposure). Injection of epinephrine into the lateral aspect of the thigh produces rapid peak plasma epinephrine concentrations. Other pseudoelectrical therapies, such as cough CPR, fist or percussion pacing, and precordial thump have all been described as temporizing measures in select patients who are either periarrest or in the initial seconds of witnessed cardiac arrest (before losing consciousness in the case of cough CPR) when definitive therapy is not readily available. The BLS care of adolescents follows adult guidelines. 1. Activation and retrieval of the AED/emergency equipment by the lone healthcare provider or by the second person sent by the rescuer must occur no later than immediately after the check for no normal breathing and no pulse identifies cardiac arrest. Both of these considerations support earlier advanced airway management for the pregnant patient. 3. For patients with OHCA, use of steroids during CPR is of uncertain benefit. In patients with anaphylactic shock, close hemodynamic monitoring is recommended. Ideally, activation of the emergency response system and initiation of CPR occur simultaneously. It is reasonable that TTM be maintained for at least 24 h after achieving target temperature. Technologies are now in development to diagnose the underlying cardiac rhythm during ongoing CPR and to derive prognostic information from the ventricular waveform that can help guide patient management. Three studies evaluated quantitative pupillary light reflex. do they differ from current generic or clinician-derived measures? 1. Intra-arterial pressure - If relaxation . Are there in-hospital interventions that can reduce or prevent physical impairment after cardiac arrest? National Center In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min. The optimal timing of CPR initiation and emergency response system activation was evaluated by an ILCOR systematic review in 2020. 7. The suggestion to administer epinephrine was strengthened to a recommendation based on a systematic review and meta-analysis. Components include venous cannula, a pump, an oxygenator, and an arterial cannula. Lidocaine is not included as a treatment option for undifferentiated wide-complex tachycardia because it is a relatively narrow-spectrum drug that is ineffective for SVT, probably because its kinetic properties are less effective for VT at hemodynamically tolerated rates than amiodarone, procainamide, or sotalol are. Chest compressions are the most critical component of CPR, and a chest compressiononly approach is appropriate if lay rescuers are untrained or unwilling to provide respirations. If so, what dose and schedule should be used? One large RCT in OHCA comparing bag-mask ventilation with endotracheal intubation (ETI) in a physician-based EMS system showed no significant benefit for either technique for 28-day survival or survival with favorable neurological outcome. 3. Nonvasopressor medications during cardiac arrest. One expected challenge faced through this process was the lack of data in many areas of cardiac arrest research. Observational studies evaluating the utility of cardiac receiving centers suggest that a strong system of care may represent a logical clinical link between successful resuscitation and ultimate survival. For patients with severe hypothermia (less than 30C [86F]) with a perfusing rhythm, core rewarming is often used. 1. 2. The clinical signs associated with severe hyperkalemia (more than 6.5 mmol/L) include flaccid paralysis, paresthesia, depressed deep tendon reflexes, or shortness of breath.13 The early electrocardiographic signs include peaked T waves on the ECG followed by flattened or absent T waves, prolonged PR interval, widened QRS complex, deepened S waves, and merging of S and T waves.4,5 As hyperkalemia progresses, the ECG can develop idioventricular rhythms, form a sine-wave pattern, and develop into an asystolic cardiac arrest.4,5 Severe hypokalemia is less common but can occur in the setting of gastrointestinal or renal losses and can lead to life-threatening ventricular arrhythmias.68 Severe hypermagnesemia is most likely to occur in the obstetric setting in patients being treated with IV magnesium for preeclampsia or eclampsia.