Family-witnessed resuscitation

2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

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The 2020 Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) are a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics. They have been developed for resuscitation providers and AHA instructors to focus on the resuscitation science and guidelines recommendations that are most significant or controversial, or those that will result in resuscitation training and practice changes and provide the rationale for the recommendations.

Highlights

“Top 10 Changes” Project: CPR & ECC Guidelines Infographic Series

2020 AHA Algorithms

Post ROSC

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System Action
Airway Intubate → Ventilation tidal volume @ 6-8 mL/kg
Place OG or NG tube
Confirm endotracheal and OG/NG tube placement with chest x-ray
Breathing SpO2 goal >94% → adjust PEEP & FiO2 to achieve goal
EtCO2 goal 30-40 mmHg → adjust respiratory rate to achieve
Circulation 12-lead ECG → Activate cardiac catheterization lab for STEMI; consult cardiology for all other patients
SBP goal >90 mmHg (MAP > 65 mmHg) → Use fluids, norepinephrine infusion, then epinephrine infusion to achieve goal
Place central line
Place arterial line
Perform point of care ultrasound with the cardiac, lung, and IVC views
Send labs, which includes an arterial blood gas and serum lactate
Place Foley catheter → Goal urine output 0.5-1 mL/kg/hr
Consider CT chest angiography to rule-out a pulmonary embolism
Disability Begin cooling → Goal temperature 32–36°C
Consider head CT

 

 

 

Should Families Watch CPR in the Emergency Department?

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The evidence behind the practice of Family-witnessed resuscitation (FWR) generally supports its use but within a specific set of circumstances. FWR may give patients’ family members one last moment to say good-bye and allow them to see the level of effort that went into the resuscitation. A designated supportive staff member (SSM) is important for a successful experience for families. The SSM should be trained and committed to the supportive process during resuscitative efforts. The SSM should initially communicate with family members prior to entering the resuscitation area. Family members should be given the option to be present and prepared for the visual and emotional stress of the clinical scenario. They should be instructed where to stand at the bedside to be close to their family member without interfering with the delivery of care. If there is uncertainty about crowd control or ability to function appropriately, it may not be appropriate for family to be present. Ideally, there should be a designated area that provides adequate seating for the family as well as a direct line of vision to the patient and the delivery of care. Family members should be allowed to leave and reenter the room if they become uncomfortable with the situation. The SSM should be solely dedicated to the family throughout the resuscitative efforts and should provide appropriate education and communication regarding clinical status and medical interventions.