Guidelines recommend prompt defibrillation for treatment of in-hospital cardiac arrest due to an initial rhythm of ventricular fibrillation (or pulseless ventricular tachycardia) Epinephrine (adrenaline) is recommended only when patients remain in refractory ventricular fibrillation or pulseless ventricular tachycardia after many defibrillation attempts. Use of epinephrine before defibrillation is associated with lower odds of survival to discharge and of favourable neurological survival, probably due to lower odds of achieving return of spontaneous circulation
- The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
- Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
- Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
- Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.
Once we’ve achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause.
If you see a teen or adult suddenly collapse, hands-only CPR is the recommended form of cardiopulmonary resuscitation (CPR). It not only increases the likelihood of surviving breathing and cardiac emergencies that occur outside of medical settings, but it’s simple to learn and easy to remember. For a refresher any time, you can print up this page and keep it with the rest of your first-aid supplies.
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.