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viernes, 8 de abril de 2016

Norwegian Resuscitation Council CPR Guidelines

Posted on April 6, 2016 - By Thomas D
The Norwegian Resuscitation Council has released revised guidelines for CPR, and presented them at the Scandinavian conference for emergency medicine, SAM 16. These recommendations might differ from international recommendations.
  1. Always give a shock as soon as a defibrillator is available, don’t give a round of compressions first. The recommendation used to be initial defib in witnessed arrest where a defibrillator was immediately available. Now, a shock is recommended as soon as you get your hands on a defibrillator and have it ready to go.
  2. With initial VF/VT, wait with drugs until you’ve done 4 mins of Advanced CPR. This follows the trend that recognises that early and goood CPR is what really makes a difference in survival. Drugs come in as an adjuct once good CPR is up and running.
  3. Intubation only by anaesthetic personnel with regular training. There are too many failed intubations, and intubations necessitating long pauses in CPR with untrained personnel. In Norway, only anaesthetic personnel currently has this regular training.
  4. Mechanical CPR is an alternative to standard manual CPR. LUCAS and friends are great for transportation, freeing up hands, and for facilitating procedures like PCI. This has been known for some years.
  5. Temperature range for therapeutic hypothermia is now 32-36°C. Finally recognising the TTM trial.
  6. Prehospital initiation of therapeutic hypothermia is not recommended. Trials so far have been a let-down.
  7. In pregnant patients in cardiac arrest, perimortem caesarian should be initiated after 4 mins of unsuccessful CPR. Yes!
  8. Transport to facility that can perform emergent PCI should be considered in selected pts in refractory VT/VF. This has been done for quite a long time, nice to finally have it in the guidelines.
  9. ECMO can be considered in selected patients. Finally, also in the guidelines…
  10. Traumatic arrests should be treated as actively and aggressively as medical arrests. Yes, but resuscitation of traumatic arrests shouldn’t follow the medical CPR algorithm! It’s a different entity! Read up on traumatic arrest algorithm here