Resuscitation Guidelines 2005 Team Leader Training Day

The Main Changes - Adults CPR now 30:2 CPR for two minutes before defibrillating if arrest unwitnessed No more “stacked shocks” Increasing energy regime Fine VF CPR after every shock Amiodarone

30:2 Research shows that chest compressions are very important to good outcome The more chest compressions are given without interruption, the better the perfusion pressure Some ventilation happens whilst compressions take place Unnecessary interruptions in chest compressions significantly increase mortality Start and end two minute cycles on compressions

The emphasis should be put on good quality chest compressions We recognise that some interruptions are inevitable in the pre-hospital environment. The guidelines have been written so that these interruptions are absolutely minimal This should be emphasised to staff, and reinforced during practice and assessment

CPR before Defibrillation Blue hearts don’t start! The heart becomes distended and hypoxic after cardiac arrest Two minutes of CPR should make the heart more susceptible to cardioversion Only do CPR if the arrest was unwitnessed. For witnessed arrests the best chance of cardioversion is immediate defibrillation

Lone Responders RG2005 carries no guidance for solo workers Following discussion, it is advised that if a solo worker attends an unwitnessed cardiac arrest, it is best to do one minute CPR, attach the defib., and then do a further minute of CPR prior to rhythm analysis

No Stacked Shocks No evidence for stacked shocks No evidence for single shocks! Theory is that single shocks lead to smaller interruptions in CPR If the first shock is not successful, are subsequent shocks – when the heart is more hypoxic – going to be successful? AEDs (or manual defib. with AED function activated) should NOT be used by professional ambulance staff, even after software upgrade

Increasing Energy Guidelines 2005 are very vague about energy regimes, as are JRCALC Following some new advice from Medtronic, the recommended energy regime is 200j, 300j, 360j for LifePak 12 If you are using other machines, please consult the Clinical Department for guidance

Fine VF Fine VF is unlikely to be cardioverted Therefore if there is any confusion about whether the presenting rhythm is fine VF or Asystole, perform CPR rather than shock Good quality CPR will hopefully increase the amplitude and frequency of the VF, therefore making successful cardioversion more likely

CPR After Every Shock No rhythm check should be performed immediately after defibrillation CPR should be IMMEDIATELY resumed with no interruption Rhythm/pulse checks should only be performed prior to delivering the next shock To do otherwise is adverse to patient outcome, and is therefore a FAIL point on all assessments

Amiodarone Amiodarone is considered a superior anti- arrhythmic drug to Lignocaine Administer after three unsuccessful shocks (ie just before the 4 th shock)

Amiodarone Do not mix Amiodarone and Lignocaine Lignocaine should now be unavailable, but if you do find it in a drugs bag, use Amiodarone for preference in cardiac arrest, however if it is unavailable or Lignocaine has already been given, Lignocaine can be given to a maximum dose of 100mg (200mg ET) (Dispose of any Lignocaine stocks as per protocol – there is no need to carry it if Amiodarone is available)

Administration of Amiodarone in Cardiac Arrest Amiodarone is an irritant It should be flushed through an intravascular line with at least 20ml crystalloid NEVER give Amiodarone via the ET route – IV or IO only Administer 300mg bolus once only just before the 4 th shock (Remember Amiodarone can be given for symptomatic VT, but Lignocaine cannot)

Summary There are significant changes to adult ALS in the 2005 Guidelines It is only by practicing with the new guidelines that we will become competent It is massively important that staff not only are aware of the changes but also realise the rationale behind the changes It is your job to ensure that staff are competent at ALS/ILS