2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Abstract

The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post–cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.

Norepinephrine Leads to More Cardiopulmonary Toxicities than Epinephrine by Catecholamine Overdose in Rats

“…From the 2019 ACLS guideline update, there were no survival benefits of high-dose E compared to standard-dose E [2]. Although few studies with large sample sizes have directly reported the toxicity of catecholamines, a number of case reports have documented the link between E overdose with a series of arrhythmia changes including sinus tachycardia, and idioventricular rhythm with multifocal premature ventricular complex [27] or ST elevation due to myocardial injury [28].…”

Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study

“…Only when conventional CPR efforts failed, and skilled physicians could quickly establish ECMO, ECMO might be considered as a rescue treatment. 23,24 Our found that MAP was associated with NSE and S100B protein (NSE and S100B were often used to evaluate the degree of brain injury). 27 Ameloot et al study included 112 out-of-hospital cardiac arrest patients, found that higher than reduces brain ischemia, and improves outcome.…”

Role of extracorporeal cardiopulmonary resuscitation in adults

“…According to the ELSO registry, the incidence of ECPR use increased more than 10-fold between 2003 and 2014, from 35 to over 400 per year ( Figure 2) [6,7], and the overall survival to hospital discharge was 29% in adults [8]. The Advanced Cardiac Life Support (ACLS) Guidelines state that ECPR may be considered for selected patients as rescue therapy when CCPR efforts are failing in settings in which it can be expeditiously implemented and supported by skilled providers (class 2b; level of evidence, C-LD) [9,10]. However, there is insufficient evidence to recommend its routine use in patients with cardiac arrest.…”