2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Abstract

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This “2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support” summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.

Out‐of‐hospital cardiac arrest: pathways for extracorporeal cardiopulmonary resuscitation in the United Kingdom

“…Life Support Organisation and American Heart Association [13,18] and are summarised in Box 1. Evidence suggests a significant fall in survival with ECPR initiated after 60 min of conventional CPR [18].…”

“…Patient selection criteria for extracorporeal cardiopulmonary resuscitation (ECPR) (adapted from[13,18]). Witnessed cardiac arrest with early bystander CPR Age < 70 y Absence of life-limiting comorbidities Treatment is consistent with patient's wishes Initial cardiac rhythm ventricular fibrillation/tachycardia or pulseless electrical activity No known aortic valve incompetence (beyond mild aortic regurgitation) End-tidal carbon dioxide > 1.3 kPa during conventional CPR Ability to institute ECPR within 60 min of starting conventional CPR (`low-flow´interval)…”

“…The International Liaison Committee on Resuscitation comprises eight international member organisations (including the European produced by distilling international guidelines and adapting for UK services [11]. Resuscitation guidelines from all these groups recommend that ECPR should be considered as a rescue therapy (weak recommendation, low certainty of evidence) [10,[12][13][14]. However, it is surprising that the International Liaison Committee on Resuscitation recommends ECPR despite not being convinced by the evidence.…”