European Resuscitation Council Guidelines 2021: Adult advanced life support

Soar, Jasmeet; Böttiger, Bernd W.; Carli, Pierre; Couper, Keith; Deakin, Charles D.; Djärv, Therese; Lott, Carsten; Olasveengen, Theresa M.; Paal, Peter; Pellis, Tommaso; Perkins, Gavin D; Sandroni, Claudio; Nolan, Jerry P.

doi:10.1016/j.resuscitation.2021.02.010

Cited by 776 publications

(696 citation statements)

References 425 publications

(322 reference statements)

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“…Another purpose for data use relying on accurate time-related CPR documentation is process quality management. For example, in-hospital VF should be defibrillated within less than 3 min [ 16 ]. Therefore, the latency between circulatory arrest and the first defibrillation is part of the Utstein template for CPR documentation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis

et al. 2021

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Background According to the literature, the validity and reliability of medical documentation concerning episodes of cardiopulmonary resuscitation (CPR) is suboptimal. However, little is known about documentation quality of CPR efforts during intensive care unit (ICU) stays in electronic patient data management systems (PDMS). This study analyses the reliability of CPR-related medical documentation within the ICU PDMS. Methods In a retrospective chart analysis, PDMS records of three ICUs of a single university hospital were searched over 5 y for CPR check marks. Respective datasets were analyzed concerning data completeness and data consistency by comparing the content of three documentation forms (physicians’ log, nurses’ log, and CPR incident form), as well as physiological and therapeutic information of individual cases, for missing data and plausibility of CPR starting time and duration. To compare data reliability and completeness, a quantitative measure, the Consentaneity Index (CI), is proposed. Results One hundred sixty-five datasets were included into the study. In 9% (n = 15) of cases, there was neither information on the time points of CPR initiation nor on CPR duration available in any data source. Data on CPR starting time and duration were available from at least two data sources in individual cases in 54% (n = 90) and 45% (n = 74), respectively. In these cases, the specifications of CPR starting time did differ by a median ± interquartile range of 10.0 ± 18.5 min, CPR duration by 5.0 ± 17.3 min. The CI as a marker of data reliability revealed a low consistency of CPR documentation in most cases, with more favorable results, if the time interval between the CPR episode and the time of documentation was short. Conclusions This study reveals relevant proportions of missing and inconsistent data in electronic CPR documentation in the ICU setting. The CI is suggested as a tool for documentation quality analysis and monitoring of improvements.

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Section: Discussionmentioning

confidence: 99%

Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis

et al. 2021

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“…Wenn ein sofortiger Defibrillationsversuch nicht erfolgreich ist, kann das Outcome möglicherweise mit einem zweiten und bei Bedarf mit einem dritten Versuch verbessert werden, bevor mit der CPR begonnen wird. In Anbetracht dessen und der relativ begrenzten Zeitverzögerung eines Vorgehens mit 3 initialen Schocks empfehlen wir, bei beobachtetem VF/pVT – trotz sehr begrenzter Evidenz – die Verwendung eines Ansatzes mit multiplen Schocks für diejenigen Kinder, die überwacht werden und bei denen ein Defibrillator sofort einsatzbereit ist [ 676 , 677 ]. Dieser Ansatz der multiplen Schocks wurde auch während des ALS für Patienten mit COVID 19 empfohlen, bei denen die Helfer noch keine angemessene persönliche Schutzausrüstung tragen [ 7 ].…”

Section: Evidenzen Für Die Leitlinienunclassified

“…Daten und Leitlinien für Erwachsene schlagen eine erste Energiedosis von 120–200 J (abhängig von der Art der Wellenform) mit eskalierenden Dosen für refraktäres oder wiederkehrendes VF vor. Leitlinien für Erwachsene empfehlen außerdem, unabhängig von der Amplitude, einen Defibrillationsversuch bei einem VF durchzuführen, selbst wenn dies als „fein“ (im Sinn einer kleinen Amplitude) oder als „nahe an der Asystolie“ beurteilt wird [ 677 ].…”

Section: Evidenzen Für Die Leitlinienunclassified

“…Obwohl es andere Ursachen für Kreislaufstillstände geben könnte, die als reversibel angesehen werden könnten – einige Quellen schlagen 5 oder sogar 6 Hs und Ts vor – soll die Merkhilfe „4 H’s und HITS“ beibehalten werden, da sie sowohl mit den Leitlinien für Erwachsene übereinstimmt, als auch die Schulung erleichtert [ 677 ]. Es wurden Hyperthermie (siehe RR 17.1) und Hypoglykämie (siehe RR 15) hinzugefügt und Azidose als reversible Ursache gestrichen (siehe RR 31.4).…”

Section: Evidenzen Für Die Leitlinienunclassified

“…676,677]. Dieser Ansatz der multiplen Schocks wurde auch während des ALS für Patienten mit COVID 19 empfohlen, bei denen die Helfer noch keine angemessene persönliche Schutzausrüstung tragen[7].…”

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Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

Voorde

Turner

Djakow

et al. 2021

Notfall Rettungsmed

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Die Leitlinien des European Resuscitation Council (ERC) zu den lebensrettenden Maßnahmen bei Kindern (Paediatric Life Support, PLS) basieren auf dem 2020 verfassten „International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations“ der ILCOR (International Liaison Committee on Resuscitation). Dieses Kapitel beinhaltet Leitlinien zur Behandlung kritisch kranker oder verletzter Säuglinge, von Kindern und Jugendlichen vor, während und nach einem Atem-Kreislauf-Stillstand.

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Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest

Andersen

Isbye

Kjærgaard

et al. 2021

JAMA

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IMPORTANCE Previous trials have suggested that vasopressin and methylprednisolone administered during in-hospital cardiac arrest might improve outcomes.OBJECTIVE To determine whether the combination of vasopressin and methylprednisolone administered during in-hospital cardiac arrest improves return of spontaneous circulation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, placebo-controlled trial conducted at 10 hospitals in Denmark. A total of 512 adult patients with in-hospital cardiac arrest were included between October 15, 2018, and January 21, 2021. The last 90-day follow-up was on April 21, 2021.INTERVENTION Patients were randomized to receive a combination of vasopressin and methylprednisolone (n = 245) or placebo (n = 267). The first dose of vasopressin (20 IU) and methylprednisolone (40 mg), or corresponding placebo, was administered after the first dose of epinephrine. Additional doses of vasopressin or corresponding placebo were administered after each additional dose of epinephrine for a maximum of 4 doses. MAIN OUTCOMES AND MEASURESThe primary outcome was return of spontaneous circulation. Secondary outcomes included survival and favorable neurologic outcome at 30 days (Cerebral Performance Category score of 1 or 2). RESULTS Among 512 patients who were randomized, 501 met all inclusion and no exclusion criteria and were included in the analysis (mean [SD] age, 71 [13] years; 322 men [64%]). One hundred of 237 patients (42%) in the vasopressin and methylprednisolone group and 86 of 264 patients (33%) in the placebo group achieved return of spontaneous circulation (risk ratio, 1.30 [95% CI, 1.03-1.63]; risk difference, 9.6% [95% CI, 1.1%-18.0%]; P = .03). At 30 days, 23 patients (9.7%) in the intervention group and 31 patients (12%) in the placebo group were alive (risk ratio, 0.83 [95% CI, 0.50-1.37]; risk difference: −2.0% [95% CI, −7.5% to 3.5%]; P = .48). A favorable neurologic outcome was observed in 18 patients (7.6%) in the intervention group and 20 patients (7.6%) in the placebo group at 30 days (risk ratio, 1.00 [95% CI, 0.55-1.83]; risk difference, 0.0% [95% CI, −4.7% to 4.9%]; P > .99). In patients with return of spontaneous circulation, hyperglycemia occurred in 77 (77%) in the intervention group and 63 (73%) in the placebo group. Hypernatremia occurred in 28 (28%) and 27 (31%), in the intervention and placebo groups, respectively.CONCLUSIONS AND RELEVANCE Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone, compared with placebo, significantly increased the likelihood of return of spontaneous circulation. However, there is uncertainty whether this treatment results in benefit or harm for long-term survival.

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European Resuscitation Council Guidelines 2021: Adult advanced life support

Cited by 776 publications

References 425 publications

Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis

Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest

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