CPR GUIDELINES,WHAT IS NEW IN 2017?

NATIONAL CPR COMMITTEE

2017 INTERNATIONAL CONSENSUS AND TREATMENT RECOMMENDATIONS(

COSTR) ON CARDIOPULMONARY RESUSCITATION AND EMERGENCY

CARDIAC CARE

NOV 7TH, 2017 AT CIRCULATION

EVIDENCE PRODUCTION OF TREATMENT AND RECOMMENDATION OF 2015 CPR UPDATES

EVALUATE EVIDENCES

FORMULATION BY REVIEW BOARD

IMPLEMENTATION

EVIDENCE BASED GUIDELINES

TREATMENT RECOMMENDATIONS

SET QUESTION

ILCOR

RESUS COUNCILS

INDIVIDUAL COUNCILS WRITE GUIDELINES

• Specific recommendations vary between regions because of:

• Local drug or device availability

• Different interpretation of data

• Decisions about topics with " insufficient evidence to recommend for or against..."

THE NEWEST DEVELOPMENT IN RESUSCITATION SINCE 2010 NOTICED IN THE IMPROVEMENT OF OUTCOMES AFTER OHCA FOR WITNESSED SHOCKABLE CA

COMPRESSION TO VENTILATION RATIO-DISPATCH ASSISSTED - ADULT

Dispatcher Instructions (2015) ILCOR Treatment Recommendation We recommend that dispatchers provide chest compression– only CPR instructions to callers for adults with suspected OHCA (strong recommendation, low-quality evidence). (2015) SHA Recommendation: ( we highly recommend a specific tailored education program for dispatchers in EMS systems including those in the red crescent authorities, the civil defense, and police dispatchers. That might improve the effective communication with the callers and provide CPR and other instructions regarding the critical situation or suspected OHCA.) • 2017 NO change in the recommendation in spite of NO RCT in

consistent to this, but for the sake of quick telephone and small doses of instructions, so chest compression only favorable than conventional CPR telephone instructions.

Chest Compression–Only CPR Versus Conventional CPR- Bystander - adult

(2015) ILCOR Treatment Recommendations: We recommend that chest compressions should be performed for all patients in cardiac arrest (strong recommendation, very-low-quality evidence). We suggest that those who are trained and willing to give rescue breaths do so for all adult patients in cardiac arrest (weak recommendation, very-low-quality evidence). SHA Recommendation: (ventilation is a skillful action which need a quite professional training, whereas chest compressions is easy to learn. So chest compressions should be delivered for all patients in cardiac arrest and ventilation provided with trained rescuers. Training on ventilation skills should include bystanders and lay persons in addition to health care provider). • 2017 ILCOR recommendation is the same. However, the task force had

acknowledged the potential additional benefits of conventional CPR when delivered by trained laypersons, particularly in a settings where EMS response intervals are long and for asphyxial causes of cardiac arrest.

Chest Compression–Only CPR Versus Conventional CPR- Bystander - pediatric

( 2015 ) The pediatric task force recommends that rescuers provide rescue breaths and chest compressions for pediatric IHCA and OHCA, because most pediatric cardiac arrests are caused by asphyxia. If rescuers cannot provide rescue breaths, they should at least perform chest compressions( strong recommendation, very low quality evidence SHA recommendation: we are applying the same recommendation since 2010 adapted guidelines.

• 2017 ILCOR recommendation: we recommend that bystanders provide CPR with ventilation for infants and children younger than 18 years with OHCA( weak recommendation,very low quality evidence). We continue to recommend that if bystanders can not provide rescue breaths as part of CPR for infants and children younger than 18 years with OHCA( good practice statements), they should at least provide chest compression.

EXAMPLE OF ADAPTATION PROCESS

BLS UPDATE

1. Sequence of Chest Compressions and Ventilation: Compressions-Airway-Breathing (CAB) Versus Airway-Breathing-Compressions(ABC)(pediaric)

The task force concluded that, in light of the limited literature available, no specific recommendation could be made. The task force acknowledged the equipoise that exists to allow resuscitation councils to decide on using either compressions-airway-breathing (C-A-B) or airway-breathing-compressions (A-B-C) in their guidelines.

SHA recommendation: we recommend the use of A-B-C sequence as most of the cardiac arrest causes in pediatric group due to respiratory problems.

CHEST COMPRESSION TO VENTILATION RATIO - ADULT

(2015)ILCOR Treatment Recommendation: We suggest a compression-ventilation ratio of 30:2 compared with any other compression-ventilation ratio in patients in cardiac arrest (weak recommendation, low-quality evidence). SHA Recommendation: ( we recommend no change in the current practice as it is going with the same recommendation)

(2017) ILCOR RECOMMENDATION: the same, no change

CHEST COMPRESSION TO VENTILATION RATIO IN - HOSPITAL - ADULT ( INTUBATED)

2017 ILCOR RECOMMENDATION: Whenever tracheal intubation or a supraglottic device is achieved during in hospital CPR we suggest providers perform continuous compression with positive pressure ventilations delivered without pausing chest compression( weak recommendation, very low quality of evidence).

EDUCATIONAL, IMPLEMENTATION AND TEAM (EIT)STRATEGY

• TRAINING:

• High-fidelity manikins may be preferred to standard manikins at training centers/organizations that have the infrastructure, trained personnel, and resources to maintain the program.

• CPR feedback devices (providing directive feedback) are useful to learn psychomotor CPR skills.( SHA ) new model of training

• Retraining cycles of 1 to 2 years are not adequate to maintain competence in resuscitation skills. The optimal retraining intervals are yet to be defined. We found that the use of in hospital Mock drill with briefing or debriefing has a great influence in improving the teams performance.

EDUCATIONAL, IMPLEMENTATION AND TEAM (EIT)STRATEGY

• SYSTEMS:

• Systems that facilitate performance measurement and quality improvement initiatives are to be used where possible.

• Data-driven, performance-focused debriefing can help improve performance of resuscitation teams.

• There is increasing evidence (in-spite of low quality) that treatment of post–cardiac arrest patients in regionalized cardiac arrest centers is associated with increased survival. OHCA victims should be considered for transport to a specialist cardiac arrest center as part of a wider regional system of care.

• The role of technology/social media in the bystander CPR response for OHCA is evolving rapidly. We need a huge campaign for public.

Saudi Heart Association( SHA) CPR guidelines 2015; what is the difference from 2010

WE HAVE CONTINUALLY EVIDENCE EVALUATION AND UPDATE OF THE GUIDELINES ACCORDING TO THE

EMERGING EVIDENCE