NATIONAL CPR COMMITTEE

CPR GUIDELINES,WHAT IS NEW IN 2018?

NOV 5TH, 2018 ONLINE AT RESUSCITATION

2018 INTERNATIONAL CONSENSUS AND TREATMENT RECOMMENDATIONS(

COSTR) ON CARDIOPULMONARY RESUSCITATION AND EMERGENCY

CARDIAC CARE

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..."

2018 REVIEW WAS ADDRESSING THE USE OF ANTIARRYTHMIC DRUGS IN

ADULT AND PEDIATRIC IN ADDITION TO THE PERIOD IMMEDIATELY AFTER (ROSC)

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

RANKING THE OUTCOMES

The rank ing of the outcomes cons idered long term pat ient centered outcome more important than short term ones.

In 2018 updates, to measure the efficacy of antiarrythmic drugs ILCOR considered the short term outcomes like termination of VF, return of rosc or survival to hospital admission

OVERVIEW VF/ PVT

• common in adults than children

• The reported incidence varies due to the variability in the precise definition and the population studied

• Most of the data available is for OHCA with few data about IHCA

VF / PVT OHCA / IHCA INCIDENCE

Adult Adult Child Child

Region/ location OHCA IHCA OHCA IHCA

7 asian countries 4.1-19.8% 3-14%(Jap Reg)

Australia-NZ 27.9% 7% 9%

US 21.3 19.5 7,8% 10-14%

27 eurpian 4.4-50%(22.2%

4-12%(Sweden)

Itally 18.9%

Uk 16.9%

VF / PVT OHCA / IHCA TREATMENT

The anti arrhythmic treatment for VF /pVT is used if it persists after the defibrillation attempt.

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.

ILCOR RECOMMENDATION AND TREATMENTANTIARRYTHMIC DRUGS USE FOR ADULTS

• We suggest the use of amiodarone or lidocaine in adults with shock- refractory VF/pVT (weak recommendation, low-quality

evidence).

• We suggest against the routine use of magnesium in adults with shock-refractory VF/pVT (weak recommendation, very low-quality

evidence).

ILCOR RECOMMENDATION AND TREATMENTANTIARRYTHMIC DRUGS FOR ADULTS

• The confidence in effect estimates is currently too low to support an ALS Task Force recommendation about the use of bretylium, nifekalant, or sotalol in the treatment of adults in

cardiac arrest with shock-re- fractory VF/pVT.

• The confidence in effect estimates is currently too low to support an ALS Task Force recommendation about the use of prophylactic anti-arrhythmic drugs immediately after ROSC in

adults with VF/pVT cardiac arrest.

ILCOR RECOMMENDATION AND TREATMENT

ANTIARRYTHMIC DRUGS USE IN INFANTS AND PEDIATRIC

• We suggest that amiodarone or lidocaine be used in the treatment of pediatric shock-refractory VF/pVT (weak

recommendation, very low- quality evidence).

CONCLUSION

SHA ADAPTATION FOR THE USE OF ANTIARRYTHMIC DRUGS IN ADULTS AND PEDIATRIC IS TO KEEP THE CURRENT

PRACTICE OF IT EB 2015 GUIDELINES

• To keep the current practice with the use of amiodarone first in refractory VF / pVT if it available or the lidocaine as second choice

if no response or amiodarone is unavailable.

• We suggest against the routine use of magnesium in adults with shock-refractory VF/pVT (weak recommendation, very low-quality

evidence).

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

EMERGING 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.