Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1

A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions.

In Part 1 of ACLS Guidelines 2015 - Cardiac Arrest Controversies we discuss the science and controversies around the following questions: What exactly determines 'high quality CPR' and how can we best achieve it? How do we best assess cardiac output during our resuscitation? How and when should we be giving epinephrine or vasopressin in the cardiac arrest patient? What’s the best way to manage refractory Ventricular Fibrillation? How soon do we need to intubate in cardiac arrest? and many more...



When you're finished Part 1 Go HERE for Part 2 of this series on ACLS Guidelines 2015 Controversies: Post Arrest Care with a special guest appearance by Scott Weingart



Written Summary and blog post prepared by Dr. Anton Helman, October 2015

Cite this podcast as: Helman, A, Morrison, L, Lin, S. ACLS Guidelines 2015 - Cardiac Arrest Controversies Part 1. Emergency Medicine Cases. October, 2015. https://emergencymedicinecases.com/acls-guidelines-2015-cardiac-arrest/. Accessed [date].

Go to part 2 of this 2-part podcast on ACLS Guidelines 2015

Quick List - ACLS Guidelines 2015 for Cardiac Arrest Update





* The recommended chest compression rate is 100-120 per minute which is updated from the at least 100/min.





* The recommended chest compression depth is 5-6cm or just over 2 inches, but not more than 6cm as too deep can be harmful.





* Use Audiovisual devices such as metronomes and compression depth analyzers which can be used to optimize CPR quality.





* The routine use of impedence threshold devices (ITDs) alone or mechanical chest compression devices alone are not recommended, however in out of hospital situations where manual compressions are difficult due to physical space limitations, mechanical devices may be useful.





* A recent RCT suggests that the use of the ITD plus active compression decompression CPR is associated with improved neurological intact survival for patients with out of hospital cardiac arrest.





* ECMO or ECPR may be considered for selected patients with refractory cardiac arrest where a reversible cause of cardiac arrest is suspected.





* Vasopressin has been removed from the algorithm altogether, and an emphasis on EARLY administration of epinephrine is stressed.





* Ultrasound has been added as an additional method for helping to confirm ROSC and for confirming ETT placement.





* Use maximum inspired oxygen during CPR and then after ROSC, titrate oxygen to an oxygen saturation of 94% rather than continuing maximum oxygen delivery.





* A low end tidal CO2 in intubated patients after 20 minutes of CPR is associated with a very low likelihood of survival,