Elsevier

Resuscitation

Volume 81, Issue 10, October 2010, Pages 1219-1276
Resuscitation

European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary

https://doi.org/10.1016/j.resuscitation.2010.08.021Get rights and content

Introduction

The publication of these European Resuscitation Council (ERC) Guidelines for cardiopulmonary resuscitation (CPR) updates those that were published in 2005 and maintains the established 5-yearly cycle of guideline changes.1 Like the previous guidelines, these 2010 guidelines are based on the most recent International Consensus on CPR Science with Treatment Recommendations (CoSTR),2 which incorporated the results of systematic reviews of a wide range of topics relating to CPR. Resuscitation science continues to advance, and clinical guidelines must be updated regularly to reflect these developments and advise healthcare providers on best practice. In between the 5-yearly guideline updates, interim scientific statements can inform the healthcare provider about new therapies that might influence outcome significantly.3

This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2005. Detailed guidance is provided in each of the remaining nine sections, which are published as individual papers within this issue of Resuscitation. The sections of the 2010 guidelines are:

  • 1.

    Executive summary;

  • 2.

    Adult basic life support and use of automated external defibrillators;4

  • 3.

    Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing;5

  • 4.

    Adult advanced life support;6

  • 5.

    Initial management of acute coronary syndromes;7

  • 6.

    Paediatric life support;8

  • 7.

    Resuscitation of babies at birth;9

  • 8.

    Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution;10

  • 9.

    Principles of education in resuscitation;11

  • 10.

    The ethics of resuscitation and end-of-life decisions.12

The guidelines that follow do not define the only way that resuscitation can be delivered; they merely represent a widely accepted view of how resuscitation should be undertaken both safely and effectively. The publication of new and revised treatment recommendations does not imply that current clinical care is either unsafe or ineffective.

Section snippets

Basic life support

Changes in basic life support (BLS) since the 2005 guidelines include:4, 13

  • Dispatchers should be trained to interrogate callers with strict protocols to elicit information. This information should focus on the recognition of unresponsiveness and the quality of breathing. In combination with unresponsiveness, absence of breathing or any abnormality of breathing should start a dispatch protocol for suspected cardiac arrest. The importance of gasping as sign of cardiac arrest is emphasised.

  • All

Epidemiology and outcome of cardiac arrest

Ischaemic heart disease is the leading cause of death in the world.20 In Europe, cardiovascular disease accounts for around 40% of all deaths under the age of 75 years.21 Sudden cardiac arrest is responsible for more than 60% of adult deaths from coronary heart disease.22 Summary data from 37 communities in Europe indicate that the annual incidence of EMS-treated out-of-hospital cardiopulmonary arrests (OHCAs) for all rhythms is 38 per 100,000 population.22a Based on these data, the annual

The International Consensus on Cardiopulmonary Science

The International Liaison Committee on Resuscitation (ILCOR) includes representatives from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Council of Southern Africa (RCSA), the Inter-American Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Since 2000, researchers from the ILCOR member councils have evaluated

From science to guidelines

As in 2005, the resuscitation organisations forming ILCOR will publish individual resuscitation guidelines that are consistent with the science in the consensus document, but will also consider geographic, economic and system differences in practice, and the availability of medical devices and drugs. These 2010 ERC Resuscitation Guidelines are derived from the 2010 CoSTR document but represent consensus among members of the ERC Executive Committee. The ERC Executive Committee considers these

Conflict of interest policy for the 2010 ERC Guidelines

All authors of these 2010 ERC Resuscitation Guidelines have signed COI declarations (Appendix B).

The Chain of Survival

The actions linking the victim of sudden cardiac arrest with survival are called the Chain of Survival (Fig. 1.1). The first link of this chain indicates the importance of recognising those at risk of cardiac arrest and calling for help in the hope that early treatment can prevent arrest. The central links depict the integration of CPR and defibrillation as the fundamental components of early resuscitation in an attempt to restore life. Immediate CPR can double or triple survival from VF OHCA.42

Adult BLS sequence

Throughout this section, the male gender implies both males and females.

Basic life support comprises the following sequence of actions (Fig. 1.2).

  • 1. Make sure you, the victim and any bystanders are safe.

  • 2. Check the victim for a response:

    • gently shake his shoulders and ask loudly: “Are you all right?“

  • 3a. If he responds:

    • leave him in the position in which you find him, provided there is no further danger;

    • try to find out what is wrong with him and get help if needed;

    • reassess him regularly.

  • 3b. If he

Automated external defibrillators

Automated external defibrillators (AEDs) are safe and effective when used by either laypeople or healthcare professionals (in- or out-of-hospital). Use of an AED by a layperson makes it possible to defibrillate many minutes before professional help arrives.

Prevention of in-hospital cardiac arrest

Early recognition of the deteriorating patient and prevention of cardiac arrest is the first link in the Chain of Survival.180 Once cardiac arrest occurs, fewer than 20% of patients having an in-hospital cardiac arrest will survive to go home.36, 181, 182 Prevention of in-hospital cardiac arrest requires staff education, monitoring of patients, recognition of patient deterioration, a system to call for help and an effective response.183

Sequence of actions

Rescuers who have been taught adult BLS and have no specific knowledge of paediatric resuscitation may use the adult sequence, as outcome is worse if they do nothing. Non-specialists who wish to learn paediatric resuscitation because they have responsibility for children (e.g., teachers, school nurses, lifeguards), should be taught that it is preferable to modify adult BLS and perform five initial breaths followed by approximately one minute of CPR before they go for help (see adult BLS

Preparation

Relatively few babies need any resuscitation at birth. Of those that do need help, the overwhelming majority will require only assisted lung aeration. A small minority may need a brief period of chest compressions in addition to lung aeration. Of 100,000 babies born in Sweden in one year, only 10 per 1000 (1%) babies of 2.5 kg or more appeared to need resuscitation at delivery.571 Of those babies receiving resuscitation, 8 per 1000 responded to mask inflation and only 2 per 1000 appeared to need

Electrolyte abnormalities

Life-threatening arrhythmias are associated most commonly with potassium disorders, particularly hyperkalaemia, and less commonly with disorders of serum calcium and magnesium. In some cases therapy for life-threatening electrolyte disorders should start before laboratory results become available. There is little or no evidence for the treatment of electrolyte abnormalities during cardiac arrest. Guidance during cardiac arrest is based on the strategies used in the non-arrest patient. There are

Principles of education in resuscitation

Survival from cardiac arrest is determined by the quality of the scientific evidence behind the guidelines, the effectiveness of education and the resources for implementation of the guidelines.687 An additional factor is how readily guidelines can be applied in clinical practice and the effect of human factors on putting the theory into practice.688 Implementation of Guidelines 2010 is likely to be more successful with a carefully planned, comprehensive implementation strategy that includes

The ethics of resuscitation and end-of-life decisions

Several considerations are required to ensure that the decisions to attempt or withhold resuscitation attempts are appropriate, and that patients are treated with dignity. These decisions are complex and may be influenced by individual, international and local cultural, legal, traditional, religious, social and economic factors.766

The 2010 ERC Guidelines include the following topics relating to ethics and end-of-life decisions.

  • Key principles of ethics.

  • Sudden cardiac arrest in a global

Acknowledgements

Many individuals have supported the authors in the preparation of these guidelines. We would particularly like to thank Annelies Pické and Christophe Bostyn for their administrative support and for co-ordinating much of the work on the algorithms, and Bart Vissers for his role as administrative lead and member of the ERC Guidelines Steering Group. The algorithms were created by Het Geel Punt bvba, Melkouwen 42a, 2590 Berlaar, Belgium ([email protected]).

ERC Guidelines Writing Group: Gamal

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References (767)

  • F.K. Lippert et al.

    European Resuscitation Council Guidelines for Resuscitation 2010. Section 10. The ethics of resuscitation and end-of-life decisions

    Resuscitation

    (2010)
  • R.W. Koster et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 5. Adult basic life support

    Resuscitation

    (2010)
  • K. Sunde et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6. Defibrillation

    Resuscitation

    (2010)
  • C.D. Deakin et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 8. Advanced life support

    Resuscitation

    (2010)
  • L. Bossaert et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 9. Acute coronary syndromes

    Resuscitation

    (2010)
  • A.R. de Caen et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 10. Pediatric basic and advanced life support

    Resuscitation

    (2010)
  • J. Wyllie et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 11. Neonatal resuscitation

    Resuscitation

    (2010)
  • C.J. Murray et al.

    Mortality by cause for eight regions of the world: global burden of disease study

    Lancet

    (1997)
  • C. Atwood et al.

    Incidence of EMS-treated out-of-hospital cardiac arrest in Europe

    Resuscitation

    (2005)
  • T.D. Rea et al.

    Incidence of out-of-hospital cardiac arrest

    Am J Cardiol

    (2004)
  • D.A. Agarwal et al.

    Ventricular fibrillation in Rochester, Minnesota: experience over 18 years

    Resuscitation

    (2009)
  • R.A. Waalewijn et al.

    Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest

    Resuscitation

    (2002)
  • M.L. Weisfeldt et al.

    Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million

    J Am Coll Cardiol

    (2010)
  • P.T. Morley et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 3. Evidence evaluation process

    Resuscitation

    (2010)
  • J.E. Billi et al.

    Conflict of interest management before, during, and after the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

    Resuscitation

    (2005)
  • M. Shuster et al.

    International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4. Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

    Resuscitation

    (2010)
  • M. Holmberg et al.

    Survival after cardiac arrest outside hospital in Sweden. Swedish Cardiac Arrest Registry

    Resuscitation

    (1998)
  • R.A. Waalewijn et al.

    Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARREST)

    Resuscitation

    (2001)
  • I.G. Stiell et al.

    Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support

    Ann Emerg Med

    (1999)
  • R.A. Waalewijn et al.

    Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic

    Resuscitation

    (2001)
  • J. Engdahl et al.

    Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Goteborg

    Resuscitation

    (2000)
  • A. Langhelle et al.

    In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway

    Resuscitation

    (2003)
  • B.G. Carr et al.

    Inter-hospital variability in post-cardiac arrest mortality

    Resuscitation

    (2009)
  • J. Herlitz et al.

    Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest

    Resuscitation

    (2006)
  • J. Bahr et al.

    Skills of lay people in checking the carotid pulse

    Resuscitation

    (1997)
  • J. Nyman et al.

    Cardiopulmonary resuscitation skills in nurses and nursing students

    Resuscitation

    (2000)
  • J. Tibballs et al.

    Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest

    Resuscitation

    (2009)
  • M. Ruppert et al.

    Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons

    Ann Emerg Med

    (1999)
  • G.D. Perkins et al.

    Birmingham assessment of breathing study (BABS)

    Resuscitation

    (2005)
  • R.B. Taylor et al.

    A model for regional blood flow measurements during cardiopulmonary resuscitation in a swine model

    Resuscitation

    (1988)
  • T.P. Aufderheide et al.

    Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression–decompression techniques

    Resuscitation

    (2005)
  • D. Yannopoulos et al.

    Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest

    Resuscitation

    (2005)
  • J.P. Ornato et al.

    Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic

    Ann Emerg Med

    (1990)
  • P. Hew et al.

    Reluctance of paramedics and emergency medical technicians to perform mouth-to-mouth resuscitation

    J Emerg Med

    (1997)
  • I. Turner et al.

    Does the compression to ventilation ratio affect the quality of CPR: a simulation study

    Resuscitation

    (2002)
  • E. Dorph et al.

    Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs

    Resuscitation

    (2004)
  • M.A. Peberdy et al.

    Adverse events associated with lay emergency response programs: the public access defibrillation trial experience

    Resuscitation

    (2006)
  • N.T. Sugerman et al.

    Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study

    Resuscitation

    (2009)
  • R.S. Hoke et al.

    Is external defibrillation an electric threat for bystanders?

    Resuscitation

    (2009)
  • C.L. Dickinson et al.

    Accidental shock to rescuer during successful defibrillation of ventricular fibrillation—a case of human involuntary automaticity

    Resuscitation

    (2008)
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    1

    Appendix A (the list of the writing group members).

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