The document summarizes recommendations for protocols in adult advanced life support (ALS) based on ANZCOR and international resuscitation guidelines. It outlines:
1) Using the ALS algorithm to manage all adults requiring advanced resuscitation
2) Prioritizing high-quality CPR and minimizing time to defibrillation for cardiac arrest patients
3) Minimizing interruptions to compressions during ALS interventions
2. ANZCORGuideline11.2–ProtocolsforAdult
AdvancedLifeSupport.(June 2017)
Recommendations
1. That the Adult ALS algorithm be used as a tool to manage all
adults who require advanced life support.
2. Good quality CPR and reducing time to defibrillation are the
highest priorities in resuscitation from sudden cardiac arrest.
3. Rescuers should aim to minimise interruptions to CPR during
any ALS intervention.
3.
4. CPR
• Depth: 5cm
• Rate: 100-120bpm
• Minimise interruptions
• Cycle every 2 minutes or more frequently of required
• ETCO2 < 10mmHg = inadequate compressions
10. Shockable
CPR 2 minutes
CPR for 2 minutes
Amiodarone 300mg
IV/IO
CPR for 2 minutes
1mg Adrenaline IV/IO
(1 in 1000)
Then every 2nd cycle
• 200 J shock (biphasic)
• Recommended it is
reasonable to increase
energy level for
subsequent shocks.
18. Summary
• All cardiac arrests should follow the ALS algorithm
• Good quality CPR with minimal interruptions including
• Resuscitate with 100% O2
• Early defibrillation
• Consider higher energy levels if 1st shock unsuccessful
19. References
• Soar J, Callaway C, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ,
Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J, on behalf of the Advanced Life
Support Chapter Collaborators. Part 4: Advanced life support. 2015 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015;95:e71–
e120
• Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: Advanced life support: 2010
International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment
Recommendations. Resuscitation. [doi: DOI: 10.1016/j.resuscitation.2010.08.027]. 2010;81(1, Supplement 1):e93-e174.
• Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart
Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.AULink MS, Atkins DL,
Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE SOCirculation. 2010;122(18
Suppl 3):S706.
• Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S729.
• Andersen LW, Granfeldt A, Callaway CW, et al. Association Between Tracheal Intubation During Adult In-Hospital Cardiac
Arrest and Survival. JAMA 2017; 317:494.
Notes de l'éditeur
https://resus.org.au/guidelines/
Other management priorities during CPR:
• Minimise interruptions to CPR during ALS interventions [Class A; LOE III-2].
• Administer 100% oxygen when available (CoSTR 2015 weak recommendation, very low quality evidence).3
• Obtain intravenous or intra-osseous access [Class A; LOE II].
• Consider airway adjuncts, but attempts to secure the airway should not interrupt CPR for more than 5 seconds [Class A; Expert consensus opinion].
• Waveform capnography should be used to confirm airway placement and monitor the adequacy of CPR (CoSTR 2015 strong recommendation, low quality evidence).3
• Adrenaline should be administered every second loop (approximately every 4 minutes) [Class A; Expert consensus opinion].
• Other drugs/electrolytes should be considered depending on the individual circumstances [Class A; Expert consensus opinion].
End tidal CO2<10 = poor CPR
100% O2
Attempts to secure airway should not interrupt compressions for >5secs
Other management priorities during CPR:
• Minimise interruptions to CPR during ALS interventions [Class A; LOE III-2].
• Administer 100% oxygen when available (CoSTR 2015 weak recommendation, very low quality evidence).3
• Obtain intravenous or intra-osseous access [Class A; LOE II].
• Consider airway adjuncts, but attempts to secure the airway should not interrupt CPR for more than 5 seconds [Class A; Expert consensus opinion].
• Waveform capnography should be used to confirm airway placement and monitor the adequacy of CPR (CoSTR 2015 strong recommendation, low quality evidence).3
• Adrenaline should be administered every second loop (approximately every 4 minutes) [Class A; Expert consensus opinion].
• Other drugs/electrolytes should be considered depending on the individual circumstances [Class A; Expert consensus opinion].
End tidal CO2<10 = poor CPR
Monomorphic VT
Uniform broad QRS
ANZCOR suggests that if the first shock is not successful and the defibrillator is capable of delivering shocks of higher energy, it is reasonable to increase the energy to the maximum available for subsequent shocks (CoSTR 2015 weak recommendation, very low quality evidence).3
Precordial thump – witnessed VT (not VF) not on Defibrilator
Stacked shocks – 3 sequential shocks if witnessed VT on defibriltor usually in cath lab
10ml of 10% Calcium chloride – hypoCa, HyperK, Ca channel blocker OD
Mg – TdP, HypoK, dig toxicity, HypoMg
Bicarb – Metabolic Acidosis, Arrest >15mins, Hyper K, TCA OD
Amioderone: 150mg over 10 mins then infusion (900mg/24hrs), Bolus can be repeated or