Universität zu Köln

Wenzel, V., Russo, S. G., Arntz, H. R., Bahr, J., Baubin, M. A., Boettiger, B. W., Dirks, B., Kreimeier, U., Fries, M. and Eich, C. (2010). Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council. Anaesthesist, 59 (12). S. 1105 - 1123. NEW YORK: SPRINGER. ISSN 0003-2417

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Abstract

Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O(2) if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice IV, second choice intraosseous (IO). Vasopressors: 1 mg epinephrine every 3-5 min IV. After the third unsuccessful defibrillation amiodarone (300 mg IV), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR. Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children > 1 year). Treatment of potentially reversible causes: (4 Hs and 4 Ts) hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 A mu g/kgBW IV or IO every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH(2)O). If heart rate remains < 60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34A degrees C for 12-24 h (adults) or 24 h (children); slow rewarming (< 0.5A degrees C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome < 72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg PO or IV) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg PO). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock. Any CPR training is better than nothing; simplification of contents and processes is the main aim.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wenzel, V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Russo, S. G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Arntz, H. R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bahr, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baubin, M. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Boettiger, B. W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dirks, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kreimeier, U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fries, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eich, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-491061
DOI:	10.1007/s00101-010-1820-9
Journal or Publication Title:	Anaesthesist
Volume:	59
Number:	12
Page Range:	S. 1105 - 1123
Date:	2010
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	0003-2417
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Anesthesiology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49106