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• W2062483427 abstract "During a very intensive process over many years, scientific and evidence-based data on cardiopulmonary resuscitation (CPR) were identified, critically analysed and discussed by representatives of the International Liaison Committee on Resuscitation (ILCOR) and published in the Consensus of Science Statements with Treatment Recommendations (CoSTR).1 The ILCOR currently 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), the Resuscitation Council of Southern Africa (RCSA), the InterAmerican Heart Foundation (IAHF) and the Resuscitation Council of Asia (RCA).1 The 2010 International Consensus Conference held in Dallas in February 2010 involved 313 experts from 30 countries, of which more than 100 were European specialists in resuscitation.1 The ILCOR member organisations have subsequently published resuscitation guidelines that are consistent with the science in this consensus document,1,2 but which also take into account geographical, economic and system differences in practice. They are committed to minimising international differences in resuscitation practice and optimising the effectiveness of resuscitation practice, instructional methods, teaching aids, training networks and outcomes.1 On the basis of these discussions, the new ‘European Resuscitation Council Guidelines for Resuscitation 2010’ have been created.2,3 These are the specific guidelines that are applied throughout Europe. It is only a few months since the new guidelines were published on-line and the print version has been released even more recently in the Journal Resuscitation.3 The guidelines update those which were published in 2005 and maintain the established 5-yearly cycle of guideline changes.2 The central points of the 2010 guidelines for CPR are very clear and are in line with the major developments published 5 years ago in 2005. Important changes, relevant to daily practice, have been published as an executive summary by the ERC.2,3 This summary provides the essential treatment algorithms for resuscitation of children and adults and highlights the main guideline changes since 2005.2 Basic life support Dispatchers should be trained to interrogate callers with strict protocols to elicit information. The combination of unresponsiveness, absence of breathing or any abnormality of breathing should start a dispatch protocol for suspected cardiac arrest.4 Emergency Medical Services dispatchers should provide telephone instruction in chest compression-only CPR (‘telephone-CPR’).2 Chest compressions should be ‘harder and faster’ as compared to the old guidelines of 2005: a compression frequency of 100–120 per minute as well as a compression depth of 5–6 cm is appropriate in adults.4 ‘No-flow-times’ should be reduced to a minimum to provide continuous and optimal cerebral blood flow. Chest compressions are paused briefly only to enable specific interventions.4 Ventilation is important even by trained lay persons: it should be performed twice after 30 compressions, that is, a ratio of 30 : 2. ‘Compression-only CPR’ is acceptable only for lay people who cannot or are not willing to perform mouth-to-mouth or mouth-to-nose ventilation.4 The use of prompt feedback devices during CPR will enable immediate feedback to rescuers and is encouraged. The data stored in rescue equipment can be used to monitor and improve the quality of CPR performance and provide feedback to professional rescuers.4,5 Encouragement of the further development of Automatic External Defibrillator (AED) programmes – there is a need for further deployment of AEDs in both public and residential areas.2 Advanced life support Defibrillation should be performed as soon as possible if indicated in ventricular fibrillation or pulseless ventricular tachycardia. When treating out-of-hospital cardiac arrest, good-quality CPR should be provided while a defibrillator is acquired, applied and charged. Routine delivery of a specified period of CPR before defibrillation is no longer recommended (e.g. 2 or 3 min before rhythm analysis is undertaken and a shock is delivered).6 Atropine is no longer recommended for routine use in asystole or pulseless electrical activity.6 Increased emphasis is on the use of capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide an early indication of return of spontaneous circulation (ROSC).6 Cardiopulmonary resuscitation in special conditions Fibrinolysis should be considered when cardiac arrest is caused by proven or suspected acute pulmonary embolism. It should not be used routinely in cardiac arrest.2,7 ‘Lipid resuscitation’ should be used to treat local anaesthetic intoxication.7 Postresuscitation care Toxicity of oxygen is a common hazard after return of a spontaneous circulation when using high oxygen concentrations. Hyperoxia should be omitted and an oxygen saturation of 94–98% is usually appropriate.6 The use of therapeutic hypothermia is safe8 and should always be used after ROSC in comatose survivors – even in paediatric patients9 and newborn infants.10 Although its benefit is documented for shockable rhythms, it should also be used in non-shockable rhythms.6 Recognition that many of the accepted predictors of poor outcome in comatose survivors of cardiac arrest are unreliable, especially if the patient has been treated with therapeutic hypothermia.2 All these changes can further improve the outcome of patients who have suffered cardiac arrest. It will be possible to improve survival and quality of survival significantly in the future if appropriate and continuous resuscitation attempts are performed.11 This is an important key message, which should be in everyone's mind. It is our goal to provide an optimum standard of resuscitation for a better outcome of patients. Teaching and encouraging doctors, nurses and medical students as well as lay persons, including even school children may increase significantly both the number of resuscitation efforts by lay people and resuscitation quality and success in the future. Therefore, implementation of these key points in anaesthesiology training programmes is essential, especially for those in postgraduate training.12 The estimated 350 000 fatalities per year after cardiac arrest and unsuccessful resuscitation attempts in Europe is enormous and the data for the United States of America are comparable (310 000 deaths per year from cardiac arrest and resuscitation).13 Using these calculations and the estimated improvement in survival with full implementation of the new ERC guidelines 2010, an additional 100 000 lives could be saved in Europe during a single year.3 It is our responsibility to implement the new guidelines and to improve the quality of resuscitation as soon as possible. This article was checked and accepted by the editors, but was not sent for external peer-review." @default.
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