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• W2910041110 abstract "The 2010 international evidence evaluation process addressed many questions related to the performance of basic life support. These have been grouped into the following categories: (1) epidemiology and recognition of cardiac arrest, (2) chest compressions, (3) airway and ventilation, (4) compression–ventilation sequence, (5) special circumstances, (6) emergency medical services (EMS) system, and (7) risks to the victim. Defibrillation is discussed separately in Part 6 because it is both a basic and an advanced life support skill. In the following summary, each question specific to the population, intervention, control group, and outcome (PICO Question) is listed with the consensus on science and treatment recommendation. There have been several important advances in the science of resuscitation since the last ILCOR review in 2005. Not all topics reviewed in 2005 were reviewed in 2010. When evaluating the published science, evidence reviewers considered studies with adult and paediatric victims of cardiac arrest published or accepted for publication in peer-reviewed journals. However, the treatment recommendations in this chapter generally are limited to treatment of adult victims of cardiac arrest. Please see Part 10: “Paediatric Basic and Advanced Life Support” for information on basic life support for paediatric cardiac arrest victims. The following is a summary of the most important evidence-based recommendations for the performance of basic life support in adults:•Rescuers should begin CPR if the victim is unresponsive and not breathing (ignoring occasional gasps). Gasping should not prevent initiation of CPR because gasping is not normal breathing, and gasping is a sign of cardiac arrest.•Following initial assessment, rescuers may begin CPR with chest compressions rather than opening the airway and delivering rescue breathing.•All rescuers, trained or not, should provide chest compressions to victims of cardiac arrest.•A strong emphasis on delivering high-quality chest compressions remains essential: rescuers should push hard to a depth of at least 2 in. (or 5 cm) at a rate of at least 100 compressions per minute, allow full chest recoil, and minimise interruptions in chest compressions.•Rescuers trained to provide ventilations use a compression–ventilation ratio of 30:2.•For untrained rescuers, EMS dispatchers should provide telephone instruction in chest compression-only CPR. Many millions of people die prematurely every year from sudden cardiac arrest (SCA) worldwide, often associated with coronary heart disease. The following section summarises the burden, risk factors, and potential interventions to reduce the risk (Table 1).Table 1Global incidence of cardiac arrest per 100,000 population.Incidence definition (number of studies)All ages includedAdult onlyMean(SD)Mean(SD)Incidence of out-of-hospital cardiac arrest (n = 5)82.9(21.4)213.1(177)Incidence of patients considered for CPR (n = 34)76.3(35.7)95.9(30.5)Incidence of arrest with CPR initiated (n = 55)41.5(18.4)64.2(19.9)Incidence of arrest with CPR initiated, cardiac cause (n = 87)40.5(17.1)61.8(37.7)Adjusted incidence of arrest with CPR initiated, cardiac cause (n = 14)56.6(13.7)84.7(58.8)Percentage of cases with CPR initiated (n = 43)72.3(20.4)68.9(25.6)Percentage of cases with cardiac aetiology (n = 48)71.8(12.4)72.0(11.8) Open table in a new tab Download .pdf (.23 MB) Help with pdf files BLS-014B What is the incidence, prevalence, and aetiology of cardiopulmonary arrest in-hospital and out-of-hospital? Measuring the global incidence of cardiac arrest is challenging, because there are many different definitions of patient populations. The Table lists the average crude incidence per 100,000 population reported for adult cases of cardiac arrest and cases of all ages (children and adults). The number of studies included is shown for each category.1Cheung W. Flynn M. Thanakrishnan G. Milliss D.M. Fugaccia E. Survival after out-of-hospital cardiac arrest in Sydney, Australia.Crit Care Resusc. 2006; 8: 321-327PubMed Google Scholar, 2Dunne R.B. Compton S. Zalenski R.J. Swor R. Welch R. Bock B.F. Outcomes from out-of-hospital cardiac arrest in Detroit.Resuscitation. 2007; 72: 59-65Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 3Eckstein M. Stratton S.J. Chan L.S. Cardiac arrest resuscitation evaluation in Los Angeles: CARE-LA.Ann Emerg Med. 2005; 45: 504-509Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar, 4Estner H.L. Gunzel C. Ndrepepa G. et al.Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style.Am Heart J. 2007; 153: 792-799Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 5Fairbanks R.J. Shah M.N. Lerner E.B. Ilangovan K. Pennington E.C. Schneider S.M. Epidemiology and outcomes of out-of-hospital cardiac arrest in Rochester, New York.Resuscitation. 2007; 72: 415-424Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 6Garza A.G. Gratton M.C. Salomone J.A. Lindholm D. McElroy J. Archer R. Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest.Circulation. 2009; 119: 2597-2605Crossref PubMed Scopus (69) Google Scholar, 7Hollenberg J. Herlitz J. Lindqvist J. et al.Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew – witnessed cases and bystander cardiopulmonary resuscitation.Circulation. 2008; 118: 389-396Crossref PubMed Scopus (84) Google Scholar, 8Iwami T. Kawamura T. Hiraide A. et al.Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest.Circulation. 2007; 116: 2900-2907Crossref PubMed Scopus (160) Google Scholar, 9Jennings P.A. Cameron P. Walker T. Bernard S. Smith K. Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes.Med J Aust. 2006; 185: 135-139PubMed Google Scholar, 10Kamarainen A. Virkkunen I. Yli-Hankala A. Silfvast T. Presumed futility in paramedic-treated out-of-hospital cardiac arrest: an Utstein style analysis in Tampere, Finland.Resuscitation. 2007; 75: 235-243Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 11Kette F. Pellis T. Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy.Resuscitation. 2007; 72: 52-58Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 12Moore M.J. Glover B.M. McCann C.J. et al.Demographic and temporal trends in out of hospital sudden cardiac death in Belfast.Heart. 2006; 92: 311-315Crossref PubMed Scopus (22) Google Scholar, 13Nichol G. Thomas E. Callaway C.W. et al.Regional variation in out-of-hospital cardiac arrest incidence and outcome.J Am Med Assoc. 2008; 300: 1423-1431Crossref PubMed Scopus (494) Google Scholar, 14Olasveengen T.M. Vik E. Kuzovlev A. Sunde K. Effect of implementation of new resuscitation guidelines on quality of cardiopulmonary resuscitation and survival.Resuscitation. 2009; 80: 407-411Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 15Ong M.E. Ng F.S. Anushia P. et al.Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore.Resuscitation. 2008; 78: 119-126Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 16Pleskot M. Babu A. Kajzr J. et al.Characteristics and short-term survival of individuals with out-of-hospital cardiac arrests in the East Bohemian region.Resuscitation. 2006; 68: 209-220Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 17Polentini M.S. Pirrallo R.G. McGill W. The changing incidence of ventricular fibrillation in Milwaukee, Wisconsin (1992–2002).Prehosp Emerg Care. 2006; 10: 52-60Crossref PubMed Scopus (36) Google Scholar, 18Sasson C. Rogers M.A. Dahl J. Kellermann A.L. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81Crossref PubMed Scopus (181) Google Scholar, 19Shiraki T. Osawa K. Suzuki H. et al.Incidence and outcomes of out-of-hospital cardiac arrest in the eastern part of Yamaguchi prefecture.Int Heart J. 2009; 50: 489-500Crossref PubMed Scopus (8) Google Scholar, 20Sipria A. Novak V. Veber A. Popov A. Reinhard V. Slavin G. Out-of-hospital resuscitation in Estonia: a bystander-witnessed sudden cardiac arrest.Eur J Emerg Med. 2006; 13: 14-20Crossref PubMed Scopus (8) Google Scholar, 21Steinmetz J. Barnung S. Nielsen S.L. Risom M. Rasmussen L.S. Improved survival after an out-of-hospital cardiac arrest using new guidelines.Acta Anaesthesiol Scand. 2008; 52: 908-913Crossref PubMed Scopus (51) Google Scholar, 22Woodall J. McCarthy M. Johnston T. Tippett V. Bonham R. Impact of advanced cardiac life support-skilled paramedics on survival from out-of-hospital cardiac arrest in a statewide emergency medical service.Emerg Med J. 2007; 24: 134-138Crossref PubMed Scopus (17) Google Scholar There are no significant differences in the incidence of out-of-hospital cardiac arrest (OHCA) or the incidence of patients in whom resuscitation was attempted with all causes of arrest when comparing Europe, North America, Asia, and Australia. The incidence of patients with OHCA considered for resuscitation is lower in Asia (55 per year per 100,000 population) than in Europe (86), North America (94), and Australia (113). The incidence of patients in OHCA with presumed cardiac cause in whom resuscitation was attempted is higher in North America (58 per year per 100,000 population) than in the other three continents (35 in Europe, 32 in Asia, and 44 in Australia). For in-hospital cardiac arrest, there are more limited incidence data.23Hillman K. Chen J. Cretikos M. et al.Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial.Lancet. 2005; 365: 2091-2097Abstract Full Text Full Text PDF PubMed Scopus (502) Google Scholar Early recognition is a key step in the initiation of early treatment of cardiac arrest and relies on using the most accurate method of determining cardiac arrest. Download .pdf (.26 MB) Help with pdf files BLS-003A Download .pdf (.1 MB) Help with pdf files BLS-003B In adults and children who are unresponsive (out-of-hospital and in-hospital), are there any specific factors (or clinical decision rules) as opposed to standard assessment that increase the likelihood of diagnosing cardiac arrest (as opposed to non-arrest conditions, such as post-seizure, hypoglycaemia or intoxication)? There are no studies assessing the accuracy of checking the pulse to detect human cardiac arrest. There have been 9 LOE D5 studies demonstrating that both lay rescuers24Bahr J. Klingler H. Panzer W. Rode H. Kettler D. Skills of lay people in checking the carotid pulse.Resuscitation. 1997; 35: 23-26Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar, 25Brennan R.T. Braslow A. Skill mastery in public CPR classes.Am J Emerg Med. 1998; 16: 653-657Abstract Full Text PDF PubMed Google Scholar, 26Chamberlain D. Smith A. Woollard M. et al.Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.Resuscitation. 2002; 53: 179-187Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar and healthcare providers27Eberle B. Dick W.F. Schneider T. Wisser G. Doetsch S. Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.Resuscitation. 1996; 33: 107-116Abstract Full Text PDF PubMed Scopus (198) Google Scholar, 28Lapostolle F. Le Toumelin P. Agostinucci J.M. Catineau J. Adnet F. Basic cardiac life support providers checking the carotid pulse: performance, degree of conviction, and influencing factors.Acad Emerg Med. 2004; 11: 878-880Crossref PubMed Google Scholar, 29Liberman M. Lavoie A. Mulder D. Sampalis J. Cardiopulmonary resuscitation: errors made by pre-hospital emergency medical personnel.Resuscitation. 1999; 42: 47-55Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 30Moule P. Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions.Resuscitation. 2000; 44: 195-201Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 31Nyman J. Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students.Resuscitation. 2000; 47: 179-184Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 32Tibballs J. Russell P. Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest.Resuscitation. 2009; 80: 61-64Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar have difficulty mastering the pulse check and remembering how to perform it. Three LOE D5 studies support the ability of healthcare providers to perform the pulse check; two evaluated the direct ear-to-chest method in infants,33Inagawa G. Morimura N. Miwa T. Okuda K. Hirata M. Hiroki K. A comparison of five techniques for detecting cardiac activity in infants.Paediatr Anaesth. 2003; 13: 141-146Crossref PubMed Scopus (26) Google Scholar, 34Sarti A. Savron F. Casotto V. Cuttini M. Heartbeat assessment in infants: a comparison of four clinical methods.Pediatr Crit Care Med. 2005; 6: 212-215Crossref PubMed Scopus (17) Google Scholar and the third supported an alternative technique for the carotid pulse check when tested by dental students on healthy volunteers.35Graham C.A. Lewis N.F. Evaluation of a new method for the carotid pulse check in cardiopulmonary resuscitation.Resuscitation. 2002; 53: 37-40Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar In 1 LOE D5 study,36Albarran J.W. Moule P. Gilchrist M. Soar J. Comparison of sequential and simultaneous breathing and pulse check by healthcare professionals during simulated scenarios.Resuscitation. 2006; 68: 243-249Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar the technique of simultaneous pulse check and breathing check by professional rescuers increased the diagnostic accuracy. Two LOE D5 studies32Tibballs J. Russell P. Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest.Resuscitation. 2009; 80: 61-64Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 37Tibballs J. Weeranatna C. The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation.Resuscitation. 2010; 81: 671-675Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar conducted in infants and children with nonpulsatile circulation during extracorporeal membrane oxygenation (ECMO) demonstrated that doctors and nurses in a paediatric tertiary care institution, when blinded to whether the child was receiving ECMO support or not, commonly assessed pulse status inaccurately and often took longer than 10 s. In these paediatric studies, healthcare professionals were able to accurately detect a pulse by palpation only 80% of the time. They mistakenly perceived a pulse when it was nonexistent 14–24% of the time and failed to detect a pulse when present in 21–36% of the assessments. Although some of the children in this study were pulseless, all children had circulation (i.e., none were in cardiac arrest), so other signs typically associated with pulseless arrest (delayed capillary refill, poor color) were absent in this population. Several studies have shown that lay rescuers do not easily master the techniques of breathing assessment, and they are often unable to recognise agonal gasps (LOE D525Brennan R.T. Braslow A. Skill mastery in public CPR classes.Am J Emerg Med. 1998; 16: 653-657Abstract Full Text PDF PubMed Google Scholar, 26Chamberlain D. Smith A. Woollard M. et al.Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.Resuscitation. 2002; 53: 179-187Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar, 38Perkins G.D. Stephenson B. Hulme J. Monsieurs K.G. Birmingham assessment of breathing study (BABS).Resuscitation. 2005; 64: 109-113Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 39Ruppert M. Reith M.W. Widmann J.H. 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; 34: 720-729Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar). There is a high incidence of agonal gasps after cardiac arrest (LOE D440Bang A. Herlitz J. Martinell S. Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.Resuscitation. 2003; 56: 25-34Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 41Bohm K. Rosenqvist M. Hollenberg J. Biber B. Engerstrom L. Svensson L. Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system.Eur J Emerg Med. 2007; 14: 256-259Crossref PubMed Scopus (22) Google Scholar, 42Bobrow B.J. Zuercher M. Ewy G.A. et al.Gasping during cardiac arrest in humans is frequent and associated with improved survival.Circulation. 2008; 118: 2550-2554Crossref PubMed Scopus (67) Google Scholar, 43Vaillancourt C. Verma A. Trickett J. et al.Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions.Acad Emerg Med. 2007; 14: 877-883Crossref PubMed Scopus (0) Google Scholar), and EMS dispatchers have difficulty in diagnosing agonal gasping.40Bang A. Herlitz J. Martinell S. Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.Resuscitation. 2003; 56: 25-34Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Several strategies for teaching students how to differentiate agonal gasps from normal breathing have been evaluated. In one LOE D5 study,44Perkins G.D. Walker G. Christensen K. Hulme J. Monsieurs K.G. Teaching recognition of agonal breathing improves accuracy of diagnosing cardiac arrest.Resuscitation. 2006; 70: 432-437Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar teaching recognition of agonal gasps using a video clip improved the accuracy of lay rescuers in recognizing cardiac arrest. Another study (LOE D545Clawson J. Olola C. Scott G. Heward A. Patterson B. Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing.Resuscitation. 2008; 79: 257-264Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar) demonstrated that detection of true cardiac arrest cases improved after introduction of the question “Is he breathing regularly?” in a seizure complaint question sequence used by EMS dispatchers. In the past, students were taught to recognise cardiac arrest by looking for the absence of signs of circulation, such as movement. No studies were found that measured the sensitivity and specificity of that approach for diagnosing cardiac arrest. An LOE D4 study46Hauff S.R. Rea T.D. Culley L.L. Kerry F. Becker L. Eisenberg M.S. Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation.Ann Emerg Med. 2003; 42: 731-737Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar showed that CPR guidance by EMS dispatchers was impeded by callers mentioning “signs of life.” It is reasonable that lay rescuers and healthcare professionals use the combination of unresponsiveness and absent or abnormal breathing to identify cardiac arrest. Palpation of the pulse as the sole indicator of the presence or absence of cardiac arrest is unreliable. Agonal gasps are common during cardiac arrest and should not be considered normal breathing. The general public and EMS dispatchers should be taught how to recognise agonal gasps as a sign of cardiac arrest. Download .pdf (.05 MB) Help with pdf files BLS-050A Download .pdf (.07 MB) Help with pdf files BLS-050B In adults and children with presumed cardiac arrest (out-of-hospital and in-hospital), are there any factors/characteristics that increase the likelihood of differentiating between an SCA (i.e., VF or pulseless ventricular tachycardia [VT]) and other etiologies (e.g., drowning, acute airway obstruction)? In 1 registry study (LOE 247Herlitz J. Svensson L. Engdahl J. et al.Characteristics of cardiac arrest and resuscitation by age group: an analysis from the Swedish Cardiac Arrest Registry.Am J Emerg Med. 2007; 25: 1025-1031Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar), cardiac arrest was more likely to be due to a cardiac cause in victims above the age of 35 years and to a noncardiac cause up to the age of 35 years. Two other registry studies (LOE 348Engdahl J. Bang A. Karlson B.W. Lindqvist J. Herlitz J. Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology.Resuscitation. 2003; 57: 33-41Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 49Weston C.F. Jones S.D. Wilson R.J. Outcome of out-of-hospital cardiorespiratory arrest in south Glamorgan.Resuscitation. 1997; 34: 227-233Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar) do not demonstrate diagnostically useful cut-off ages. An additional registry study (LOE 250Ong M.E. Stiell I. Osmond M.H. et al.Etiology of pediatric out-of-hospital cardiac arrest by coroner's diagnosis.Resuscitation. 2006; 68: 335-342Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar) demonstrated that 83% of cardiac arrests under the age of 19 years are of noncardiac origin. One prospective study (LOE 251Kuisma M. Alaspaa A. Out-of-hospital cardiac arrests of non-cardiac origin: epidemiology and outcome.Eur Heart J. 1997; 18: 1122-1128Crossref PubMed Google Scholar) and 1 retrospective study (LOE 352Kurkciyan I. Meron G. Behringer W. et al.Accuracy and impact of presumed cause in patients with cardiac arrest.Circulation. 1998; 98: 766-771Crossref PubMed Google Scholar) showed that identification of the cause of cardiac arrest by healthcare providers can be inaccurate, leading to an underestimation of noncardiac aetiology cardiac arrest, in particular, failure to diagnose exsanguination. Additional studies in children are summarised in Part 10: “Paediatric Basic and Advanced Life Support.” For lay rescuers there is insufficient evidence to recommend any diagnostically reliable method to differentiate SCA of cardiac origin from one of noncardiac origin. Except in cases of obvious external causes of cardiac arrest (e.g., gunshot wound, drowning), professional rescuers should rely on rhythm analysis from cardiac monitors or AEDs and other diagnostic tests to determine the cause of cardiac arrest. Download .pdf (.09 MB) Help with pdf files BLS-008B In adults and children with cardiac arrest (out-of-hospital and in-hospital), does the interruption of CPR to check circulation, as opposed to no interruption of CPR, improve outcome (e.g., ROSC, survival)? A study in manikins (LOE D529Liberman M. Lavoie A. Mulder D. Sampalis J. Cardiopulmonary resuscitation: errors made by pre-hospital emergency medical personnel.Resuscitation. 1999; 42: 47-55Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar) confirmed a low ability (<50%) of EMS providers to correctly identify the presence of a carotid pulse as an indication to stop further chest compressions. A palpable pulse is usually absent immediately after defibrillation during OHCA (LOE 553van Alem A.P. Sanou B.T. Koster R.W. Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in out-of-hospital cardiac arrest.Ann Emerg Med. 2003; 42: 449-457Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 54Rea T.D. Shah S. Kudenchuk P.J. Copass M.K. Cobb L.A. Automated external defibrillators: to what extent does the algorithm delay CPR?.Ann Emerg Med. 2005; 46: 132-141Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar). AED algorithms that recommend that rescuers check for a pulse immediately after a shock delivery are not useful and will lead to delay in resumption of chest compressions following shock delivery (LOE 553van Alem A.P. Sanou B.T. Koster R.W. Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in out-of-hospital cardiac arrest.Ann Emerg Med. 2003; 42: 449-457Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 54Rea T.D. Shah S. Kudenchuk P.J. Copass M.K. Cobb L.A. Automated external defibrillators: to what extent does the algorithm delay CPR?.Ann Emerg Med. 2005; 46: 132-141Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 55Rea T.D. Helbock M. Perry S. et al.Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest: survival implications of guideline changes.Circulation. 2006; 114: 2760-2765Crossref PubMed Scopus (144) Google Scholar). Three LOE D5 studies show that measurement of thoracic impedance through the AED electrode pads may be an indicator of return of circulation.56Cromie N.A. Allen J.D. Turner C. Anderson J.M. Adgey A.A. The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies.Crit Care Med. 2008; 36: 1578-1584Crossref PubMed Scopus (7) Google Scholar, 57Risdal M. Aase S.O. Kramer-Johansen J. Eftestol T. Automatic identification of return of spontaneous circulation during cardiopulmonary resuscitation.IEEE Trans Biomed Eng. 2008; 55: 60-68Crossref PubMed Scopus (10) Google Scholar, 58Losert H. Risdal M. Sterz F. et al.Thoracic-impedance changes measured via defibrillator pads can monitor signs of circulation.Resuscitation. 2007; 73: 221-228Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar One LOE D5 study in adults27Eberle B. Dick W.F. Schneider T. Wisser G. Doetsch S. Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.Resuscitation. 1996; 33: 107-116Abstract Full Text PDF PubMed Scopus (198) Google Scholar and two LOE D5 studies in children with nonpulsatile circulation32Tibballs J. Russell P. Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest.Resuscitation. 2009; 80: 61-64Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 37Tibballs J. Weeranatna C. The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation.Resuscitation. 2010; 81: 671-675Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar showed that blinded healthcare providers commonly made inaccurate assessments of the presence or absence of a pulse and often took much longer than 10 s. Another study (LOE D559Mather C. O’Kelly S. The palpation of pulses.Anaesthesia. 1996; 51: 189-191Crossref PubMed Scopus (74) Google Scholar) showed that accurately determining the presence of a pulse took more than 10 s in 95% of cases. For lay rescuers, interrupting chest compressions to perform a pulse check is not recommended. For healthcare professionals, it is reasonable to check a pulse if an organised rhythm is visible on the monitor at the next rhythm check. How accurately do rescuers identify cardiac arrest outside of the hospital? Is advanced technology useful to assist with diagnosing cardiac arrest? Which specific factors improve diagnostic accuracy? What is the accuracy of the pulse check performed by healthcare professionals in cardiac arrest patients? Is there an association between the time required to successfully detect a suspected cardiac arrest victim's pulse and resuscitation outcome? Is there a difference in outcome when the decision to start CPR is based on the absence of consciousness and normal breathing as opposed to absence of a pulse? Several components of chest compressions can alter effectiveness: hand position, position of the rescuer, position of the victim, and depth and rate of" @default.
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• W2910041110 title "Part 5: Adult basic life support" @default.
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