On October 15, the new American Heart Association Guidelines for CPR and ECG will be published. Then we will get the answers to the big questions many of us have wondered about?
1. Has epinephrine in cardiac arrest seen its last days?
2. Should paramedics continue to intubate cardiac arrest patients?
3. Will traditional CPR be abandoned for cardiocerebral Resuscitation (CCR)?
Yesterday, the ILCOR Scientific Evidence Evaluation and Review System, in conjunction with the American Heart Association, published draft statements for public comment that shed light on the likely direction of at least some of these and other care questions.
The statements are available for public comment at the following link:
ILCOR Scientific Evidence Evaluation and Review System
Curiously the statements open for public comment do not seem to cover the full gamut of issues. There is only one statement on stroke care and no statement on continuous cardiac compressions (CCR).
Here are the answers to two of the above questions:
Epi in cardiac arrest
Full Question:
Among adults who are in cardiac arrest in any setting (P), does does use of epinephrine (I), compared with placebo or not using epinephrine (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC (O)?
Treatment Recommendation
Given the observed benefit in short term outcomes, we suggest Standard Dose Epinephrine be administered to patients in cardiac arrest.(weak recommendation, low quality)
Values and Preferences Statement:
In making this statement, we place value on the short-term outcomes of ROSC and survival to admission, and our uncertainty about the absolute effect on survival and neurological outcome.
Intubation
Full Question:
Among adults who are in cardiac arrest in any setting (P), does tracheal tube insertion as first advanced airway (I), compared with insertion of a supraglottic airway as first advanced airway (C), change ROSC, CPR parameters, development of aspiration pneumonia, Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Treatment Recommendation:
We suggest using either a supraglottic airway or tracheal tube as the initial advanced airway management during CPR (weak recommendation, very low quality evidence) for out of hospital cardiac arrest.
Perhaps the most fascinating part about the draft statements is in the First Aid section, which includes the following statement on spinal restriction:
Full Question:
Among adults and children with suspected traumatic cervical spinal injury (P), does spinal motion restriction (I), compared with no spinal motion restriction (C), change neurological injury, complications, overall mortality, pain, patient comfort, movement of the spine, hospital length of stay (O)?
Treatment Recommendation:
We suggest against spinal motion restriction, defined as the reduction of or limitation of cervical spinal movement, by routine application of a cervical collar or bilateral sandbags (joined with 3-inch-wide cloth tape across the forehead) in comparison to no cervical spine restriction in adults and children with blunt suspected traumatic cervical spinal injury (weak recommendation, very low quality of evidence).
Values and preferences statement: Because of proven adverse effects in studies with injured patients, and evidence concerning a decrease in head movement only comes from studies with cadavers or healthy volunteers, benefits do not outweigh harms, and routine application of cervical collars is not recommended.
Let me repeat that. They are recommending against the routine application of cervical collars in patients with suspected spinal injuries.
Here in Connecticut, we have basically banned the use of back boards for anything but movement and extrication, but we still apply collars (despite lack of evidence of collar’s utility). Perhaps this statements will convince the rest of the world to end the unproven practice of spinal immobilization once and for all.
Please check this link out, and keep in mind these are draft statements only and they are seeking and will listen to public comment. This is a great and open process that we should participate in.
