06 Sep 2006

Guidelines for resuscitation

Dr. Alessandro Capucci

Session number: 720000
Session title: Guidelines for resuscitation: from guidelines to practice Clinical Seminar - The European Society of Cardiology and the European Resuscitation Council
Authors: Capucci, A. Piacenza, Italy

Sudden cardiac death is still a matter of debate due to the poor out-of-hospital survival even in patients with VF. The new 2005 Guidelines did modify some important points, mainly as a consequence of the results of 2 prospective randomised studies published in the last years (PAD and Arrest trials).

Good quality chest compression may save lifes

Bernd Boettiger from Heidelberg distinguished:
1) a condition where the resuscitation intervention takes place for longer than 5 minutes when CPR (2 minutes) has to precede defibrillation;
2) in a witnessed cardiac arrest and in intrahospital cardiac arrest the immediate defibrillation is still the first choice.

Chest compression is therefore the main issue of a prompt reanimation and - as outlined also by Dr. Mary Hazinski from Nashville in pediatric patients - even a few seconds of its interruption can be followed by deterioration of the cerebral perfusion. This justifies a compression ventilation rate of 30:2. In a recent controlled trial (TROICA), drugs like trombolitic did not show any significant effect on survival. Vasopressin is similar to adrenaline and AAD employment is actually referred to as Amiodarone only.

In pediatric (< 18 y.o.) patients we have to distinguish a diagnosis of primary VF where prompt defibrillation is always the main value from conditions such as trauma, overdose, airway obstruction, newly born where the focus is on ventilation plus chest compression. In pediatric patients compression has to be done correctly at the centre of the chest with only minimal interruption. Dennis Cokkinos reported in the issue of intrahospital cardiac arrest a very poor discharge percentage of alive people (14%) when the cardiac arrest happens in general hospitals. Conclusion An organized devoted team composed of medical personnel, nurses and on technicians did improve survival up to 47% in the speaker experience.
Leo Bossaert finally pointed out a certain decrease of the cardiac arrest as a % in Europe such as resulted by data from an European survey (total cardiac arrests 0.4/%/1000 persons per year and 0.2/%/1000 persons per year of ventricular fibrillation). Data coming from several studies did show the importance of bystander CPR making the difference together with early shocks. The time counts for saving lives. To reach that goal we have not only to distribute the defibrillators in the many populated places but also to favour a continuous training for the devoted personnel and first responders. CPR is certainly back to a very important place in the new guidelines but we have to remember that chest compression to be effective must be of good quality.

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