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Towards the 2010 Guidelines for Resuscitation

ESC Congress 2010


The 2010 evidence-based guidelines: the process, the challenges
by Jerry Nolan (UK)


Therapeutic hypodermia after cardiac arrest
by Bernd W Boettiger (DE)


Should we use devices for chest compression?
by Sten Rubertsson (SE)


Percutaneous coronary intervention after restoration of spontaneus circulation?
by Christian Spaulding (FR)


EuReCa: monitoring resuscitation practice in Europe
by Leo L Bossaert (BE)

This year, on 18th October 2010, both the ILCOR (International Liaison Committee on Resuscitation) CoSTR document and the guidelines from the ILCOR Councils on Resuscitation will be officially released.

Dr. J.P. Nolan (Bath, GB) presented the complex process that is at the base of the revision of the scientific information, made by ILCOR, an international collaboration between important institutions from Europe (European Resuscitation Council -ERC), USA (American Heart Association – AHA), Asia and other countries in the world. A long list of structured questions has been intensively discussed and short conclusions for each issue have been drawn. At guidelines level, all these conclusions will be expanded in more detail, to guide diagnostic and therapeutic processes in the field of resuscitation.

Prof. B.W.Boettiger (Koln, DE), current chairman of ERC, addressed the very important issue of therapeutic hypothermia (TH) in patients who survived after cardiac arrest. This technique has demonstrated great advantages both in terms of survival and of neurological preservation in these patients with such a high mortality, with an impressive NNT (number needed to treat) = 6. This remarkable absolute risk reduction makes TH one of the most effective treatments in the whole field of cardiology. Unfortunately, TH is not very much diffused in the European countries and is still largely underused. New techniques have been developed, such as trans-nasal cooling, which can be directly performed during cardio-pulmonary resuscitation (CPR) in the field, with a reduction of more than three hours of the time needed to achieve adequate cooling.

Prof. S. Rubertsson (Uppsala, SE) showed new equipments (Autopulse™ and Lucas™) to perform automatic chest compression, the most important manoeuvre in CPR. Studies demonstrated that manual chest compression is rarely performed in the proper way soon after a few minutes, both as far as number of compressions per minute and depth of compression are concerned. This ineffective chest compression is strictly linked to an increased mortality. The use of these devices allows to perform effective compressions during ambulance transportation and to continue even in the cath lab during coronary angiography and PCI, while the rescuer is free to attend the patient for other needs. There are some large randomized studies addressing the clinical utility of these compression devices in CPR.

Dr. C. Spaulding (Paris, France) presented the very good results of the application of primary PCI in patients with resuscitated cardiac arrest. Many of these patients have coronary artery disease and a proportion of them have ST-elevation myocardial infarction (STEMI) on the ECG. This category is the one which takes the greatest advantages from primary PCI, even if there is an indication to perform PCI in all patients with suspected acute coronary syndrome after cardiac arrest. Whether all patients after cardiac arrest should undergo coronary angiography is still a matter of discussion.

Finally, Prof. L. Bossaert (Boechout, BE), one of the founding fathers of ERC, presented the preliminary data of the EuReCa initiative, the registry on resuscitation practice in Europe. This registry is currently restricted to 5 areas of interest in Europe and is providing some preliminary data: however, there are many difficulties in collecting a comprehensive panel of information that could yield clinically meaningful data and a deeper involvement of the National Societies and of the European Society of Cardiology is fostered to improve and expand data collection.




Towards the 2010 Guidelines for Resuscitation
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.