European Resuscitation Council Guidelines for Resuscitation ... - CPR

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18 de 0ctubre de 2010 www.elsuapdetodos.com1288 R.W. Koster et al. / Resuscitation 81 (2010) 1277–1292• A lone rescuer should perform CPR for approximately 1 minbefore going for help.• Compress the chest by at least one third of its depth; use 2 fingersfor an infant under 1 year; use 1 or 2 hands for a child over 1 yearas needed to achieve an adequate depth of compression.The same modifications of 5 initial breaths and 1 min of CPRby the lone rescuer before getting help, may improve outcome forvictims of drowning. This modification should be taught only tothose who have a specific duty of care to potential drowning victims(e.g. lifeguards). Drowning is easily identified. It can be difficult, onthe other hand, for a layperson to determine whether cardiorespiratoryarrest is a direct result of trauma or intoxication. Thesevictims should, therefore, be managed according to the standardBLS protocols.Use of an automated external defibrillatorSection 3 discusses the guidelines for defibrillation using bothautomated external defibrillators (AEDs) and manual defibrillators.AEDs are safe and effective when used by laypeople, and makeit possible to defibrillate many minutes before professional helparrives. Rescuers should continue CPR with minimal interruptionof chest compressions while applying an AED and during its use.Rescuers should concentrate on following the voice prompts immediatelythey are received, in particular, resuming CPR as soon asinstructed.Standard AEDs are suitable for use in children older than 8 years.For children between 1 and 8 years paediatric pads should be used,together with an attenuator or a paediatric mode if available; ifthese are not available, the AED should be used as it is. Use of AEDsis not recommended for children
18 de 0ctubre de 2010 www.elsuapdetodos.comR.W. Koster et al. / Resuscitation 81 (2010) 1277–1292 1289The importance of immediate defibrillation, as soon as an AEDbecomes available, has always been emphasised in guidelines andduring teaching, and is considered to have a major impact onsurvival from ventricular fibrillation. This concept has been challenged,because evidence has suggested that a period of chestcompression before defibrillation may improve survival when thetime between calling for the ambulance and its arrival exceeds5 min. 140,141 Two recent clinical studies 142,143 and a recent animalstudy 144 did not confirm this survival benefit. For this reason, a prespecifiedperiod of CPR, as a routine before rhythm analysis andshock delivery, is not recommended. High-quality CPR, however,must continue while the defibrillation pads are being applied andthe defibrillator is being prepared. The importance of early deliveryof minimally interrupted chest compression is emphasised.Given the lack of convincing data either supporting or refutingthis strategy, it is reasonable for emergency medical services thathave already implemented a specified period of chest compressionbefore defibrillation to continue this practice.Voice promptsIn several places, the sequence of actions states “follow thevoice/visual prompts”. Voice prompts are usually programmable,and it is recommended that they be set in accordance with thesequence of shocks and timings for CPR given in Section 2. Theseshould include at least:Fig. 2.21. When the shock button is pressed, make sure that nobody touches thevictim. © 2010 ERC.Fig. 2.22. After the shock the AED will prompt you to start CPR. Do not wait—startCPR immediately and alternate 30 chest compressions with 2 rescue breaths. © 2010ERC.CPR before defibrillation1. a single shock only, when a shockable rhythm is detected;2. no rhythm check, or check for breathing or a pulse, after theshock;3. a voice prompt for immediate resumption of CPR after the shock(giving chest compressions in the presence of a spontaneouscirculation is not harmful);4. a period of 2 min of CPR before a next prompt to re-analyse therhythm.The shock sequence and energy levels are discussed inSection 3. 2Fully automatic AEDsHaving detected a shockable rhythm, a fully automatic AED willdeliver a shock without further input from the rescuer. One manikinstudy has shown that untrained nursing students commit fewersafety errors using a fully automatic AED rather than a (semi-)automated AED. 145 There are no human data to determine whetherthese findings can be applied to clinical use.Public access defibrillation programmesAED programmes should be actively considered for implementationin non-hospital settings. This refers to public places likeairports, 32 sport facilities, offices, in casinos 35 and on aircraft, 33where cardiac arrests are usually witnessed and trained rescuersare quickly on scene. Lay rescuer AED programmes with veryrapid response times, and uncontrolled studies using police officersas first responders, 146,147 have achieved reported survival ratesas high as 49–74%. These programmes will be successful only ifenough trained rescuers and AEDs are available.The full potential of AEDs has not yet been achieved, becausethey are mostly used in public settings, yet 60–80% of cardiac arrestsoccur at home. Public access defibrillation (PAD) and first responderAED programmes may increase the number of victims whoreceive bystander CPR and early defibrillation, thus improving survivalfrom out-of-hospital SCA. 148 Recent data from nationwidestudies in Japan and the USA 13,43 showed that when an AED wasavailable, victims were defibrillated much sooner and with a betterchance of survival. However, an AED delivered a shock in only3.7% and 5% of all VF cardiac arrests, respectively. There was a clearinverse relationship in the Japanese study between the number ofAEDs available per square km and the interval between collapseand the first shock, and a positive relationship with survival. Inboth studies, AED shocks still occurred predominantly in a publicrather than a residential setting. Dispatched first responders likewww.elsuapdetodos.com
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