Wednesday, October 27, 2010

Key Changes: 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care

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Key Changes: 2010 AHA Guidelines for CPR and Emergency Cardiovascular Care

  • Atropine is no longer recommended for routine use in the management of PEA/asystole. For symptomatic or unstable bradycardia, IV infusion of chronotropic agents is now recommended as an equally effective alternative to external pacing when atropine is ineffective.

  • Adenosine is recommended in the initial diagnosis and treatment of stable, undifferentiated regular, monomorphic wide complex tachycardia. (Editor’s note: Clinicians should be aware that adenosine should be used with significant caution in the setting of WCT in certain patients. Click Here for a previous EMedHome Clinical Pearl on this topic)

  • The BLS sequence of steps for trained rescuers has changed from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (excluding newborns).
  • Continuous quantitative waveform capnography is now recommended for intubated patients throughout the peri-arrest period - it is the most reliable method of confirming and monitoring correct ETT placement. Capnography can also serve as a monitor of the effectiveness of chest compressions and to detect ROSC.
  • Suctioning immediately after birth should be reserved for babies who have an obvious obstruction to spontaneous breathing or require positive pressure ventilation. There is no evidence that active babies benefit from airway suctioning, even in the presence of meconium, and there is evidence of risk associated with this suctioning. The available evidence does not support or refute the routine endotracheal suctioning of depressed infants born through meconium stained amniotic fluid.
  • There is increasing evidence of benefit of delaying cord clamping for at least 1 minute in term and preterm infants not requiring resuscitation.

Reference: Circulation, Vol. 122, Issue 18, Supp 3; November 2, 2010.

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