New science, innovations, and guidelines surrounding resuscitation strategies for sudden cardiac arrest (SCA) develop at a rapid pace, and the Citizen CPR Foundation (CCPRF) is dedicated to ensuring lay rescuers and the healthcare community are kept up to date.
CCPRF was founded in 1987 with a vision to “strengthen the Chain of Survival” following sudden cardiac arrest by educating lay rescuers, dispatchers, EMTs and paramedics, emergency department personnel, and specialists in intensive care units. The foundation’s biennial Emergency Cardiovascular Care Update (ECCU) Conference transformed into the Cardiac Arrest Survival Summit and this year to simply the Citizen CPR Foundation Virtual Summit, which was held Dec. 8–9, 2020.
Robert Neumar, MD, PhD, chair of emergency medicine at the University of Michigan Medical School, opened the plenary session by presenting highlights of the 2020 resuscitation guidelines from the American Heart Association (AHA) and International Liaison Committee on Resuscitation (ILCOR) during his talk “Science and Controversies Behind the 2020 Guidelines."
ILCOR was formed in 1992 to provide a forum for liaison between principal resuscitation organizations worldwide, including AHA, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, Resuscitation Council of Asia, and many others.
ILCOR’s mission is that “how someone is treated after cardiac arrest should not depend on where it occurs,” said Neumar, cochair of ILCOR. Worldwide resuscitation experts convene into specific task forces—BLS, pediatrics, first aid, and others—to review available science and compile treatment recommendations. Their findings are published and disseminated through academic journals.
What’s new in the guidelines for 2020?
Basic Life Support (BLS):
The main focus of BLS is reducing the time to treatment via early recognition and intervention in the case of sudden cardiac arrest. Lone bystanders with a mobile phone should dial EMS and activate the speaker or hands-free function on their phones so they may immediately commence CPR with dispatcher assistance if needed.
Dispatch centers should implement a standardized approach to determine whether a patient is in cardiac arrest.
CPR should be initiated without delay in any unconscious person not breathing normally. Also, naloxone should be administered by lay rescuers in suspected cases of opioid-related respiratory or circulatory arrest.
Advanced Life Support (ALS):
The current recommendations suggest against use of a double sequential defibrillation (DSED) strategy for cardiac arrest with a shockable rhythm. More science is needed in this area, said Neumar.
IV access is recommended over IO access in the initial attempts of medication administration during adult cardiac arrest.
Recommendations suggest against the use of point-of-care echocardiography for prognostication during CPR. Recent evidence suggest it’s not a reliable strategy.
Bystanders should provide CPR with ventilation for infants and children under 18 who suffer out-of-hospital cardiac arrest.
Epinephrine should be administered as early as possible in pediatric patients with nonshockable cardiac arrest.
While chest compressions and rescue breaths may generate aerosols and lead to disease transmission, given the risk-benefit ratio, this resuscitation strategy is nonetheless recommended during the current COVID pandemic.
Following Neumar’s talk, Raina Merchant, MD, LMSHP, FAHA, assistant professor of emergency medicine at the University of Pennsylvania, stressed the unique confluence of COVID-19 and social unrest has affected millions globally and has created a “national reckoning” to respond, react, and resuscitate to save lives.
“Resuscitation science is more critical now than ever,” said Merchant, who served as chair of the AHA’s Emergency Cardiovascular Care Committee. “We have to know the data.” Trends to watch, according to Merchant, include drone-delivered AEDs and high-tech learning including CPR feedback devices, high-fidelity manikins, and gamifications. “We are at an incredibly unique time in history,” Merchant said.
Other “quick hits” from the conference:
Recent studies are challenging the long-held belief that death is inevitable after the brain is deprived of oxygen for 3–4 minutes. In fact, global cerebral metabolism can be restored multiple hours later, meaning functional survival is possible much longer than previously believed. “Death is not an event, it’s a process. It can be interrupted and reversed,” said Tom Aufderheide, MD, emergency medicine professor at the Medical College of Wisconsin. “The process of death is much longer than generally recognized. All aspects of good resuscitation practice apply now more than ever.”
The AHA recently added a sixth link to the Chain of Survival, recognizing the need for more standardized and formal medical, psychosocial, and emotional support of survivors and their rescuers. “The outcome measure most are paying attention to right now is survival to discharge,” said Katie Dainty, PhD, research chair of patient-centered outcomes at North York General Hospital in Toronto. “Hospitals slap you on the back and say, ‘Good job. Go out and live!’ We need patient-reported outcome measures (PROMs) for cardiac arrest survivors. It needs to go beyond asking clinicians how they think the patient feels.” “The most common advice given to survivors is to ‘take it easy,’” added Mary Newman, MS, executive director of the Sudden Cardiac Arrest Foundation. “Physicians are paying more attention to cardiac issues rather than psychosocial issues for survivors.”
Marcus Ong, MD, medical director for prehospital emergency care at the Ministry of Health in Singapore, explained his country’s progressive high-tech efforts in improving cardiac arrest survival rates. The country’s MyResponder app can call for help, provide a geolocation of the event, and alert nearby volunteer responders who have signed up to receive such alerts. The app is linked to a national AED database to identify the closest device and leverages the country’s existing 9-9-5 dispatch system and government mapping services. The app currently receives over 400 activations per month, Ong said. Other advancements include a "CPR card," a credit card-sized device carried by the public and rescuers that is placed on the chest during resuscitation efforts, which can monitor and capture the quality and rate of chest compressions to guide education and allow the public to be more confident during CPR. "It takes a system to save a life," said Ong.
Session recordings from the Virtual Summit 2020 will be available for 45 days following the conference. Visit citizencpr.org/virtualsummit2020-ccprf.
Jonathan Bassett, MA, NREMT, is editorial director of EMS World. Reach him at firstname.lastname@example.org.