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Monday, November 5, 2018

American Heart Association publishes updated CPR, ECC guidelines

The American Heart Association announced on Monday updated guidelines for CPR and Emergency Cardiovascular Care (ECC).

The 2018 AHA Focused Updates on Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) were published in cooperation with the International Liaison Committee on Resuscitation. They include the following:

• Amiodarone or lidocaine may be considered for ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) that is unresponsive to defibrillation. These drugs may be particularly useful for patients with witnessed arrest, for whom time to drug administration may be shorter.

• Lidocaine has been added to the ACLS Cardiac Arrest Algorithm and the ACLS Cardiac Arrest Circular Algorithm for treatment of shock-refractory VF/pVT.

• The routine use of magnesium for cardiac arrest is not recommended in adult patients. Magnesium may be considered for torsades de pointes (i.e. polymorphic VT associated with long QT interval).

• There is insufficient evidence to support or refute the routine use of a beta blocker early (within the first hour) after return of spontaneous circulation (ROSC).

• There is insufficient evidence to support or refute the routine use of lidocaine early (within the first hour) after ROSC. In the absence of contraindications, the prophylactic use of lidocaine may be considered in specific circumstances (such as during emergency medical services transport) when treatment of recurrent VF/pVT might prove to be challenging.

• While there are no changes to the depiction of sequences and therapies from the 2015 PALS algorithm, some minor edits have been made to the PALS Cardiac Arrest Algorithm in 2018 to be consistent with language in the ACLS Cardiac Arrest Algorithm.

There were no product changes and no new materials required as part of the updates, but the AHA offered the following guidance for training ACLS and PALS providers.

• Instructors may allow students to practice using either amiodarone or lidocaine during CPR in ACLS, ACLS EP, and PALS courses, consistent with the student's local protocol.

• For testing purposes, AHA Instructors will continue to use the ACLS and PALS Skills Testing Checklists and the Skills Testing Critical Skills Descriptors.

The AHA and ILCOR said last year it would begin updating AHA guidelines for CPR and ECC annually. Before 2017, the guidelines had been updated every 5 years.

Click here to view the updated guidelines in full.