Recomendaciones RCP

November 21, 2017

Updated International Guidelines for Ventilation During CPR

Daniel M. Lindberg, MD reviewing Olasveengen TM et al. Resuscitation 2017 Nov 8.

This update focuses on continuous compressions versus interruptions for ventilation.

Sponsoring Organization: International Liaison Committee on Resuscitation (ILCOR)

Target Audience: Bystanders, emergency medical services (EMS) dispatchers, EMS providers, physicians who care for patients in cardiac arrest.

Background and Objective

Quality cardiopulmonary resuscitation (CPR) has become the central factor in improving outcomes of cardiac arrest. ILCOR has moved from a 5-year cycle for releasing guidelines to a continuous process of conducting systematic reviews and annual publication of recent results. These guidelines focus on the key issue of when to give ventilations during CPR.

Key Recommendations

• Dispatchers should provide instructions for compression-only CPR to bystanders calling about an adult with suspected out-of-hospital cardiac arrest (strong recommendation).

• All bystanders should provide chest compressions. Bystanders who are trained, willing, and able should give rescue breaths (30:2; weak recommendation).

• EMS providers should perform CPR with rescue breaths (30:2) or continuous chest compressions with positive pressure ventilations until a supraglottic device or endotracheal tube is established (strong recommendation).

• When a tracheal tube is in place, give positive pressure ventilations without pausing compressions (weak recommendation).

• For children, ventilation is recommended (weak recommendation), but compressions should not be withheld if bystanders are unable or unwilling to perform rescue breaths.

What's Changed

There are no major changes from the 2015 guidelines, though the strength of some recommendations (such as ventilations for children) have been weakened by recent studies that question prior results.

COMMENT

Although questions remain about the optimal role of ventilations in CPR, several things are clear: (1) Use a 30:2 ratio of compressions:ventilations when possible and appropriate; (2) don't withhold compressions if the rescuer can't or won't give rescue breaths; and (3) once an endotracheal tube is in place, don't pause to give breaths.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Daniel M. Lindberg, MD at time of publication

Royalties	UpToDate
Grant/Research Support	Colorado Traumatic Brain Injury Trust Fund; Eunice Kennedy Shriver National Institute of Child Health and Human Development
Editorial Boards	The Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal

CITATION(S):

Olasveengen TM et al. 2017 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Resuscitation 2017 Nov 8; [e-pub]. (http://dx.doi.org/10.1016/j.resuscitation.2017.10.021)

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.