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New Changes to Resuscitation Guidelines

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					                                      AUSTRALIAN RESUSCITATION COUNCIL
CHAIRMAN:                                                                                                 SPONSORED BY
Assoc. Professor I G Jacobs BAppSc, DipEd, PhD, RN, FRCNA, FACAP                     Royal Australasian College of Surgeons
DEPUTY CHAIRMAN:                                                                                       Australian and New Zealand College
Dr P Morley MB BS, FRACP, FANZCA, FJFICM                                                       of Anaesthetists




                  New Changes to Resuscitation Guidelines
In March 2006, the Australian Resuscitation Council (ARC) released updated guidelines for Basic Life Support (BLS),
Advanced Life Support (ALS), Paediatric Advanced Life Support (PALS) and Neonatal Basic and Advanced Life Support
(NLS). These changes were based on an extensive evaluation of the resuscitation science by the International Liaison
Committee on Resuscitation (ILCOR). The findings of this evaluation process were published simultaneously in
November 2005 in the journals Circulation and Resuscitation.

          ILCOR Consensus on Science and Treatment Recommendations. Resuscitation 2005;67(2-3):157-341.
          ILCOR Consensus on Science and Treatment Recommendations. Circulation 2005;112(22) Supplement:III1-
          III136

The ARC Guidelines are available on the ARC website www.resus.org.au

Transition of the Guidelines
The ARC encourages the early and programmed implementation of the revised guidelines. However in doing so it is
clearly recognised that some variation in both the training and practice of resuscitation will temporarily exist. For
example, it will take time for organisations to develop updated training materials or manufacturers of Automated
External Defibrillators (AEDs) to reprogram these devices.
Accordingly the ARC strongly affirms that during this transitional period current practice should not be
considered to be either ineffective or unsafe. The new guidelines do not reflect that what we have previously
been doing is either wrong or harmful, but rather we may be able to do better. It is quite acceptable to continue to use
current training and resuscitation methods until the transition process is competed. We do however believe that the
transition to the new guidelines should be complete by the end of 2006.

Summary of Guideline Changes

In general terms
       Any attempt at resuscitation is better than no attempt.
       Interruptions to compressions should be minimised.
       Compressions should be delivered faster and push harder.
       Over ventilation should be avoided.
       A defibrillator should be attached and used as soon as possible.
                                                                       Page 1 of 3
____________________________________________________________________________
                                                    Australian Resuscitation Council Inc.
                                                    C/- Royal Australasian College of Surgeons
                                           College of Surgeons' Gardens, Spring Street, Melbourne 3000
                                          Telephone +61 3 9249 1214            Facsimile +61 3 9249 1216
                                                        e-mail: carol.carey@surgeons.org
Basic Life Support
        The compression ventilation ratio is now 30:2 (30 compressions to 2 ventilations) for infants, children and
        adults.
        The same compression / ventilation ratio applies regardless of the number of rescuers.
        The term “Rescue Breathing” has replaced the term expired air resuscitation (EAR).
        Rescue breathing is no longer a stand alone technique and is part of CPR. As the pulse check is not used to
        identify the need for chest compressions (this was previously removed in 2000), CPR – rescue breathing and
        chest compressions – are given to all victims requiring resuscitation.
        No signs of life equals: unconscious (unresponsive), not breathing normally and not moving. When there are no
        signs of life present then the rescuer should commence CPR.
        Method of finding the lower half of the sternum – The rescuer should visualise the “centre of the chest” and
        compress at that point. There is no need to measure or remeasure in order to determine the location point for
        chest compressions.
        Give two initial breaths instead of five breaths.
        Compress the chest at a rate of 100 compressions per minute.
        Ignore the number of compression / ventilation cycles per minute.
        Increased emphasis on the importance of Defibrillation as part of BLS.

Advanced Life Support
      Minimise interruptions to chest compressions.
      Give a single shock instead of stacked shocks (Single shock strategy) for ventricular fibrillation / pulseless
      ventricular tachycardia.
      Where the arrest is witnessed by a health care professional and a manual defibrillator is available, then up to
      three shocks may be given (Stacked shock strategy) at the first defibrillation attempt.
      Monophasic defibrillation – all shocks 360 joules.
      Biphasic defibrillation – Where specific devices have been identified to be efficacious at other energy levels
      these should be used if known. HOWEVER, where the health care professional is unsure of the energy level
      recommended for a specific device, a default energy level of 200J should be used without delay.
      After each defibrillation attempt give two minutes of CPR before checking rhythm and pulse.
      Increased emphasis on considering correctable causes during cardiac arrest.
Defibrillation Energy Levels
         AED: These devices should use the energy levels recommended and programmed by the manufacturer.
         MANUAL Defibrillators: A default biphasic energy level of 200J has been recommended as this falls within the
         range of published energy levels that have demonstrated efficacy for first and subsequent shocks. This is a
         consensus recommended energy level not an ideal energy level. Where specific defibrillators have
         demonstrated efficacy at other energy levels these should be used. Manufacturers should clearly identify on the
         defibrillator the recommended energy level for that particular device. Where the health care provider is unaware
         or unsure of the recommended energy level for any particular defibrillator then 200J should be used (default
         energy level).
Paediatric Advanced Life Support
       Compression ventilation ratio of 15:2 for infants and children should be used in an advanced life support
       situation (i.e. in a hospital setting)
       Give a single shock instead of stacked shocks (Single shock strategy) for ventricular fibrillation / pulseless
       ventricular tachycardia.
       Where the arrest is witnessed by a health care professional and a manual defibrillator is available, then up to
       three shocks may be given (Stacked shock strategy) at the first defibrillation attempt.
       Monophasic or biphasic defibrillation – First shock – 2J/kg, subsequent shocks – 4J/kg.
                                                                                                           Page 2 of 3
____________________________________________________________________________
                                          Australian Resuscitation Council Inc.
                                           C/- Royal Australasian College of Surgeons
                                  College of Surgeons' Gardens, Spring Street, Melbourne 3000
                                 Telephone +61 3 9249 1214            Facsimile +61 3 9249 1216
                                               e-mail: carol.carey@surgeons.org
Neonatal Advanced Life Support

    •   The neonatal section has been developed as new guidelines.

The ARC acknowledges that these guideline changes will raise a number of questions and queries in regard to
resuscitation training and practice. Accordingly the ARC is establishing a resuscitation guideline FAQ (frequently asked
questions) section on its website to assist with implementation of these guidelines.


With kind regards




Associate Professor Ian Jacobs
Chairman

27th March 2006




                                                                       Page 3 of 3
____________________________________________________________________________
                                          Australian Resuscitation Council Inc.
                                           C/- Royal Australasian College of Surgeons
                                  College of Surgeons' Gardens, Spring Street, Melbourne 3000
                                 Telephone +61 3 9249 1214            Facsimile +61 3 9249 1216
                                               e-mail: carol.carey@surgeons.org

				
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