Written by Jason Lesnick
Here are the latest evidence updates on basic, advanced, and pediatric life support – and more – from this expert literature review.
Why does this matter?
Cardiac arrest is a multifaceted problem, and we’re constantly trying to improve outcomes in these patients. Treatment recommendations based on recent literature reviewed by experts can be a helpful way to stay up to date with such a broad topic. Here are key take home points.
But did you try a precordial thump? Just kidding, please don’t.
This annual publication reviewed over 400 publications and addressed 60 topics broken down by Basic Life Support (LS), Advanced LS, Pediatric LS, Neonatal LS, Education Implementation and Teams, and First Aid. I will highlight some of the most EM-relevant topics, but it’s worth a look to see if there’s anything else you might need to know.
Most recommendations made were weak to very weak and based on low to very low certainty evidence.
One interesting recommendation was that CPR be done on scene rather than using ambulance transport, unless an appropriate indication exists such as ECMO (weak recommendation with very low certainty evidence). This recommendation stemmed mainly from associations with decreased CPR quality, increased risk to providers with CPR performed during transport, and a single study that found lower survival among transported patients (though there was considerable risk of confounding).
The authors made a strong recommendation against the use of a precordial thump for cardiac arrest (very low certainty evidence).
There is a weak recommendation for actively preventing fever by targeting a temperature to ≤37.5℃ for patients who remain comatose after ROSC (low certainty evidence) based on 6 RCTs comparing hypothermia with normothermia or fever prevention.
Something many of us EM folks use often – POCUS – had a weak recommendation against routine use during CPR based on very low certainty evidence, but they suggest it may be considered as an additional diagnostic tool when clinical suspicion for a specific reversible cause is present (weak recommendation, very low certainty evidence).
There were weak recommendations against the use of vasopressin and steroids in addition to usual care for adult in-hospital cardiac arrest (low to moderate certainty evidence) and out-of-hospital cardiac arrest (very low to low certainty evidence).
Overall, this document contains some massive efforts from the authors covering relevant recent cardiac arrest literature.
2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022 Nov 3. doi: 10.1161/CIR.0000000000001095. Online ahead of print.