Written by Clay Smith
Spoon Feed
This is what you need to know from the annual International Liaison Committee on Resuscitation (ILCOR) update from 2024. There is a lot here but not much that actually changes my practice.
>100 pages…I am tired
So, lots of word here…but not much is practice-changing. I’m going to give you hours of your life back after wading in and pulling out the few, tiny pearls of goodness that might change your practice.
- Evidence for dispatcher-assisted CPR is sketchy. The best advice is to tell other bystanders to find an AED.
- Pocket AEDs are becoming more common, but there is not enough evidence to support or recommend against their use.
- Give 100% O2 in prehospital setting post-ROSC until a reliable SpO2 or PaO2 can be measured, then target 94-98%, with caution to avoid veiled hypoxemia in darkly pigmented patients. Other post-ROSC goals are: normocapnia (PCO2 35-45), MAP 60-65 mmHg (or SBP >10th percentile for children), and temperature ≤37.5ºC.
- If unable to get a standard airway and you’re trained, obtain front of neck access via cricothyrotomy.
- VL beats DL for advanced airway management.
- Don’t give prophylactic anticonvulsant medication to children or adults post-ROSC.
- Emphasize good bagging over advanced airways for pediatric OHCA.
- For children with pulmonary hypertension, in addition to avoiding hypoxia, hypercapnia, acidosis, stressors, agitation, dehydration, fluid overload, anemia, infection, arrhythmias, or otherwise making them cranky in any way – remember, ECMO is an option for those who are clinically worsening or peri-arrest.
- In preterm infants <37 weeks who don’t need immediate resuscitation, delay cord clamping 60 seconds. Cord milking is also an option for infants 28-37 weeks.
- Consider therapeutic hypothermia (33-34ºC) for term (>37 week) babies with evolving moderate-to-severe hypoxic-ischemic encephalopathy if in a neonatal specialty center.
How will this change my practice?
This was a massive, commendable effort by the authors. Lots has been published. But not a lot that can be combined into systematic reviews to warrant a major change in practice. That said, pocket AED use is a hot topic to watch. Post-ROSC parameters are now pretty well agreed upon. And preterm delayed cord clamping has solid evidence when feasible.
Source
2024 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. 2024 Nov 14. doi: 10.1161/CIR.0000000000001288. Epub ahead of print. PMID: 39540293.
