2015 CPR/ECC Update

Preamble: Blair Bigham, MD, MSc, ACPf

Coauthors of the infographic: Teresa Chan, MD, BEd, Sarah Luckett-Gatopoulos, MD, MSc, Brent Thoma, MD, MA, & Blair Bigham, MD, MSc, ACPf

Download a pdf of the infographic here.

Full guidelines at https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/

It’s the quintessential 9-1-1 call: Someone has collapsed, isn’t breathing, and has no pulse. Alarms ring, and we scramble to our ambulances, fire trucks and zoom cars. We hope that this call, unlike the others, will be the one we get back. Our heart rates accelerate and our minds rush. We think about all of the variables within our control: drug dosages, airway adjuncts, defibrillation. We chat about who will do what, and when it will be done. We try to bring order to the chaos that undoubtedly will ensue. Just as quickly as it all started, it will end; the end of an algorithm, the time on our watch, or a rote phone call. We will turn off the monitors, shut off the oxygen, and turn to face the family.

I can easily recall each resuscitation I’ve terminated. The memory is not always vivid, but each pronouncement is there, very real to me still. The “failed” codes I have run are many, and have often made me question why we bother to resuscitate those whose hearts have stopped. I can list the causes and describe the pathology. Like a mechanic who declares a car has driven its last mile, I know when the human body has given up. Still, the alarms go off and I don’t sink down in despair; I jump with excitement. This code could be the one! Even when we get that precious return of spontaneous circulation, we can’t help but wonder if our actions have been wise. Will our efforts result in a waste of resources and dollars, with death being postponed only a few hours? Will we add another member to the proverbial cabbage-patch? Will this person ever open their eyes, speak words to a loved one, or live a meaningful life?

Our perspective in these cases is brief, and often negative. That Baywatch moment of coughing, eye-blinking and a full return to consciousness is something I’ve never seen. Recovery from cardiac arrest takes hours, days, weeks, or even months. Despite our limited perspective, the numbers don’t lie; survival from out of hospital cardiac arrest has tripled in the last 10 years. The numbers continue to rise as the science that guides our treatment evolves and is translated into action. Two in one hundred used to survive; now that number is ten. In some places overseas, it is 20. For patients in ventricular fibrillation, survival can be as high as 60%. That’s more than half. This is how far we have come. The science continues to improve, the guidelines continue to evolve, and we continue to get better at bringing back the dead.

In October 2015, the American Heart Association, in partnership with resuscitation organizations all over the world and the highly· regarded International Liaison Committee on Resuscitation, released the latest scientific statements, treatment recommendations and practice guidelines for the care of victims of cardiac arrest. This infographic summarizes what you need to know before you respond to your next arrest.

We know that the devil is in the details, and that strong leadership, teamwork and attention to detail make a difference. By studying the latest guidelines and applying them in earnest, we can all do our part to ensure survival rates from cardiac arrest continue to climb. How high can survival from cardiac arrest go? That’s one question science hasn’t yet answered. —Blair Bigham, MD, MSc, ACPf