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Cardiac arrest - out of hospital care - Management
Basis for recommendation
These recommendations are based on guidelines from the Resuscitation Council (UK) [Resusucitation Council, 2010].
Basis for undertaking cardiopulmonary resuscitation before defibrillation
- Evidence indicates that a period of cardiopulmonary resuscitation (CPR) before defibrillation may improve survival after prolonged collapse (greater than 5 minutes) [Wik et al, 2003]. The duration of collapse is frequently difficult to estimate accurately, so it is recommended to give CPR before attempting defibrillation outside hospital, unless the arrest is witnessed by a healthcare professional or an automated external defibrillator (AED) is being used. This advice does NOT apply to lay responders using an AED outside hospital, who should apply the AED as soon as it is available.
Basis for giving adrenaline
- Current evidence is insufficient to support or refute the routine use of any particular drug, or sequence of drugs, during defibrillation. The recommendation to use adrenaline is based largely on experimental data; the alpha-adrenergic actions of adrenaline cause vasoconstriction, which increases myocardial and cerebral perfusion pressure during cardiac arrest.
- Immediate resumption of CPR after shock delivery, along with the elimination of a rhythm check at this stage, makes it difficult to select an ideal point at which to give adrenaline. The recommendation to give adrenaline immediately after confirmation of the rhythm and just before shock delivery is based on expert consensus.
Basis for giving amiodarone
- There is some evidence that the use of amiodarone in shock-refractory VF improves survival to hospital admission compared with placebo or lidocaine [Kudenchuk et al, 1999; Dorian et al, 2002]. There are no data on the use of amiodarone for shock-refractory VF/VT when single shocks are used. The recommendation to give amiodarone if VF/VT persists after three shocks is based on expert consensus.
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