Consensus on CPR and Emergency CV Care Science: Key Points

The following are key points to remember from an international consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science with treatment recommendations:

1. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation (ILCOR) task force science experts.
2. Once a cardiac arrest is recognized during the emergency call and CPR has been started, dispatchers should ask if there is an automated external defibrillator (AED) (or defibrillator) immediately available at the scene and ask the caller to update them when one arrives (good practice statement).
3. There is currently insufficient evidence on the clinical effectiveness of ultraportable or pocket AEDs to make a treatment recommendation.
4. The ILCOR suggests performing chest compressions on a firm surface when this is practical and does not significantly delay the start of chest compressions (weak recommendation, very low–certainty evidence).
5. ILCOR suggests activation of the CPR mode to increase mattress stiffness if available for in-hospital cardiac arrest (good practice statement). For health care systems that have already incorporated backboards into routine use during resuscitations, the evidence was considered insufficient to suggest against their continued use (weak recommendation, very low–certainty of evidence).
6. ILCOR recommends the use of 100% inspired oxygen until the arterial oxygen saturation or the partial pressure of arterial oxygen can be measured reliably in adults with return of spontaneous circulation (ROSC) after cardiac arrest in the prehospital setting (strong recommendation, moderate-certainty evidence) and in-hospital setting (strong recommendation, low-certainty evidence).
7. Following reliable measurement of arterial oxygen values, ILCOR suggests targeting an oxygen saturation of 94-98% or a partial pressure of arterial oxygen of 75-100 mm Hg (~10-13 kPa) in adults with ROSC after cardiac arrest in any setting (good practice statement).
8. There is insufficient scientific evidence to recommend a specific blood pressure goal after cardiac arrest. Therefore, ILCOR suggests a mean arterial blood pressure of ≥60-65 mm Hg in patients after out-of-hospital (moderate-certainty to low-certainty evidence) and in-hospital cardiac arrest (low-certainty to very low–certainty evidence).
9. ILCOR suggests actively preventing fever by targeting a temperature ≤37.5°C for patients who remain comatose after ROSC from cardiac arrest (weak recommendation, low-certainty evidence). Whether subpopulations of cardiac arrest patients may benefit from targeting hypothermia at 32-34°C remains uncertain.
10. ILCOR suggests that adults with out-of-hospital cardiac arrest should be cared for in cardiac arrest centers (weak recommendation, low-certainty evidence).

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001288