Oct. 18, 2010 Elsevier announces the publication of the 2010 European Resuscitation Council (ERC) Guidelines in the journal Resuscitation. These guidelines are based on an extensive international review of all the science supporting cardiopulmonary resuscitation (CPR), the 2010 International Consensus on CPR Science, which is also published in the current issue of Resuscitation. This year is the 50th anniversary of CPR.
Throughout Europe, each year, about 500,000 people have an out-of-hospital sudden cardiac arrest. Less than 10% of these will survive. If a bystander undertakes CPR, the chance of a cardiac arrest victim surviving is increased by about 2.5 times. Currently, CPR is given by a bystander in only about 25-30% of cardiac arrests. Standard CPR includes compressing the chest and giving mouth-to-mouth breathing (rescue breathing).
Recent evidence indicates that in many cases giving chest compressions alone ('compression-only CPR') has the same benefit as standard CPR. The new ERC Guidelines emphasize that if a bystander sees someone collapse suddenly, and if they are unresponsive and not breathing normally, the bystander should start chest compressions by pushing down at least 5 cm in the middle of the chest at a rate of least 100 compressions per minute. If the bystander is trained in standard CPR, and they are confident and willing to provide rescue breathing, after giving 30 chest compressions they should give two rescue breaths followed by another 30 chest compressions. CPR is continued with this compression to breathing ratio of 30:2. The bystander who is untrained in CPR should at least give chest compressions continuously ('press hard and fast') until the ambulance arrives: 'any CPR is better than no CPR'.
The ERC Guidelines indicate that if an ambulance dispatcher gives telephone advice to a bystander on how to do CPR, they should be told to do compression-only CPR. Recent evidence confirms that this approach will save more lives than if the dispatcher includes advice on rescue breathing. Jerry Nolan, the Editor-in-Chief of Resuscitation, states that "80% of cardiac arrests occurring outside of hospital happen in the home -- the dispatcher giving telephone advice on providing CPR is likely to be speaking to the victim's relative."
The ERC Guidelines in the latest issue of Resuscitation include detailed advice for healthcare professionals on how to treat cardiac arrest and how to continue to treat the patient after the heart has been restarted. In many cases, this will include cooling the patient (therapeutic hypothermia) for 24 hours -- this has been shown to increase the chance of survival.
The last ERC Guidelines were published in 2005; in the 2010 Guidelines, changes have been made only if supported by scientific evidence or if the change simplifies the resuscitation process.
The 2010 ERC guidelines and the International Consensus on CPR Science can be downloaded from http://www.sciencedirect.com/science/journal/03009572 or http://www.erc.edu.
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