2010 American Heart Association Guidelines for by Mary Fran Hazinski, John M. Field

By Mary Fran Hazinski, John M. Field

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Extra info for 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science

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Support for the prehospital protocol should be sought from collaborating external agencies (eg, destination hospital emergency departments [EDs], coroner, medical directors, and police) before implementation. Terminating Resuscitative Efforts in an ALS Out-of-Hospital System A different rule may be useful when the additional diagnostic and therapeutic capabilities of an advanced life support EMS response are available to the victim. 33 This rule recommends considering terminating resuscitation when ALL of the following criteria apply before moving to the ambulance for transport (see Figure 2): (1) arrest was not witnessed; (2) no bystander CPR was provided; (3) no ROSC after full ALS care in the field; and (4) no AED shocks were delivered.

This rule has been retrospectively externally validated for adult patients in several regions in the US, Canada, and Europe,25,27–29 and it is reasonable to employ this rule in all ALS services (Class IIa, LOE B). 25,28,29 The BLS rule is reasonable to use in these services (Class IIa, LOE B). Termination of Resuscitative Efforts and Transport Implications Field termination reduces unnecessary transport to the hospital by 60% with the BLS rule and 40% with the ALS rule,25 reducing associated road hazards34,35 that put the provider, patient, and public at risk.

Meaney PA, Nadkarni VM, Cook EF, Testa M, Helfaer M, Kaye W, Larkin GL, Berg RA. Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests. Pediatrics. 2006;118: 2424 –2433. Eckstein M, Stratton SJ, Chan LS. Termination of resuscitative efforts for out-of-hospital cardiac arrests. Acad Emerg Med. 2005; 12:65–70. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs. 1998; 24:400 – 405. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT.

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