Cardiac Arrest
Cardiac arrests, both in and out of hospital, have very poor outcomes.
In arrest, commence with compressions at a rate of 100-120 beats/min, to a depth of 5-6cm in adults, 5cm in children and 4cm in infants, delivered with 2 hands to adults and 1 hand for children and 2 fingers for infants. The exceptions to this are arrests due to trauma, drowning and neonates.
A universal compression to ventilation ratio of 30:2 is recommended. For children where there are at least 2 rescuers present a ratio of 15:2 is preferred. In newborns a rate of 3:1 is recommended unless a cardiac cause is known in which case a 15:2 ratio is used.
If an advanced airway such as an endotracheal tube or LMA is in place then delivery of respirations should occur without pauses in compressions at a rate of no more than 8 per minute.
The Australian Resuscitation Council has all the updated guidelines in easy to use format.
The Cardiac Arrests in NSW study compared two one year periods, 2004-05 with 2009-10. Of note, it found that in NSW there was a decrease in the number of out of hospital cardiac arrests but survival rates were reduced.
Go to the ILCOR site for links to the various bodies which relate to cardiac arrest and further information.
Mechanical CPR Devices
The LUCAS and other mechanical CPR devices are being used more commonly now in pre-hospital care and ED settings, with the thought that they provide more consistent and continuous chest compressions, especially during patient transport. They also improve staff safety and free up staff to perform other procedures. Recent studies have shown no significant difference in outcomes between using the LUCAS device and manual chest compressions.
Rubertsson S, Lindgren E, Smekal D, et al. Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out of Hospital Cardiac Arrest – The LINC Randomized Trial. JAMA. 2014;311(1):53-61.
Perkins G, Lall R, Quinn T, et al. Mechanical versus manual chest compression for out of hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet 2015; 385 (9972): 947-955.
For further information about mechanical CPR, see the Westmead Hospital education site.
ECMO for cardiac arrest
The CHEER study conducted at The Alfred Hospital in Melbourne, showed improved outcomes for refractory cardiac arrest by using a protocol including mechanical CPR, peri-arrest therapeutic hypothermic and ECMO.
Stub D, Bernard S, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 2015; 86: 88-94
The 2CHEER trial is currently being conducted in Sydney – a collaboration between St Vincent's Hospital, Royal Prince Alfred Hospital and NSW Ambulance.
Further resources about ED ECMO can be found at The ED ECMO project.