The following points summarise the most recent evidence and treatment recommendations from the International Consensus on Cardiopulmonary Resuscitation and the International Liaison Committee on Resuscitation (ILCOR):
- Dispatcher Guidance and AED Use
- During emergency calls, once cardiac arrest is confirmed and CPR has started, dispatchers should ask whether an automated external defibrillator (AED) is available at the scene. They should also prompt the caller to notify them once an AED arrives (good practice statement). Guidelines from the International Consensus emphasise this approach.
- Current evidence does not support a treatment recommendation for ultraportable or pocket AEDs due to insufficient clinical data on their effectiveness.
- Chest Compressions and Firm Surfaces
- Chest compressions should ideally be performed on a firm surface when feasible, provided this does not delay the initiation of compressions (weak recommendation, very low-certainty evidence). The International Consensus emphasises the importance of firm responses without delay.
- For in-hospital settings, activating a CPR mode to increase mattress stiffness is advised when available (good practice statement). For healthcare systems using backboards during resuscitation, the evidence is insufficient to suggest discontinuation of their use (weak recommendation, very low-certainty evidence).
- Oxygenation Post-Cardiac Arrest
- Administering 100% inspired oxygen is recommended until arterial oxygen saturation or partial pressure of arterial oxygen can be reliably measured. This applies to both prehospital (strong recommendation, moderate-certainty evidence) and in-hospital settings (strong recommendation, low-certainty evidence). According to the consensus, precise oxygen control is crucial.
- Once reliable oxygenation measurements are available, targeting an oxygen saturation of 94-98% or partial pressure of oxygen between 75-100 mm Hg (~10-13 kPa) is suggested (good practice statement).
- Blood Pressure Management
- No specific blood pressure target can be definitively recommended post-cardiac arrest. However, maintaining a mean arterial pressure (MAP) of ≥60-65 mm Hg is suggested for both out-of-hospital (moderate- to low-certainty evidence) and in-hospital cardiac arrest (low- to very low-certainty evidence). According to the International Consensus, maintaining MAP is beneficial.
- Temperature Control in Post-Cardiac Arrest Care
- Fever prevention is advised, with a target temperature ≤37.5°C for patients who remain comatose after return of spontaneous circulation (ROSC) (weak recommendation, low-certainty evidence). As highlighted by consensus, such measures are effective in management.
- The potential benefits of targeted hypothermia at 32-34°C for specific subgroups remain uncertain and require further research.
- Cardiac Arrest Centres
- Adults experiencing out-of-hospital cardiac arrest should ideally receive care in specialized cardiac arrest centres (weak recommendation, low-certainty evidence). Recognition as noted by the international group is critical.
This summary reflects the latest advancements in resuscitation science, emphasizing evidence-based practices while acknowledging areas where further research is needed.
