The routine use of steroids for patients with shock after ROSC is of uncertain value. The cause of the bradycardia may dictate the severity of the presentation. This recommendation is based on the fact that nonconvulsive seizures are common in postarrest patients and that the presence of seizures may be important prognostically, although whether treatment of nonconvulsive seizures affects outcome in this setting remains uncertain. These include activation of the emergency response, provision of high-quality CPR and early defibrillation, ALS interventions, effective post-ROSC care including careful prognostication, and support during recovery and survivorship. We recommend that cardiac arrest survivors and their caregivers receive comprehensive, multidisciplinary discharge planning, to include medical and rehabilitative treatment recommendations and return to activity/work expectations. Electroencephalography is widely used in clinical practice to evaluate cortical brain activity and diagnose seizures. Administration of sodium bicarbonate for cardiac arrest or life-threatening cardiac conduction delays (ie, QRS prolongation more than 120 ms) due to sodium channel blocker/tricyclic antidepressant (TCA) overdose can be beneficial. What is the interrater agreement for physical examination findings such as pupillary light reflex, corneal An updated systematic review on several aspects of this important topic is needed once currently ongoing clinical trials have been completed. Time to drug in IHCA is generally much shorter, and the effect of epinephrine on outcomes in the IHCA population may therefore be different. DWI/ADC is a sensitive measure of injury, with normal values ranging between 700 and 800106 mm2 /s and values decreasing with injury. Each recommendation was developed and formally approved by the writing group. Regardless of the underlying QT interval, all forms of polymorphic VT tend to be hemodynamically and electrically unstable. A victim may also appear clinically dead because of the effects of very low body temperature. Effective ventilation of the patient with a tracheal stoma may require ventilation through the stoma, either by using mouth-to-stoma rescue breaths or by use of a bag-mask technique that creates a tight seal over the stoma with a round, pediatric face mask. A 2017 systematic review identified 1 observational human study and 10 animal studies comparing different ventilation rates after advanced airway placement. During a resuscitation, the team leader assigns team roles and tasks to each member. 6. It is reasonable that TTM be maintained for at least 24 h after achieving target temperature. Each of these features can also be useful in making a presumptive rhythm diagnosis. We recommend that cardiac arrest survivors have multimodal rehabilitation assessment and treatment for physical, neurological, cardiopulmonary, and cognitive impairments before discharge from the hospital. The response phase is a reaction to the occurrence of a catastrophic disaster or emergency. 3. Recovery expectations and survivorship plans that address treatment, surveillance, and rehabilitation need to be provided to cardiac arrest survivors and their caregivers at hospital discharge to optimize transitions of care to home and to the outpatient setting. 4. What is optimal for the CPR duty cycle (the proportion of time spent in compression relative to the Though effective for treating a wide-complex tachycardia known to be of supraventricular origin and not involving accessory pathway conduction, verapamils negative inotropic and hypotensive effects can destabilize VT. As more and more centers and EMS systems are using feedback devices and collecting data on CPR measures such as compression depth and chest compression fraction, these data will enable ongoing updates to these recommendations. The toxicity of cyanide is predominantly due to the cessation of aerobic cell metabolism. They may repeatedly recur and remit spontaneously, become sustained, or degenerate to VF, for which electric shock may be required. It is likely that a time threshold exists beyond which the absence of ventilation may be harmful, and the generalizability of the findings to all settings must be considered with caution.1, Once an advanced airway has been placed, delivering continuous chest compressions increases the compression fraction but makes it more difficult to deliver adequate ventilation. 1. Clinicians must determine if the tachycardia is narrow-complex or wide-complex tachycardia and if it has a regular or irregular rhythm. The usefulness of S100 calcium-binding protein (S100B), Tau, neurofilament light chain, and glial fibrillary acidic protein in neuroprognostication is uncertain. 6. Aggressive rewarming, possibly including invasive techniques, may be required and may necessitate transport to the hospital sooner than would be done in other OHCA circumstances.1 The specific care of patients who are victims of an avalanche are not included in these guidelines but can be found elsewhere.2, This topic last received formal evidence review in 2010.1, Between 1.6% and 5.1% of US adults have suffered anaphylaxis.1 Approximately 200 Americans die from anaphylaxis annually, mostly from adverse reactions to medication.2 Although anaphylaxis is a multisystem disease, life-threatening manifestations most often involve the respiratory tract (edema, bronchospasm) and/or the circulatory system (vasodilatory shock). External chest compressions should be performed if emergency resternotomy is not immediately available. The primary focus of cardiac arrest management for providers is the optimization of all critical steps required to improve outcomes. The literature supports prioritizing defibrillation and CPR initially and giving epinephrine if initial attempts with CPR and defibrillation are not successful. CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycardia; and VF, ventricular fibrillation. 3. 0.00003 m b. One benefit to SSEPs is that they are subject to less interference from medications than are other modalities. Refer to the device manufacturers recommended energy for a particular waveform. It may be reasonable to use physiological parameters such as arterial blood pressure or end-tidal CO. 1. Although contradictory evidence exists, it may be reasonable to avoid the use of pure -adrenergic blocker medications in the setting of cocaine toxicity. If a jaw thrust and/or insertion of an airway adjunct are ineffective in opening the airway and allowing ventilation to occur, a head tiltchin lift may be the only way to open the airway. It does not have a pediatric setting and includes only adult AED pads. Full resuscitative measures, including extracorporeal rewarming when available, are recommended for all victims of accidental hypothermia without characteristics that deem them unlikely to survive and without any obviously lethal traumatic injury. 3. Two randomized trials from the same center reported improved survival and neurological outcome when steroids were bundled in combination with vasopressin and epinephrine during cardiac arrest and also administered after successful resuscitation from cardiac arrest. Care Science With Treatment Recommendations (CoSTR).1. The ResQTrial demonstrated that ACD plus ITD was associated with improved survival to hospital discharge with favorable neurological function for OHCA compared with standard CPR, though this study was limited by a lack of blinding, different CPR feedback elements between the study arms (ie, cointervention), lack of CPR quality assessment, and early TOR. The response phase comprises the coordination and management of resources utilizing the Incident Command System. 2. This cause of death is especially prominent in those with OHCA but is also frequent after IHCA.1,2 Thus, much of postarrest care focuses on mitigating injury to the brain. Which term refers to the ability to use readily available resources to find solutions to challenging or complex situations or issues that arise? neurological outcome? Cycles of 5 back blows and 5 abdominal thrusts 5. Recognition of cardiac arrest by healthcare providers includes a pulse check, but the importance of not prolonging efforts to detect a pulse is emphasized. Neuroimaging may be helpful after arrest to detect and quantify structural brain injury. IHCA patients often have invasive monitoring devices in place such as central venous or arterial lines, and personnel to perform advanced procedures such as arterial blood gas analysis or point-of-care ultrasound are often present. outcomes? 1. Throughout the recommendation-specific text, the need for specific research is identified to facilitate the next steps in the evolution of these questions. This link is provided for convenience only and is not an endorsement of either the linked-to entity or any product or service. A systematic review of the literature identified 5 small prospective trials, 3 retrospective studies, and multiple case reports and case series with contradictory results. Because the duration of action of naloxone may be shorter than the respiratory depressive effect of the opioid, particularly long-acting formulations, repeat doses of naloxone, or a naloxone infusion may be required. The presence of undifferentiated myoclonic movements after cardiac arrest should not be used to support a poor neurological prognosis. 4. Magnesium may be considered for treatment of polymorphic VT associated with a long QT interval (torsades de pointes). A recent systematic review of 11 RCTs (overall moderate to low certainty of evidence) found no evidence of improved survival with good neurological outcome with mechanical CPR compared with manual CPR in either OHCA or IHCA.1 Given the perceived logistic advantages related to limited personnel and safety during patient transport, mechanical CPR remains popular among some providers and systems. Postcardiac arrest care is a critical component of the Chain of Survival and demands a comprehensive, structured, multidisciplinary system that requires consistent implementation for optimal patient outcomes. 1. Rapidly intervening with patients admitted through emergency department triage C. Responding to patients during a disaster or multiple-patient situation D. Responding to patients after activation of the emergency response system Patients should be monitored constantly to verify airway patency and adequate ventilation and oxygenation. If no emergency medical services (EMS) or other trained personnel is on the scene, activate the 911 emergency system immediately.