2020 aha guideline updates - cuhk
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2020 AHA guideline updatesKaren Poon
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1. Early initiation of CPR by lay rescuers● Reaffirmed (2020): We recommend that laypersons initiate CPR for
presumed cardiac arrest because the risk of harm to the patient is low if the patient is not in cardiac arrest
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2. Early administration of epinephrine● Reaffirmed (2020): With respect to timing, for cardiac arrest with a
non-shockable rhythm, it is reasonable to administer epinephrine as soon as feasible.
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3. Real time audiovisual feedback during CPR● New (2020): : It may be reasonable to use audiovisual feedback devices
during CPR for real-time optimization of CPR performance.● Example: https://www.youtube.com/watch?v=g7Jg16wcxtU
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4. Physiological monitoring of CPR quality● New (2020) : It may be reasonable to use physiologic parameters such as
arterial blood pressure or ETCO2 when feasible to monitor and optimize CPR quality
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5. Double sequential defibrillation NOT supported● New (2020): The usefulness of double sequential defibrillation for
refractory shockable rhythm has NOT been established.● Double sequential defibrillation:
https://www.youtube.com/watch?v=F7ioMBJW48o
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6. IV access preferred over IO● New (2020): IO access may be considered if attempts at IV access are
unsuccessful or not feasible only
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7. Algorithm for opioid overdose
Standard resuscitative measures should take priority over naloxone administration
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8. Cardiac arrest in pregnancy
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8. Cardiac arrest in pregnancy
● Because pregnant patients are more prone to hypoxia, oxygenation and airway management should be prioritized during resuscitation from cardiac arrest in pregnancy.
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8. Cardiac arrest in pregnancy
● Relief of aortocaval compression through left lateral uterine placement
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8. Cardiac arrest in pregnancy
● Because of potential interference with maternal resuscitation, fetal monitoring should NOT be undertaken during cardiac arrest in pregnancy
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8. Cardiac arrest in pregnancy
● Consider perimortem cesarean delivery if no ROSC in 5 mins
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8. Cardiac arrest in pregnancy● New (2020): We recommend targeted temperature management for
pregnant women who remain comatose after resuscitation from cardiac arrest
● Fetus be continuously monitored for bradycardia as a potential complication
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9. Postresuscitative care
Key activities in post-ROSC care:
● Airway management→ Lung protective ventilation
● BP control (Sys> 90 mmHg; Mean> 65 mmHg)
● Emergent cardiac intervention● Targeted temperature management
(TTM)● Multimodal neuroprognostication
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10. Multimodal approach to neuroprognostication
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10. Multimodal approach to neuroprognostication● Predictors for poor neurological outcome
○ Neuroimaging■ CT: (<24 hrs): Cerebral edema→ GWR 1.16- 1.22■ MRI (2-5 days): Hyperintense areas on DWI→ Whole brain ADC, Proportion of
brain volume with low ADC, lowest ADC value in specific brain areas○ Electrophysiology
■ Malignant EEG patterns (>72h): Burst suppression after rewarming over an unreactive background, status epilepticus
■ Bilateral absence of N2O cortical wave of SEEP (at 72h)
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10. Multimodal approach to neuroprognostication● Predictors for poor neurological outcome
○ Clinical exam (at 72h)■ GCS motor score </= 2■ Bilaterally absent pupillary/ corneal reflex ■ Automated infrared pupillometry
○ Biomarkers (at 24, 48, 72 h)■ Neuron specific enolase (NSE)■ S-100B
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Full details of AHA guideline updates● https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlg
hts_2020_ecc_guidelines_english.pdf
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Thank you!