European Resuscitation Council Guidelines

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Questions and Answers

The European Resuscitation Council's (ERC) primary objective is to:

  • Promote research in cardiology.
  • Preserve human life by ensuring high-quality resuscitation is available. (correct)
  • Standardize first aid training globally.
  • Reduce the cost of resuscitation equipment.

In what year were the first European Resuscitation Council (ERC) guidelines for basic and advanced life support presented?

  • 2000
  • 1992 (correct)
  • 1994
  • 2005

What does ILCOR, which informs the ERC guidelines, stand for?

  • Inter-continental Life and Cardiac Organisation for Resuscitation
  • Inter-European Life-support Council on Resuscitation
  • International Liaison Committee on Resuscitation (correct)
  • International Life-saving Committee on Resuscitation

Which of the following best describes the evolution of ILCOR's evidence evaluation process?

<p>From five-year reviews to continuous evidence evaluation. (C)</p> Signup and view all the answers

Which of the following is NOT a topic covered in the 2021 European Resuscitation Council Guidelines?

<p>Burn management (D)</p> Signup and view all the answers

What is the minimum percentage of writing group members for the ERC guidelines required to be free of commercial conflicts of interest?

<p>50% (D)</p> Signup and view all the answers

What is the primary method for arriving at recommendations in the ERC guidelines when no relevant ILCOR treatment recommendation exists?

<p>Consensus achieved through review and discussion of evidence by the working group (C)</p> Signup and view all the answers

What is the quorum required for conducting writing group business and reaching consensus within the ERC guideline development process?

<p>At least 75% of the writing group (B)</p> Signup and view all the answers

Which of the following is NOT one of the three styles of evidence evaluation undertaken by ILCOR since 2015?

<p>Meta-analyses (D)</p> Signup and view all the answers

What is the main purpose of 'scoping reviews' in the context of ERC guideline development?

<p>To examine the extent, range, and nature of research activity on a broad topic. (A)</p> Signup and view all the answers

What is the purpose of 'evidence updates' within the ILCOR evidence evaluation process?

<p>To confirm the validity of existing recommendations or highlight the need for a new systematic review. (B)</p> Signup and view all the answers

According to GRADE certainty levels, 'moderate certainty' implies:

<p>We are moderately confident in the effect estimate; the true effect is likely close to the estimate. (B)</p> Signup and view all the answers

A 'strong recommendation' in ILCOR COSTRs indicates that:

<p>The task force is confident that desirable effects outweigh undesirable effects. (A)</p> Signup and view all the answers

What is the typical term used in ILCOR recommendations to indicate a 'weak recommendation'?

<p>We suggest (B)</p> Signup and view all the answers

What was the primary method used for stakeholder consultation on the ERC guidelines?

<p>Public posting of draft guidelines on the ERC website. (D)</p> Signup and view all the answers

How often does the ERC aim to produce routine updates to its guidelines and course materials?

<p>Every 5 years (B)</p> Signup and view all the answers

What is the official journal of the European Resuscitation Council (ERC) where guidelines and updates are typically published?

<p>Resuscitation (D)</p> Signup and view all the answers

During the initial COVID-19 wave, what was a commonly reported change in the cause of out-of-hospital cardiac arrests?

<p>Increase in cardiac arrests due to medical causes. (C)</p> Signup and view all the answers

Which of the following was NOT consistently observed regarding bystander CPR rates during the COVID-19 pandemic?

<p>Studies consistently reported lower rates of bystander CPR. (A)</p> Signup and view all the answers

What is the primary focus of the ERC COVID-19 guidelines?

<p>To promote resuscitation while minimizing risk to providers in suspected or confirmed COVID-19 cases. (D)</p> Signup and view all the answers

According to the epidemiology section of the 2021 ERC guidelines, approximately what percentage of European countries have out-of-hospital cardiac arrest registries?

<p>70% (B)</p> Signup and view all the answers

What is the average survival rate to hospital discharge for out-of-hospital cardiac arrest in Europe?

<p>8% (B)</p> Signup and view all the answers

In European countries where withdrawal of life-sustaining treatment (WLST) is routinely practiced, what is the typical neurological outcome for survivors of in-hospital cardiac arrest?

<p>Good neurological outcome in &gt;90% of patients. (A)</p> Signup and view all the answers

What is a key recommendation regarding population-based registries for cardiac arrest from the ERC guidelines?

<p>Health systems should implement population-based registries to monitor cardiac arrest incidence, treatment, and outcomes. (C)</p> Signup and view all the answers

The 'chain of survival' concept emphasizes:

<p>The sequence of actions linking cardiac arrest with survival, including both lay and professional actions. (B)</p> Signup and view all the answers

Which technology is highly encouraged by the ERC guidelines to improve bystander CPR rates and response times?

<p>Smartphone apps to alert first responders to nearby suspected out-of-hospital cardiac arrests. (A)</p> Signup and view all the answers

What is the recommended approach for dispatch-assisted CPR instructions regarding chest compression-only CPR compared to standard CPR?

<p>Dispatchers should provide chest compression-only CPR instructions for callers who identify unresponsive adults not breathing normally. (B)</p> Signup and view all the answers

What is the recommended compression depth for high-quality chest compressions in adult basic life support?

<p>At least 5 cm but not more than 6 cm. (C)</p> Signup and view all the answers

If a rescuer is unable to perform rescue breaths during adult basic life support, what is the recommended alternative?

<p>Perform chest compressions only, continuously. (A)</p> Signup and view all the answers

What is the recommended initial action when an Automated External Defibrillator (AED) arrives at the scene of a cardiac arrest?

<p>Switch on the AED and follow its prompts. (B)</p> Signup and view all the answers

What is the recommended course of action if an AED indicates 'no shock advised'?

<p>Immediately restart CPR with chest compressions. (C)</p> Signup and view all the answers

In the BLS algorithm, what is the compression-to-ventilation ratio for adult CPR?

<p>30:2 (A)</p> Signup and view all the answers

What is the first action to take when encountering a person suspected of having a foreign body airway obstruction (FBAO) who is conscious?

<p>Encourage the victim to cough. (C)</p> Signup and view all the answers

According to the ALS guidelines, when is adrenaline recommended for use in cardiac arrest with a non-shockable rhythm?

<p>As soon as possible. (D)</p> Signup and view all the answers

What is the expert consensus for the minimum success rate for tracheal intubation within two attempts for rescuers who choose to use this advanced airway technique?

<p>95% (A)</p> Signup and view all the answers

When is amiodarone recommended in the ALS algorithm for shockable cardiac arrest rhythms?

<p>After the third shock. (D)</p> Signup and view all the answers

In cases of refractory ventricular fibrillation (VF), what alternative defibrillation pad position might be considered?

<p>Anterior-posterior (A)</p> Signup and view all the answers

What is the recommended ventilation rate once an advanced airway (tracheal tube or supraglottic airway) is placed during ALS?

<p>8-10 breaths per minute (C)</p> Signup and view all the answers

In which type of cardiac arrest is thrombolytic drug therapy specifically mentioned as a consideration in the ERC guidelines?

<p>Pulmonary embolism (C)</p> Signup and view all the answers

What is the recommended duration of CPR to consider after administering thrombolytic drugs in cardiac arrest?

<p>60-90 minutes (D)</p> Signup and view all the answers

In peri-arrest tachycardias, when is electrical cardioversion the preferred treatment?

<p>In unstable patients displaying potentially life-threatening adverse signs. (B)</p> Signup and view all the answers

For atrial flutter and paroxysmal supraventricular tachycardia in unstable patients, what is the recommended initial shock energy?

<p>70-120J (C)</p> Signup and view all the answers

In bradycardia accompanied by adverse signs, what is the initial dose of atropine recommended?

<p>500 mcg IV (A)</p> Signup and view all the answers

Which drug might be considered for bradycardia caused by inferior myocardial infarction, cardiac transplant, or spinal cord injury?

<p>Aminophylline (C)</p> Signup and view all the answers

In managing hypothermia-induced cardiac arrest, at what core temperature is it recommended to delay further defibrillation attempts if ventricular fibrillation (VF) persists after three shocks?

<p>&lt;30°C (D)</p> Signup and view all the answers

In avalanche rescue, what is considered the most likely cause of cardiac arrest and thus the priority intervention?

<p>Hypoxia (A)</p> Signup and view all the answers

For heat stroke, at what rate of cooling is considered safe and desirable in exertional heat stroke?

<p>0.10 °C/min (D)</p> Signup and view all the answers

In cardiac arrest due to pulmonary embolism, low ETCO2 readings during CPR may:

<p>Support the diagnosis of pulmonary embolism, though it is non-specific. (D)</p> Signup and view all the answers

In the context of cardiac arrest in the operating room (OR), what type of chest compression is mentioned as an effective alternative to closed chest compression?

<p>Open cardiac compression (D)</p> Signup and view all the answers

According to the ERC guidelines, what overarching principle should guide the decision to translate new ILCOR CoSTRs into guideline and educational updates?

<p>The potential impact of the new CoSTR on lives saved, neurological outcome, and reduced costs balanced against the challenges of change. (D)</p> Signup and view all the answers

What is the recommended chest compression rate for adult CPR, according to the BLS guidelines?

<p>A rate of 100-120 compressions per minute. (D)</p> Signup and view all the answers

In the context of post-resuscitation care, which tool should be integrated with emergency care treatment plans to increase clarity of treatment goals?

<p>Advanced Care Planning (B)</p> Signup and view all the answers

According to the ERC guidelines, after failed defibrillation attempts and in the context of refractory VF, what alternative defibrillation pad position may be considered?

<p>Anterior-posterior (D)</p> Signup and view all the answers

What is the suggested first action a healthcare provider should take for a patient presenting with syncope, palpitations and dizziness?

<p>Investigate it, as the symptoms may relate to an arrhythmia. (A)</p> Signup and view all the answers

In post-cardiac arrest care, what is the recommendation for temperature management according to the ERC?

<p>Targeted Temperature Management (TTM) between 32°C and 36°C. (B)</p> Signup and view all the answers

In avalanche rescue, what intervention is the first priority?

<p>Ventilations (B)</p> Signup and view all the answers

During the administration of chest compressions, 'hands-on' defibrillation poses what risk?

<p>Risk to the rescuer, even when wearing clinical gloves (D)</p> Signup and view all the answers

What action should be performed after delivering an initial shock using an AED?

<p>Immediately restart CPR with compressions. (B)</p> Signup and view all the answers

According to the ERC guidelines, what is a critical component of the initial assessment of a person with a suspected foreign body airway obstruction (FBAO)?

<p>Encouraging the person to cough. (A)</p> Signup and view all the answers

In which specific situation should IV fluids be administered during cardiac arrest?

<p>Only in cases caused or possibly caused by hypovolemia. (B)</p> Signup and view all the answers

According to the guidelines, after providing initial care for burns, what is the next step?

<p>Cover burn loosely with a dry, sterile dressing. (D)</p> Signup and view all the answers

Following the European Resuscitation Council (ERC) guidelines, which of these actions is emphasized to improve bystander CPR rates and response times?

<p>Using smartphone apps to alert trained persons nearby. (B)</p> Signup and view all the answers

In managing peri-arrest arrythmias, which condition requires anaesthesia or sedation before synchronised cardioversion?

<p>A conscious patient displaying life-threatening adverse signs. (C)</p> Signup and view all the answers

You are called to attend to a person who has fallen in the snow. They are unresponsive with a thermometer reading of 29 degrees Celcius. They have had three unsuccessful defibrillation attempts. What is the next best step?

<p>Delay further defibrillation attempts until &gt; 30°C. (C)</p> Signup and view all the answers

What is the immediate next best step if faced with a patient who may have a neck injury?

<p>Use a jaw thrust and attempt to visualize the airway (D)</p> Signup and view all the answers

If an adult patient does not respond to initial treatment with atropine, what should be considered next for bradycardia?

<p>Isoprenaline (D)</p> Signup and view all the answers

During manual defibrillation, how should the pads be placed on a patient with an implanted device?

<p>Greater than 8cm away from the device (A)</p> Signup and view all the answers

According to the ERC guidelines, what is the suggested weight to volume ratio for crystalloid solution administration for those in shock?

<p>10ml/kg (B)</p> Signup and view all the answers

Following current ERC guidance, which type of layperson is encouraged to perform CPR and should be free from concerns of harming victims not in cardiac arrest?

<p>All laypeople (C)</p> Signup and view all the answers

In regards to tidal volume and lung ventilation once a tracheal tube is in place, what is the current guideline?

<p>Ventilate the lungs at a rate of 10/min. (C)</p> Signup and view all the answers

A person is suspected of having a stroke but conscious nonetheless. What is the first action to take?

<p>Call EMS and check stroke severity using Stroke Scale (D)</p> Signup and view all the answers

In what situation is the action of chest compressions contraindicated?

<p>If there are clear signs of life (B)</p> Signup and view all the answers

A patient who has overdosed on an unknown drug has now gone into cardiac arrest. What treatment is essential to provide?

<p>Prolong the resuscitation period (B)</p> Signup and view all the answers

Flashcards

ERC objective

To preserve human life by making high-quality resuscitation available to all.

ILCOR's goal

To save more lives globally through resuscitation.

Clinical practice guidelines

Healthcare systems rely increasingly on them.

ILCOR Evidence Evaluation process

The ERC Guidelines are informed by this.

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Chain of survival

Actions linking the victim of cardiac arrest with survival.

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KIDS SAVE LIVES

Use Check, Call, Compress to apply chest compressions.

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Dispatch-assisted CPR

Dispatch centers should have systems to make sure call handlers provide CPR instructions for unresponsive persons not breathing normally.

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How to Recognize Cardiac Arrest

Start CPR in any unresponsive person with absent or abnormal breathing.

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Dispatch-assisted chest compression

CPR only, instructions for callers to adult persons.

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What Does CHECK CALL COMPRESS represent?

Check call Compress, to teach CPR to all school children.

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High-quality chest compressions

Minimize interruptions to chest compression deliver compressions.

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ERC COVID-19 guidelines

Minimizing infection risk to first responders.

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How to alert the emergency services

Alert EMS if person is unconscious without normal breathing.

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Rescue breaths

Alternate 30 compressions and 2 rescue breaths.

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Advanced airway

Use trained professional to secure air.

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Thrombolytic drugs administration

CPR 60-90 min after thrombolytic drugs administered.

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Electrical conversion

Immediate cardioversion to treat arrhythmia.

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Renal Replacement therapy

To reverse hyperkalemia or hyperthermia during cardiac arrest.

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For Ventricular tachycardia with a pulse

Ischemia: use energy burst in cardiac, stroke.

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Hypoxia after cardiac arrest

Immediately ventilate with highest O2.

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Avalanche Rescue

Start with five ventilations in cardiac arrest since hypoxia.

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Study Notes

2021 European Resuscitation Council Guidelines: Executive Summary

  • The 2021 ERC Guidelines present the most current evidence-based guidelines for resuscitation practice throughout Europe.

Guidelines Scope

  • Epidemiology of cardiac arrest
  • Role of systems in saving lives
  • Adult basic and advanced life support
  • Resuscitation in special circumstances
  • Post resuscitation care, first aid, neonatal and pediatric life support
  • Focus on ethics and education.

Objective

  • Preserve human life
  • Make high quality resuscitation available to all through up-to-date, evidence-based European guidelines for cardiac arrest prevention and treatment, as well as other life-threatening emergencies

History

  • First ERC guidelines were presented in Brighton in 1992, covering basic and advanced life support.
  • Guidelines for Paediatric Life Support (PLS) and peri-arrest arrhythmias were then followed.
  • Guidelines for airway and ventilation in resuscitation were introduced in Seville in 1996.
  • Updated guidelines appeared at the 4th ERC Scientific Congress in Copenhagen (1998).
  • 2000: International resuscitation guidelines were produced with ILCOR collaboration, which the ERC summarised in 2001.
  • ERC produced the guidelines every five years following this, in 2005, 2010, and 2015, with annual updates linked to ILCOR's Consensus on Science and Treatment Recommendations from 2017 onward
  • Guidelines addressing resuscitation during the 2019 coronavirus disease (COVID-19) were introduced in 2020.

Development

  • Healthcare systems are increasingly relying on these evidence-based guidelines, and they have also grown in influence
  • Improving norms and transparency in guideline development.

Standards

  • The Institute of Medicine established clinical practice guideline quality standards in 2011 which was shortly followed.
  • The ERC Guidelines were then developed by the Guidelines International Network, adhering to their principles for guideline development.

Process

  • Guidance on panel composition, decision-making, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding were taken into account.
  • The writing group chairs and members were selected on the grounds of their credibility as prominent resuscitation scientists, clinicians, and methodologists.
  • Ensure a balance in terms of professions (doctors, nurses, paramedics), gender, early career specialists, ethnicity, Europe-wide geographic representation and representation from key stakeholders

Writing Group Member Roles

  • Providing clinical and scientific knowledge to the guideline's writing process
  • Engaging actively in the majority of writing group conference calls
  • Conducting thorough literature reviews on specified topics upon guideline request
  • Presenting review results and facilitating group discussions on particular topics
  • Refining and developing clinical practice algorithms and guidelines
  • Meeting the International Committee of Medical Journal Editors' (ICMJE’s) authorship requirements
  • Being ready to be held accountable in public about what the guidelines contain and encouraging their use
  • Abiding by the ERC’s conflict of interest regulations.

Decision Making

  • ERC standards are drawn from the recommendations of the International Liaison Committee on Resuscitation, or ILCOR
  • In areas with no ILCOR treatment recommendations, expert consensus was achieved through working group review and debate of the evidence.
  • Open, constructive discussions were ensured by the writing group chairs, allowing each member to express and argue their opinions.
  • All group members had to approve each recommendation, and any failure to achieve consensus was noted in the recommendation's wording.
  • At least 75% of the members of the writing group must be present to constitute a quorum for writing group business and consensus
  • The ERC General Assembly received and approved the guidelines' scope and final version

Financial Support

  • Business alliances support the ERC's overall activities, although the ERC guidelines are developed entirely without the influence of business partners.

Conflict of Interest

  • Adhering to the ERC's COI policy
  • Completing annual COI declarations that are reviewed by the Governance Committee, with conflict reports available on the ERC website
  • Requiring the writing group chair, and at least 50% of the writing group members, to be free of commercial COIs.
  • Allowing writing group members who have a COI to still participate in discussions relevant to that subject, but not to be involved in drafting or approving recommendations at the chair’s discretion

Figure 1

  • Step-wise process for developing the ERC guidelines:
    • Define Topics
    • Appoint Writing Groups
    • Develop Scope
    • Consultation
    • Identify Evidence
    • Summary and Recommendations
    • Consultation
    • Publication

ILCOR

  • The ERC is one of its founding members, and closely collaborates to achieve their goals.
  • Key activities include systematic evidence evaluation and producing global science consensus with treatment recommendations.
  • After switching to ongoing evidence assessment in 2017, ILCOR, which initially produced reports every five years, released the 2020 CoSTR, which incorporates 184 studies of resuscitation science

Evidence Assessment Styles

  • ILCOR's systematic reviews
    • Methodological principles coming from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the Institute of Medicine, and the Cochrane Collaboration
    • Presented as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA.
  • Supplementing systematic reviews with scoping reviews-performed internally or by members of the ERC writing groups in order to take a broader approach to the topic
  • Evidence Updates are to address topics that had not been formally reviewed for a number of years and to identify if a formal review should be prompted

Information on Grading of Recommendations Assessment, Development and Evaluation (GRADE)

  • High: Very confident that the true effect is near the estimate of the effect
  • Moderate: Likely to have the true effect lie near the effect estimate and moderate confidence
  • Low: Confidence is constrained and the true effect may be substantially different from the estimate, effect estimate is limited
  • Very Low: With little certainty as the true result and limited confidence, It’s possible that the estimate varies significantly from the true impact

Main guideline areas:

  • Systems in place for saving lives
  • First aid including resuscitation
  • Adult, pediatric and neonatal life support
  • Conditions requiring specific treatment when patients need resuscitation
  • Ethics
  • Education

Council Network

  • Guidelines are disseminated through network of 33 resuscitation councils
  • Audience: lay people, first aiders, first respondents, members of the community health
  • Staff, nurses and other members of ambulance and hospital staffs, trainers, lecturers as well as policy experts in the field of healthcare
  • Settings: relevant in both community and in-hospital environments

COVID-19 Statistics

  • 10 studies, including 35,379 participants, showed an increase in the incidence of out-of-hospital cardiac arrest during the initial COVID-19 wave
  • Increased cardiac arrest was attributed to direct and indirect effects of COVID-19

Continuous Review

  • These guidelines are continuously updated online as new evidence becomes accessible.
  • The primary ERC Guidelines deal with resuscitation for those who are at low risk or confirmed to be negative for COVID-19.

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