New Guidelines regarding Defibrillation

[fishy]

Hi Folks,

as of november last year the ERC (European Rescucitation Council) in cooperation with the AHA and ILCOR (International Liaision Comitee on Rescucitation) issued new ALS guidelines.
A few changes have been implemented compare to the guidelines issued in 2000, some of them rather minor, some of which I think of rather major changes.

First and foremost - apart from changing the compression:ventilation ratio to 30:2 with no initial 2 ventilations - they totally changed our algorhythm on defibrillation. Prior to 2000 it took them years to brainwash us, that defibrillation was the most important and most efficiant procedure in an arrest situtation. They started AED courses for lay people and implemented public acces AEDs all over the place (still not even close to the number of AEDs you have in america, but at least airports and a lot public buildings) and never did they stop telling us how important and life saving those shocks were.
However now, the 2005 guidelines tell us that defibrillation is to be postponed until at least 2 minutes of CPR have been performed on a non-witnessed cardiac arrest situation.
So its basically like this, if the downtime is greater than 5 minutes (which it usually is, since we need some time to get to the scene), we are to perform at least 2 minutes of CPR prior to defibrillation on any shockable rhytmform.
If the arrest is witnessed however our first course of action is to defibrillate.

Do you guys handle it the same? And what are your thoughts on this?
I'm really interested in what you folks have to say to this.

[PSYCtest040]

Hi Folks,

as of november last year the ERC (European Rescucitation Council) in cooperation with the AHA and ILCOR (International Liaision Comitee on Rescucitation) issued new ALS guidelines.
A few changes have been implemented compare to the guidelines issued in 2000, some of them rather minor, some of which I think of rather major changes.

First and foremost - apart from changing the compression:ventilation ratio to 30:2 with no initial 2 ventilations - they totally changed our algorhythm on defibrillation. Prior to 2000 it took them years to brainwash us, that defibrillation was the most important and most efficiant procedure in an arrest situtation. They started AED courses for lay people and implemented public acces AEDs all over the place (still not even close to the number of AEDs you have in america, but at least airports and a lot public buildings) and never did they stop telling us how important and life saving those shocks were.
However now, the 2005 guidelines tell us that defibrillation is to be postponed until at least 2 minutes of CPR have been performed on a non-witnessed cardiac arrest situation.
So its basically like this, if the downtime is greater than 5 minutes (which it usually is, since we need some time to get to the scene), we are to perform at least 2 minutes of CPR prior to defibrillation on any shockable rhytmform.
If the arrest is witnessed however our first course of action is to defibrillate.

Do you guys handle it the same? And what are your thoughts on this?
I'm really interested in what you folks have to say to this.

If you usend me yor e-mail address I have a pdf document from the AHA websit that explaines all the changes. I tried to upload to the fourm but it exceeds the file limit.

[PSYCtest040]

Here is the link to the AHA Currents winter 2005-2006 issue. There is a pdf document that has a lot of good information why the changes were made and the data backing up the changes. Let me know if this helps.


http://www.americanheart.org/presenter.jhtml?identifier=3035674

[fishy]

Ah, thanks for the link. I just briefly overread it and i like the layout (old vs. new --> why?). I just came home from nightshift, so i'll read it as soon as i get some sleep.

If you are interested in our guidelines check: www.erc.edu
to download the pdf's you will have to register, but registration is free of charge.

Check back with you later

[tom10406]

We got the same updates in Canada, at least in Ontario. Gotta stay in shape now, to be able to survive doing CPR on someone. They have also recomended doing CPR for at least 1 min prior to the first d-fib, as well as some changes in compression technique.

[PSYCtest040]

We got the same updates in Canada, at least in Ontario. Gotta stay in shape now, to be able to survive doing CPR on someone. They have also recomended doing CPR for at least 1 min prior to the first d-fib, as well as some changes in compression technique.

Aahhh it's not too bad, worked four codes with my ALS partner and I survived. Two of the transports were over 15 miles to nearest hospital. Unfortunetly onle one survived.

Taught a CPR class last week to a bunch of brand new CNA's, talk about a bunch of deer caught in the headlights. Teaching the class now is easy but the CNA's must have been blonde in a past life.:BangHead:

[hackmedic]

Yeah we have the new protocols also, personally i think they are a bunch of BS!, guess I'm (hate to sat it) too old school. I lost all respect for the AHA when the put Cordaron (sp?) in the ACLS algoryhthm, Can we say pay off?

[Unregistered]

the most effective thing that i have seen during a witnessed cardiac arrest (asystole) is a "pericardial thump." usually works on the first shot. ive also heard of a patient vagaling down (on their own) which brought them out of V Fibb and into a normal sinus rhythm.

[Fred Flintstone]

Hey, the AHA has to sell those books!

The AHA seems to have a habit of changing something about once every 5 years (not sure if that is the EXACT interval.......it just seems that way to me).

Last time they made a bunch of changes and then sold it to everyone with their propaganda pages full of research that "proved their position".......... so to speak.

Everyone jumped on board, and we all were relieved with the knowledge that we were finally "doing it right."

Now they've gone and made a bunch of changes again to tell us all that we've been doing it wrong for the past..........however many years and now FINALLY this is the RIGHT way to do things!

BULLSHIT!

Look............don't take my post the wrong way..........I believe in the ultimate mission of the AHA. I understand what they're trying to do, and I support their continuing research and development.

However.........It seems to me that the AHA downplays the fact (with the exception of the Asystole algorithm) that once someone is in cardiac arrest......you're already behind the 8 ball.

We can try, and try, and try...........but the fact of the matter is: if it's their turn to die.......they're gonna die.......no matter how many new types of revolutionary drugs that we pump into them, or how many joules we defibrillate them with, or how many compressions we do before we give them a breath.

I guess the point of this small rant is as follows: Take the new information......digest it........use it appropriately (please, especially if you will get in trouble for not doing so).........and above all else, use your best clinical judgement.

I doesn't matter...........in the next five years we'll probably be giving high-dose epinephrine again because some professor, who is also an AHA resuscitation council (if that's what they call it) member, had to publish some type of research study to keep his tenure at some hoity-toity prestegious medical school.

[kojoff]

I started out thinking that CPR is intended to bring some one back from the brink of death. Ive begun to realize that it is not only an attempt to restart the heart, but also to keep a organ donors organs alive. Just a brain fart. Ill shut up now.

[CombatMedic]

I have just been reading some of the posts that are here. I just have a few things to put in my self

I am an AHA BLS for HCP Instructor. I understand that the changes are making it hard on us as providers. Also remember for the update training that you have to eventually go through, instructors have already been through. But we have it worse. We have to be able to explain to students. Then we have to go out and buy new instructor materials and student books if the local college does not have them available.

I have read the reports and the studies. I can see the reasoning behind the changes. There is some good ideas here and I can see the reasons behind the research.

As for the idea of them doing it for making more money off the new books, think of it this way. The change the books for EMS and Firefighting every year or so. A lot of the materials are still the same, but the book changes. They may rearrange the chapters and add some color pictures instead of Black and white.

Those are just some of my rants on this issue.

[Fred Flintstone]

I was an AHA CPR instructor as well. My reasons for giving it up are twofold:

One, I didn't really care for how strict the service I taught for was. They really broke your balls about your paperwork, class size, etc.

Two, I make more money working an overtime shift on the truck. That is mindless. Getting up in front of a bunch of doctors, nurses, and paramedics who don't want to be in the class to begin with sucks.

My post was my opinion........that's all. I have no research to back up my opinion, nor do I pretend to know more about resuscitation than the people who work for the AHA. They've forgotten more than I'll ever know about resuscitation.

I was simply pointing out some observations that I've made, over time, as an experienced provider.

Medicine is a constantly evolving field. There are always new ideas and procedures out there to attempt to prolong death. I just think that worrying about it as much as everyone does is a sort of mental masturbation.

[ghettoredneck4205]

Yeah we have the new protocols also, personally i think they are a bunch of BS!, guess I'm (hate to sat it) too old school. I lost all respect for the AHA when the put Cordaron (sp?) in the ACLS algoryhthm, Can we say pay off?
We have been using amiodarone (cordarone) for several years now and to be honest i like it better than lidocaine. It works better on quite a few (not all but quite a few) vf/vt patients i've had. Of course if you don't get there early all you are going to have is asystole anyway.

[paramortis]

As for the idea of them doing it for making more money off the new books, think of it this way. The change the books for EMS and Firefighting every year or so. A lot of the materials are still the same, but the book changes. They may rearrange the chapters and add some color pictures instead of Black and white.

Those are just some of my rants on this issue.

I have to agree with CombatMedic on this one. I brought up the subject to my mom who started being a nurse in the early 60's. She told me that the 'new' guidelines were the same ones, about, that she had when she first started being a nurse. I think they just change them every two years just to get more money.
Also, why should my medic license not be valid if my ACLS cert is good and not my CPR? I can shock, intubate, push drugs, but I can't pound on a mouth and blow on a chest? Wait, that's BLOW on a mouth and POUND on a chest... never mind.

[PSYCtest040]

Also, why should my medic license not be valid if my ACLS cert is good and not my CPR? I can shock, intubate, push drugs, but I can't pound on a mouth and blow on a chest? Wait, that's BLOW on a mouth and POUND on a chest... never mind.

Try this. Why is it since I'm an AHA CPR instructer and my CPR card is only three months old, I have to take CPR for my intermediate class? Tjhe kicker is it's ARC not AHA.

[kjrff23]

Try this. Why is it since I'm an AHA CPR instructer and my CPR card is only three months old, I have to take CPR for my intermediate class? Tjhe kicker is it's ARC not AHA.

It's all a big plot to make money. When I was an instructor I used to run into the same problem when I needed a first aid card from ARC and I'd tell then I'm an AHA Instructor Trainer (pre NSC merger) and and EMT. I'd get " Sorry we need the ARC card as a prerequsite." Then I would generally tell them what I thought of them....

[PSYCtest040]

It's all a big plot to make money. When I was an instructor I used to run into the same problem when I needed a first aid card from ARC and I'd tell then I'm an AHA Instructor Trainer (pre NSC merger) and and EMT. I'd get " Sorry we need the ARC card as a prerequsite." Then I would generally tell them what I thought of them....

I'm trying to talk the instructor into beig excussed. As far as I know the pre req for class is having a valid BLS and CPR card which I do. The CPR card is good for the new updates and I've instructed the new updates. Now where dose it mention it has to be ARC or AHA just a valid CPR card. Aggggggggggg stupidity is so frustrating.

[jdemaio]

I am convinced that the AHA hates us.

[kjrff23]

I am convinced that the AHA hates us.

The thing that scares me is that some of the things the ARC does are not too intelligent. The AHA has their act together but they want you to have a separate card for everything, CPR, F/A, ACLS, PALS.... And I can't see charging people a ridiculous amount of money like $30 or $40 to teach them a skill (CPR) that all of us on the street can benefit from. I always taught my classes for cost.