2015 ALS Guidelines update. Is there something new (and good)? What really changes in our daily practice.
SOURCE: MEDEST118 – Who read the previous post, Evidence Based Medicine. Beyond the dogma, can understand how my attention is focused on applicability of EBM based guidelines in my clinical context, so I want to underline some controversy of these guidelines, and at the same time, to introduce which are the most relevant statements for my clinical practice and for the way we want to evolve our local prehospital emergency system.
First of all the things you already heard almost everywhere over the blogsphere.
Minor, and not so relevant, changes. Minor influence on clinical practice. Just a reinforcement to key messages issued on the previous version of the guidelines.
Let’s get deep into the guidelines :
The quality of chest compressions is now well specified. Push at least 5 cm but no more than 6 cm. Rate at least 100, maximum 120 per minute. So to assess quality of compressions (and of the whole CPR) you need a metronome and a commercial feedback device (acoustic or visive) to calculate compressions rate and deepness. I suggest capnography as alternative method to monitor chest compression quality.
Great emphasis is given to minimising interruption of chest compressions. So why not to introduce the hands only CPR at least at the beginning of resuscitation? There are good evidence for good neurological outcomes with this technique (associated to unsynchronised ventilation) and these guidelines lost the chance to make a real change on the way to a better patient centred care.
Epinephrine at 1 mg dose every 3-5 minutes is still on board despite no evidence on improving outcome (and some signal toward the detrimental side of the story). For sure such a massive dose of vasoactive drug in a patient with low flow state and low metabolic activity, when circulation restart is a big issue for the heart and the brain. Pramedic 2 trial is ongoing and will give us more definitive answers.
PEA and asystole are still considered similar entity and have a common algorithm. This is wrong, and we already treated this topic (Forget ACLS guidelines if you are dealing with Pulseless Electric Activity. Part 1. Forget ALS Guidelines when dealing with PEA. Part 2.). 2015 Guidelines reiterated this controversy… CONTINUE