My highlights from the Scientific Symposium 2015
On the 26th November I attended the Resuscitation Council’s Scientific Symposium where the new guidelines were discussed. There are no new numbers to remember but there has been some clarification and terminology strengthened. These are my highlights:-
Be aware if someone appears to have a fit
When I’m training I always talk about recognising agonal breathing. Now we are also asked to be vigilant if anyone appears to have a seizure. In the immediate moments after a cardiac arrest someone can fit due to the hypoxia (lack of oxygen) and some people have not been given CPR when they need it. Therefore please make sure they are breathing before putting them into the recovery position.
AED now part of BLS
In the past there has been a Basic Life Support (BLS) algorithm and a separate algorithm for AED. This is no longer the case and there is now only one algorithm for BLS and AED. What does this mean for practise? It means that should you be required to give someone CPR that if an AED is immediately available that you use that without delay, or that we ask a bystander to access an AED. They are often in stations, sometimes in rural areas and most GP, Dental or Health centres will have one. They are designed to be used by someone with little or no training and are very easy. Have a look at Lifesaver for an example.
If shocked within 0-2 minutes then survival rate is 71%
I’m often asked what is the real benefit of defibrillation. There was some research presented that showed that if you are defibrillated within 2 minutes the survival rate is 71%. This is a clear case for having easier access to defibrillators and more community responders.
35% survived to discharge if their cardiac arrest is witnessed, they get CPR and AED within 2 minutes and appropriate ambulance response
Receiving bystander CPR doubles the chances of survival; add AED to that and the survival rate is 35%. Many people don’t get bystander CPR. The charities joined together for the Every Child a Lifesaver campaign but unfortunately this bill did not make it through parliament. This doesn’t mean that we can’t teach our children, it doesn’t meant that you can’t learn. If you learn CPR for your job then consider sharing this information with your friends and family. Use cushions if you need to! Or use tools such as Lifesaver.
30:2 in Paediatrics
I teach paediatric (child and infant) basic life support to my Practices. It’s always a bit confusing in GP practices over what ratio is best for them. This has now been clarified and unless you expect to resuscitate a child as part of your role then use the adult algorithm with the modifiers eg 5 breaths before compressions.
Ensure full recoil of chest
The depth of the compressions has not changed in adults it-s 5-6cm, in children over 1 it’s 5cm and in infants it’s 4cm. Rescuers rarely push further than 5-6 cm so if doing CPR it is a case for ‘pushing hard’. The clarification has been around ensuring that the chest is allowed to fully recoil. This is something I see when training – people lean onto the chest and don’t allow it to come fully up in between each compression; so make sure you allow full recoil.
Any pause in CPR is bad
When we pause compressions for what ever reason then the pressure in the chest drops; we know, for example, that compression ’15’ is more effective than compression ‘1’. We therefore need to work hard to minimise any pauses, research has shown that people who suffer prolonged or additional pauses do less well. This can be difficult when using an AED so it’s important that we minimise any pauses that we can:-
- work around the person delivering chest compressions when putting pads on
- as soon as the shock is delivered immediately restart compressions
- if giving breaths this needs to take no longer than 10 seconds
- continue CPR until they clearly show a sign of life or your help is ready to take over
- co-ordinate swapping rescuers
“Call upon everyone with an AED to register it with local Ambulance Service”
The Resuscitation Council are asking all owners of defibrillators to register them with their local ambulance services so that they can be deployed if needed in the immediate area. I’ve spoken to my local ambulance service and they assure me that if an AED is used in the community then they will replace the pads. The other advantage of registering your AED is that if you phone 999 they will know you have an AED on the premises and the Dispatcher will assist you.
Titrate oxygen to 94-98%
In 2008 and the British Thoracic Society produced guidelines around the use of oxygen. As trainers we have continued to advise that if someone is acutely unwell that the appropriate thing is to give them oxygen. There has been further work around the use of oxygen and the production of free radicals and we now know that giving high flow oxygen to someone who is having a heart attack can increase the size of the infarct.
This was therefore discussed and clarified; if giving oxygen we should be measuring oxygen saturations and aiming for a saturations level of 94-98%. This is especially important with patients complaining of cardiac type chest pain.
Therefore I’m encouraging my Practices to consider purchasing a Pulse Oximeter of which there are many cheap and simple varieties on the market.
6 monthly training better than annual
The other point made was that frequent training is better than infrequent. With infrequent considered to be more than 6 monthly intervals. You don’t have to now do your training every 6 months but be mindful that it’s a good idea to refresh your skills. I blogged about how to keep up to date previously, but you run drills or use Lifesaver for example.
This is my quick summary of a whole day conference. If you have any questions or comments please get in touch.
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