Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Basic Life Support
Passive Ventilation Techniques
Minimizing Pauses in Chest Compressions
CPR During Transport
BLS Task Force Interpretation of Available Evidence for CPR Quality Outcomes
|Correct hand positioning||Transport appears to have little impact on cor- rect hand positioning.|
|Chest compression rate||Appropriate chest compression rates can be achieved during transport; however, there is greater variation in chest compression rate dur- ing transport compared with at the scene.|
|Chest compression depth||Appropriate chest compression depth can be achieved during transport; however, there is greater variation in chest compression depth during transport compared with at the scene.|
|Pauses||Transport appears to have little impact on extending pauses.|
|Leaning on the chest/ incomplete release||Transport appears to have little impact on complete release.|
|CPR fraction||There is significant variation in chest compres- sion fraction. Transport appears to have a nega- tive impact on chest compression fraction.|
|Ventilation||Transport appears to have little impact on ventilation rates.|
|Overall correct CPR||There is significant variation in overall correct CPR. Transport appears to have a negative impact on overall correct CPR.|
C-A-B or A-B-C in Drowning
BLS Unchanged Recommendations
Basic Life Support Unchanged Recommendations in 2022
|Topic/PICO||Existing treatment recommendation|
|ALS-E-030A Paddle size and placement for defibrillation||It is reasonable to place pads on the exposed chest in an anterior-lateral position. An accept- able alternative position is anterior posterior. In large-breasted individuals, it is reasonable to place the left electrode pad lateral to or below the left breast, avoiding breast tissue. Consid- eration should be given to the rapid removal of excessive chest hair before the application of pads, but emphasis must be on minimizing delay in shock delivery.
There is insufficient evidence to recommend a specific electrode size for optimal external
defibrillation in adults. However, it is reasonable to use a pad size >8 cm.
|BLS 342 Barrier devices||Providers should take appropriate safety pre- cautions when feasible and when resources are available to do so, especially if the subject is known to have a serious infection (for ex- ample, HIV, tuberculosis, HBV, or SARS).|
|BLS 343 Chest compres- sion rate||We recommend a manual chest compression rate of 100–120/min (strong recommendation, very low–certainty evidence).|
|BLS 345 Rhythm check timing||We suggest immediate resumption of chest compressions after shock delivery for adults in cardiac arrest in any setting (weak recommen- dation, very low–certainty evidence).|
|BLS 346 Timing of CPR cycles (2 min vs other)||We suggest pausing chest compressions every 2 min to assess the cardiac rhythm (weak rec- ommendation, low-certainty evidence).|
|BLS 347 Public-access AED programs||We recommend the implementation of PAD programs for patients with OHCA (strong rec- ommendation, low-certainty evidence).|
|BLS 348 Check for circulation during BLS||Outside of the ALS environment, when invasive monitoring is available, there are insufficient data on the value of a pulse check while per- forming CPR. We therefore do not make a treatment recommendation for the value of a pulse check.|
|BLS 349 Rescuer fatigue in CCO-CPR||We recommend no modification to current CCO-CPR guidelines for cardiac arrest to miti- gate rescuer fatigue (strong recommendation, very low–certainty evidence).|
|BLS 353 Harm from CPR to victims not in arrest||We recommend that laypeople initiate CPR for presumed cardiac arrest without concerns of harm to patients not in cardiac arrest (strong recommendation, very low–certainty evidence).|
|BLS 354 Harm to rescu- ers from CPR||Evidence supporting rescuer safety during CPR is limited. The few isolated reports of adverse effects resulting from the widespread and frequent use of CPR suggest that perform- ing CPR is relatively safe. Delivery of a defibril- lator shock with an AED during BLS is also safe. The incidence and morbidity of defibrilla- tor-related injuries in the rescuers are low.|
|BLS 357 Hand position during compres- sions||We suggest performing chest compressions on the lower half of the sternum on adults in cardiac arrest (weak recommendation, very low–certainty evidence).|
|BLS 359 Dispatch- assisted CCO-CPR vs conventional CPR||We recommend that dispatchers provide CCO-CPR instructions to callers for adults with suspected OHCA (strong recommenda- tion, low-certainty evidence).|
|BLS 360 EMS CCO-CPR vs conven- tional CPR||We recommend that EMS providers perform CPR with 30 compressions to 2 breaths (30:2 ratio) or continuous chest compressions with PPV delivered without pausing chest compres- sions until a tracheal tube or supraglottic de- vice has been placed (strong recommendation, high-certainty evidence).
We suggest that when EMS systems have adopted minimally interrupted cardiac resusci- tation, this strategy is a reasonable alternative to conventional CPR for witnessed shockable OHCA (weak recommendation, very low– certainty evidence).
|BLS 362 CV ratio||We suggest a CV ratio of 30:2 compared with any other CV ratio in patients with cardiac ar- rest (weak recommendation, very low–quality evidence).|
CPR before defibrillation
|We suggest a short period of CPR until the defibrillator is ready for analysis or defibrillation in unmonitored cardiac arrest (weak recom- mendation, low-certainty evidence).|
|BLS 366 Chest compres- sion depth||We recommend a chest compression depth of »5 cm (2 in; strong recommendation, low- certainty evidence) while avoiding excessive chest compression depths (>6 cm [>2.4 in] in an average adult) during manual CPR (weak recommendation, low-certainty evidence).|
|BLS 367 Chest wall recoil||We suggest that rescuers performing manual CPR avoid leaning on the chest between com- pressions to allow full chest wall recoil (weak recommendation, very low–quality evidence).|
|BLS 368 Foreign-body airway obstruc- tion||We suggest that backslaps be used initially in adults and children with a foreign-body airway obstruction and an ineffective cough (weak recommendation, very low–certainty evidence).
We suggest that abdominal thrusts be used in adults and children (>1 y of age) with a foreign-body airway obstruction and an inef- fective cough when backslaps are ineffective (weak recommendation, very low–certainty evidence).
We suggest that rescuers consider the man- ual extraction of visible items in the mouth (weak recommendation, very low–certainty evidence).
We suggest against the use of blind finger sweeps in patients with a foreign-body airway obstruction (weak recommendation, very low– certainty evidence).
We suggest that appropriately skilled health care providers use Magill forceps to remove a foreign-body airway obstruction in patients
with OHCA resulting from foreign-body airway obstruction (weak recommendation, very low– certainty evidence).
We suggest that chest thrusts be used in unconscious adults and children with a foreign- body airway obstruction (weak recommenda- tion, very low–certainty evidence).
We suggest that bystanders undertake in- terventions to support foreign-body airway obstruction removal as soon as possible after recognition (weak recommendation, very low– certainty evidence).
We suggest against the routine use of suction- based airway clearance devices (weak recom- mendation, very low–certainty evidence).
|BLS 370 Firm surface for CPR||We suggest performing chest compressions on a firm surface when possible (weak recom- mendation, very low–certainty evidence)
During IHCA, we suggest that when a bed has a CPR mode that increases mattress stiffness, it should be activated (weak recommendation, very low–certainty evidence).
During IHCA, we suggest against moving a pa- tient from the bed to the floor to improve chest compression depth (weak recommendation, very low–certainty evidence).
During IHCA, we suggest in favor of either a backboard or no-backboard strategy to improve chest compression depth (conditional recom- mendation, very low–certainty evidence).
|BLS 372 In-hospital CCO-CPR vs conventional CPR||Whenever tracheal intubation or an SGA is achieved during in-hospital CPR, we suggest that providers perform continuous compres- sions with PPV delivered without pausing chest compressions (weak recommendation, very low–certainty evidence).|
|BLS 373 Analysis of rhythm during chest compression||We suggest against the routine use of artifact- filtering algorithms for analysis of electrocardio- graphic rhythm during CPR (weak recommen- dation, very low–certainty evidence).
We suggest that the usefulness of artifact- filtering algorithms for analysis of electrocar- diographic rhythm during CPR be assessed in clinical trials or research initiatives (weak recommendation, very low–certainty evi- dence).
|BLS 374 Alternative compression techniques (cough, precor- dial thump, fist pacing)||We recommend against the routine use of cough CPR for cardiac arrest (strong recom- mendation, very low–certainty evidence).
We suggest that cough CPR may be consid- ered only as a temporizing measure in excep- tional circumstance of a witnessed, monitored IHCA (for example, in a cardiac catheterization laboratory) if a nonperfusing rhythm is recog- nized promptly before loss of consciousness (weak recommendation, very low–certainty evidence).
We recommend against fist pacing for cardiac arrest (strong recommendation, very low– certainty evidence).
We suggest that fist pacing may be consid- ered only as a temporizing measure in the exceptional circumstance of a witnessed, monitored IHCA (for example, in a cardiac catheterization laboratory) attributable to bradyasystole if such a nonperfusing rhythm is recognized promptly before loss of con- sciousness (weak recommendation, very low–certainty evidence).
We recommend against the use of a precordial thump for cardiac arrest (strong recommenda- tion, very low–certainty evidence).
|BLS 546 Tidal volumes and ventilation rates||For mouth-to-mouth ventilation for adult victims using exhaled air or bag-mask ventilation with room air or oxygen, it is reasonable to give each breath within a 1-s inspiratory time and with a volume of »600 mL to achieve chest rise. It is reasonable to use the same initial tidal volume and rate in patients regardless of the cause of the cardiac arrest.|
|BLS 547 Lay rescuer CCO-CPR vs conventional CPR||We continue to recommend that bystanders perform chest compressions for all patients in cardiac arrest (good practice statement).
We suggest that bystanders who are trained, able, and willing to give rescue breaths and chest compressions do so for all adult patients in cardiac arrest (weak recommendation, very low–certainty evidence).
|BLS 661 Starting CPR (C-A-B vs A- B-C)||We suggest starting CPR with compressions rather than ventilation in adults with cardiac ar- rest (weak recommendation, very low–certainty evidence).|
|BLS 740 Dispatcher recognition of cardiac arrest||We recommend that dispatch centers imple- ment a standardized algorithm or standardized criteria to immediately determine whether a patient is in cardiac arrest at the time of emer- gency call (strong recommendation, very low– certainty evidence).
We suggest that dispatch centers monitor and track diagnostic capability.
We suggest that dispatch centers look for ways to optimize sensitivity (minimize false- negatives).
We recommend high-quality research that ex- amines gaps in this area.
|BLS 811 Resuscitation care for sus- pected opioid- associated emergencies||We suggest that CPR be started without delay in any unconscious person not breathing nor- mally and that naloxone be used by lay rescu- ers in suspected opioid-related respiratory or circulatory arrest (weak recommendation based on expert consensus).|
|BLS 1527 CPR before call for help||We recommend that a lone bystander with a mobile phone should dial EMS, activate the speaker or other hands-free option on the mo- bile phone, and immediately begin CPR with dispatcher assistance if required (strong rec- ommendation, very low–certainty evidence).|
|BLS Video- Based Dispatch Systems||We suggest that the usefulness of video-based dispatch systems be assessed in clinical trials or research initiatives (weak recommendation, very low–certainty evidence).|
|BLS Head-Up CPR||We suggest against the routine use of head-up CPR during CPR (weak recommendation, very low–certainty evidence).
We suggest that the usefulness of head-up CPR during CPR be assessed in clinical trials or research initiatives (weak recommendation, very low–certainty evidence).
Advanced Life Support
Temperature Management After Cardiac Arrest
POCUS as a Diagnostic Tool During Cardiac Arrest
Use of Vasopressin and Corticosteroids During Cardiac Arrest
Post–Cardiac Arrest Coronary Angiography
ALS Unchanged Recommendations
Advanced Life Support Unchanged Recommendations in 2022
|Topic/PICO||Existing treatment recommendation|
|ALS 659 Vasopressors during cardiac arrest||We recommend administration of epinephrine during CPR (strong recommendation, low- to moderate-certainty evidence).
For nonshockable rhythms (PEA/asystole), we recommend administration of epinephrine as soon as feasible during CPR (strong recommendation, very low–certainty evidence).
For shockable rhythms (VF/pVT), we suggest administration of epinephrine after initial defibrillation attempts are unsuccessful during CPR (weak recommendation, very low–certainty evidence).
We suggest against the administration of vasopressin in place of epinephrine during CPR (weak recommendation, very low– certainty evidence).
We suggest against the addition of vasopressin to epinephrine during CPR (weak recommendation, low-certainty evidence).
|ALS 581 Cardiac arrest from PE||We suggest administering fibrinolytic drugs for cardiac arrest when PE is the suspected cause of cardiac arrest (weak rec- ommendation, very low–certainty evidence).
We suggest the use of fibrinolytic drugs, surgical embolec- tomy, or percutaneous mechanical thrombectomy for cardiac arrest when PE is the known cause of cardiac arrest (weak recommendation, very low–certainty evidence).
The role of extracorporeal life support (ECPR) techniques was addressed in the 2019 ILCOR CoSTR.
We suggest that ECPR may be considered as a rescue therapy for selected patients with cardiac arrest when conven- tional CPR is failing in settings in which it can be implemented (weak recommendation, very low–certainty evidence).
Pediatric Life Support
PEWSs With or Without Rapid Response Teams
PLS Unchanged Recommendations
Pediatric Life Support Unchanged Recommendations in 2022
|Topic/PICO||Existing treatment recommendation|
|Peds 709 Sequence of chest compressions and ventilations: C-A-B vs A-B-C||The confidence in effect estimates is so low that the panel decided a recommendation was too speculative.|
|Peds 414 CCO-CPR vs conventional CPR||We recommend that rescuers provide rescue breaths and chest compressions for pediatric IHCA and OHCA. If rescuers cannot provide rescue breaths, they should at least perform chest compressions (strong recommendation, low-quality evidence).|
|PLS new Drugs for the treatment of bradycardia||Epinephrine may be administered to infants and children with bradycardia and poor perfu- sion that is unresponsive to ventilation and oxygenation. It is reasonable to administer atropine for bradycardia caused by increased vagal tone or anticholinergic drug toxicity.
There is insufficient evidence to support or refute the routine use of atropine for pediatric cardiac arrest.
|PLS new Emergency transcutaneous pacing for bradycardia||In selected cases of bradycardia caused by complete heart block or abnormal function of the sinus node, emergency transthoracic
pacing may be lifesaving. Pacing is not helpful in children with bradycardia secondary to a postarrest hypoxic/ischemic myocardial insult or respiratory failure. Pacing was not shown to be effective in the treatment of asystole in children.
|Peds 407 ECPR for pediatric cardiac arrest||We suggest that ECPR may be considered as an intervention for selected infants and children (for example, cardiac populations) with IHCA refractory to conventional CPR in settings in which resuscitation systems allow ECPR to be well performed and implemented (weak recommendation, very low–certainty evidence).
There is insufficient evidence in pediatric OHCA to formulate a treatment recommenda- tion for the use of ECPR.
|PLS, part of nodal ALS 2046 Intraosseous versus intravenous route of drug administration||Intraosseous cannulation is an acceptable route of vascular access in infants and children with cardiac arrest. It should be considered early in the care of critically ill children whenever venous access is not read- ily available.|
|Sodium bicarbon- ate administration for children in cardiac arrest (PLS 388)||Routine administration of sodium bicarbonate is not recommended in the management of pediatric cardiac arrest.|
|TTM*||The PLS Task Force recommendations from 2020 for the pediatric population remain unchanged in 2021, with minor wording clari- fication of temperature targets:
We suggest that for infants and children who remain comatose after ROSC from OHCA or IHCA, active control of temperature be used to maintain a central temperature £37.5° C (weak recommendation, moderate-certainty evidence). There is inconclusive evidence
to support or refute the use of induced hypothermia (32° C–34° C) compared with active control of temperature at normothermia (36° C–37.5° C; or an alternative temperature) for children who achieve ROSC but remain comatose after OHCA or IHCA.
Neonatal Life Support
Maintaining Normal Temperature Immediately After Birth in Late Preterm and Term Infants
Suctioning Clear Amniotic Fluid at Birth
Tactile Stimulation for Resuscitation Immediately After Birth
Delivery Room Heart Rate Monitoring to Improve Outcomes for Newborn Infants
CPAP Versus No CPAP for Term Respiratory Distress in the Delivery Room
SGAs for Neonatal Resuscitation
Respiratory Function Monitoring During Neonatal Resuscitation at Birth
Education, Implementation, and Teams
Prearrest Prediction of Survival After IHCA
BLS Training for Likely Rescuers of High-Risk Populations
Patient Outcome and Resuscitation Team Members Attending ALS Courses
Blended Learning for Life Support Education
Faculty Development Approaches for Life Support Courses
Interventions to Improve Instructional Competence
|Internet-based||Comparing internet-based AHA CIC with tradi- tional classroom-based AHA CIC||There was no difference in pretest and posttest practical scores. Candidates in the online group had significantly higher adjusted posttest scores.|
|Train-the-trainer courses||Instructor course with train-the-trainer model, sending the “trained trainers” to deliver further resuscitation training||Train-the-trainer programs may be effective in improving resuscitation knowledge and skills and are important for developing local expertise.|
|System-wide instructor training program||Retrospective analysis of 24 pediatric and neona- tal CPR instructor courses certified by the Span- ish Paediatric and Neonatal Resuscitation Group, held between 1999 and 2019||A specific pediatric and neonatal CPR instructor course is an adequate method for sustainable training of health pro- fessionals to teach pediatric resuscitation.|
|Modified instructor course with lectures, instruction practice, and self-developed resuscitation scenarios||New instructor course compared with conven- tional training||There was improved confidence in teaching neonatal CPR when participating in the new course.|
|Web-based questionnaire survey for instructors||Web-based survey with a 29-item Competence Importance Performance scale||Several important factors for the competence of instructors were identified.|
|Assessment for chest compression with real-time compression feedback||Real-time compression feedback||There were improved chest compression performance skills with real-time feedback without comparable improvement in chest compression assessment skills in video review.|
|Assessment for chest compression with self-learning||Recorded chest compressions by motion-capture camera||There was improved ability of novice instructors to assess chest compressions after self-training, but it does not equal that of experienced instructors.|
|Delivery of BLS training using fully-body sensor-equipped manikins||Use of sensor-equipped manikins for accredited instructors asked to deliver BLS training||Instructors felt that the manikins were useful and felt confi- dent when delivering the course, and that may be beneficial to a trainer’s perception.|
|Teaching skills enhancement|
|Different feedback method383||Learning conversation structured methods of feedback delivery in BLS training, compared with the sandwich technique (that is, positive feed- back—negative feedback—positive feedback)||Using learning conversation structured methods by instruc- tors was preferred over using the sandwich technique by instructors, and may give instructors more confidence.|
|Using standardized script by novice instruc- tors to facilitate team debriefing386||Use of scripted debriefing by novice instructors or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests.||Use of a standardized script to debrief by novice instructors improved students’ knowledge acquisition and team leader behavioral performance during subsequent simulated car- diopulmonary arrests.|
|Tape recording and a later critical viewing of a lecture390||Record the lecture provided by BLS/AED or ALS instructor candidates with a tape, a later video review, and oral self-assessment.||The opinion of all participants was positive when they were asked about comparing their subjective impressions with the objective viewing.|
|Additional course for instructors|
|Educational program to teach ACLS instructors to evaluate team leader performance389||Educational program to review commonly ob- served errors and to identify critical errors||Trained instructors identified more critical errors and gave more correct grade assignments.|
|ATP||ATP as additional training, focusing on decision making in equivocal situations||Trained instructors were less prone to incorrectly giving fail- ing scores to candidates.398 Instructors with additional train- ing were significantly more confident at assessing.397|
|Neonatal resuscitation workshop||2-d neonatal resuscitation workshop||There were significant improvements in participants’ per- ceptions of their teaching ability.|
|Clinical teacher-training course/workshop (enhance teaching skills and methods)||2-d BLS and emergency medicine teacher- training program||Students taught by untrained teachers performed better in some domains. Teaching quality was rated significantly bet- ter by students of untrained teachers.|
Education, Implementation, and Teams Topics Reviewed by EvUps
|Topic/PICO||Existing treatment recommendation|
|EIT 626 Willingness to provide CPR||To increase willingness to perform CPR, laypeople should receive training in CPR. This training should include the recognition of gasping or abnormal breathing as a sign of cardiac arrest when other signs of life are absent. Laypeople should be trained to start resuscitation with chest compres- sions in adult and pediatric victims. If unwilling or unable to perform ventilation, rescuers should be instructed to continue CCO-CPR. EMS dispatch- ers should provide CPR instructions to callers who report cardiac arrest. When providing CPR instruc- tions, EMS dispatchers should include recognition of gasping and abnormal breathing.|
|EIT 631 Team and leadership training||We suggest that specific team and leadership training be included as part of ALS training for health care providers (weak recommendation, very low–certainty evidence).|
|EIT 638 Rapid response sys- tems in adults||We suggest that hospitals consider the introduc- tion of a rapid response system (rapid response team/medical emergency team) to reduce the in- cidence of IHCA and in-hospital mortality (weak recommendation, low-quality evidence).|
|EIT 641 Community initiatives to promote BLS implementation||We recommend implementation of resuscita- tion guidelines within organizations that provide care for patients in cardiac arrest in any setting (strong recommendation, very low–quality evi- dence).|
|EIT 645 and NLS 1562 Debriefing of resuscitation performance||EIT 645:
We suggest data-driven, performance-focused debriefing of rescuers after IHCA for both adults and children (weak recommendation, very low– certainty evidence).
We suggest data-driven, performance-focused debriefing of rescuers after OHCA in both adults and children (weak recommendation, very low– certainty evidence).
There was no previous treatment recommenda- tion on the topic. This ScopRev did not identify sufficient evidence to prompt a SysRev.
|EIT 1601 Spaced vs massed learning||For learners undertaking resuscitation courses, we suggest that spaced learning (training or retraining distributed over time) may be used instead of massed learning (training provided at 1 single time point; weak recommendation, very low–certainty evidence).|
The Recovery Position for Maintenance of Adequate Ventilation and the Prevention of Cardiac Arrest
Topics Reviewed by EvUps
|Topic/PICO||Existing treatment recommendation|
|FA 202 Oral dilution for caustic substance ingestion||Administration of a diluent in FA may be considered if a caustic substance has been ingested, if advised to do so by a health care provider (weak recommendation, very low– certainty evidence|
|FA 503 Recognition of anaphylaxis||FA providers should not be expected to recognize the signs and symptoms of anaphylaxis without repeated episodes of training and encounters with victims of anaphylaxis.|
|FA 511 Compression wraps for acute closed ankle joint injury||We suggest either application of a compression bandage or no application of a compression bandage for adults with an acute closed ankle joint injury (weak recommendation, very low–certainty evidence).
Because of a lack of identified evidence, we are unable to recommend for or against use of a compression bandage for closed joint injuries besides the ankle.
|FA 525 Open chest wound dressings||We suggest against the application of an occlusive dressing or device by FA providers to individuals with an open chest wound (weak recommendation, very low–quality evidence).|
|FA 534 Bronchodilators for acute asthma exacerbation||When an individual with asthma is experiencing difficulty breathing, we suggest that trained FA providers assist the individual with administration of a bronchodilator (weak rec- ommendation, very low–quality evidence).|
|FA 770 Optimal duration of cooling of burns with water||We recommend the immediate active cooling of thermal burns using running water as a FA intervention for adults and children (strong recommendation, very low–certainty evidence).
Because no difference in outcomes could be demonstrated with the different cooling durations studied, a specific dura- tion of cooling cannot be recommended.
Young children with thermal burns that are being actively cooled with running water should be monitored for signs and symp- toms of excessive body cooling (good practice statement).
|FA 798 Preventive interventions for presyncope||We recommend the use of any type of physical counterpressure maneuver by individuals with acute symptoms of presyncope attributable to vasovagal or orthostatic causes in the FA setting (strong recommendation, low- and very low–certainty evidence).
We suggest that lower body physical counterpressure maneuvers are preferable to upper body and abdominal physical counterpressure maneuvers (weak recommendation, very low–certainty evidence).
|FA 799 Single-stage scoring systems for concussion||No recommendation. We acknowledge the role that a simple, validated, single-stage concussion scoring system could play in the FA provider’s recognition and referral of victims of suspected head injury. However, review of the available literature shows no evidence on the application of such scoring systems by the FA provider. 2022 good practice statement:
It is critically important that concussion is recognized and managed appropriately. In the absence of a validated, simple, single-stage concussion scoring system, the FA assessment for a person with a possible concussion should be based on the typical signs and symptoms of concussion.
|FA 1545 Cooling techniques for exertional hyperthermia and heatstroke||For adults with exertional hyperthermia or exertional heat- stroke, we recommend immediate active cooling using whole- body (neck down) water immersion techniques (1° C–26° C "[33.8° F–78.8° F]) until a core body temperature of <39° C (102.2° F) is reached (weak recommendation, very low– certainty evidence).
We recommend that when water immersion is not available, any other active cooling technique be initiated (weak recom- mendation, very low–certainty evidence).
We recommend immediate cooling using any active or pas- sive technique available that provides the most rapid rate of cooling (weak recommendation, very low–certainty evidence).
For adults with nonexertional heatstroke, we cannot make a recommendation for or against any specific cooling technique compared with an alternative cooling technique (no recom- mendation, very low–certainty evidence).
For children with exertional or nonexertional heatstroke, we cannot make a recommendation for or against any specific cooling technique compared with an alternative cooling tech- nique (no recommendation, very low–certainty evidence).
|FA 1549 FA Use of supplemental oxygen for acute stroke||For adults with suspected acute stroke, we suggest against the routine use of supplemental oxygen in the FA setting compared with no use of supplemental oxygen (weak recom- mendation, low- to moderate-certainty evidence).|
|FA 1585 Methods of glucose administration for hypoglycemia in the FA setting||We recommend the use of oral glucose (swallowed) for individu- als with suspected hypoglycemia who are conscious and able to swallow (strong recommendation, very low–certainty evidence).
We suggest against buccal glucose administration compared with oral glucose administration for individuals with sus- pected hypoglycemia who are conscious and able to swallow (weak recommendation, very low–certainty evidence).
If oral glucose (for example, tablet) is not immediately avail- able, we suggest a combined oral+buccal glucose (for exam- ple, glucose gel) administration for individuals with suspected hypoglycemia who are conscious and able to swallow (weak recommendation, very low–certainty evidence).
We suggest the use of sublingual glucose administration for suspected hypoglycemia for children who may be uncoopera- tive with the oral (swallowed) glucose administration route (weak recommendation, very low–certainty evidence).
|Pediatric tourniquet types for life-threatening extremity bleeding (new)||We suggest the use of a manufactured windlass tourniquet for the management of life-threatening extremity bleeding in children (weak recommendation, very low–certainty evidence).
We are unable to recommend for or against the use of other tourniquet types in children because of a lack of evidence. For infants and children with extremities that are too small to allow the snug application of a tourniquet before activating the circumferential tightening mechanism, we recommend the use of direct manual pressure with or without the application of a hemostatic trauma dressing (good practice statement).
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
November 3, 2022
Country of Publication
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
Male, Female, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Childcare center, Correctional facility, Emergency care, Hospital, Long term care, Medical transportation, School, Operating and recovery room
Athletics coaching, law enforcement, medical assistant, nurse, nurse practitioner, paramedic emt, physician, physician assistant
Assessment and screening, Treatment, Management
sudden cardiac arrest, cardiac arrest, Cardiopulmonary Resuscitation, CPR, cardiopulmonary, Life support, Pediatric life support, Neonatal Life support, Basic life support
Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022 Nov 3. doi: 10.1161/CIR.0000000000001095. Epub ahead of print. PMID: 36325905.