The 2021 guidelines build on the 2015 guidelines and the latest recommendations from the European Resuscitation Council (ERC), providing the best up-to-date evidence for clinical practice in the UK, including the use of escalating and high levels of energy.
The guidelines also recognise that many cardiac arrests have premonitory signs and are preventable. Anthony Freestone, RCUK regional representative for the North West and advanced clinical practitioner at Blackpool Teaching Hospitals NHS Foundation Trust, explains: “The focus must always be on preventing cardiac arrest from occurring. Greater emphasis on recognising and treating the deteriorating patient should be every NHS Trust’s responsibility, in line with other Guidelines such as NICE (CG50).
“With the growing recognition that many cardiac arrests can be identified in advance, it makes sense to employ comprehensive monitoring where possible to reduce mortality. Our defibrillator supplier builds precision monitoring into its defibrillators, to assist in peri and post arrest resuscitation stages.”
On the latest defibrillation and cardioversion guidelines, Mr Freestone said: “Working in a Regional Cardiac Centre, with some of the best and most qualified staff within the field, I feel that energy plays a major part in resuscitation. In my experience for both defibrillation and cardioversion, using the highest possible energy level is a clinical necessity, a shock strategy re-enforced by both the RCUK and the ERC in certain situations. The guidelines call for an ‘initial synchronised shock at maximum defibrillator output’ to respond to atrial fibrillation, as this arrythmia often requires greater levels of energy to terminate.
“Our Mindray defibrillators can rapidly charge and produce a biphasic shock at up to 360J in five seconds, so we are ideally equipped to meet this guideline.
“For fixed high energy versus escalating shocks protocols, this is a very exciting time. The guidelines again highlight escalation of energy after a failed shock, and for patients where refibrillation has occurred, but now give us the option of starting within an energy range, empowering Resuscitation Departments to think outside the box when it comes to defibrillation energy requirements.”
The new guidelines clarify the RCUK’s position on capnography, requiring it be used to monitor the quality of CPR.
“While defibrillation is important, we need to continue to push for high quality CPR, where the only recommendation is for capnography, which had previously always been more of a consideration. The technology does more than just tell the user to push harder, it’s an accurate display of how the resuscitation attempt is going and can provide a real insight into performance and feedback.” Mr Freestone comments.
“Our Mindray devices provide up to 360J, capnography and a full range of peri and post arrest monitoring, which from a point of care perspective enables the patient to have the best possible chance of survival no matter the stage of resuscitation they are in.”
Published in Resuscitation Today, July 2021: https://www.resustoday.com/back-issues/