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Dear
AHA Training Network & Volunteers,
Today,
in cooperation with the International Liaison Committee on
Resuscitation (ILCOR), the AHA published the 2018 AHA Focused Updates on
Advanced Cardiovascular Life Support and Pediatric Advanced Life
Support (2018 Focused Updates).
The
2018 Focused Updates represent our move to a continuous evidence
evaluation process and more frequent focused updates. Continuous
evidence evaluation allows the rigor of a comprehensive review and
expert consensus in as close to real time as possible. Prior to 2017,
the official AHA Guidelines for CPR and ECC had been updated every
five years.
Updates
include the following:
- Amiodarone or
lidocaine may be considered for Ventricular
Fibrillation/pulseless Ventricular Tachycardia (VF/pVT) that is
unresponsive to defibrillation. These drugs may be particularly
useful for patients with witnessed arrest, for whom time to drug
administration may be shorter.
- Lidocaine has been
added to the ACLS Cardiac Arrest Algorithm and the ACLS Cardiac
Arrest Circular Algorithm for treatment of shock-refractory
VF/pVT.
- The routine use of
Magnesium for cardiac arrest is not recommended in adult
patients. Magnesium may be considered for torsades de pointes
(i.e., polymorphic VT associated with long QT interval).
- There is insufficient
evidence to support or refute the routine use of a β-blocker
early (within the first hour) after return of spontaneous
circulation (ROSC).
- There is insufficient
evidence to support or refute the routine use of lidocaine early
(within the first hour) after ROSC. In the absence of
contraindications, the prophylactic use of lidocaine may be
considered in specific circumstances (such as during emergency
medical services transport) when treatment of recurrent VF/pVT
might prove to be challenging.
- While there are no
changes to the depiction of sequences and therapies from the
2015 PALS algorithm, some minor edits have been made to the PALS
Cardiac Arrest Algorithm in 2018 to be consistent with language
in the ACLS Cardiac Arrest Algorithm.
For
the 2018 Focused Updates, there will be no changes to products and no
new materials are required. However, the AHA offers the following
guidance for training ACLS and PALS providers:
- Instructors may allow
students to practice using
either amiodarone or lidocaine during CPR in ACLS,
ACLS EP, and PALS courses, consistent with the student’s local
protocol.
- For testing purposes,
AHA Instructors will continue to use the ACLS and PALS Skills
Testing Checklists and the Skills Testing Critical Skills
Descriptors.
For
more information, AHA Instructors should visit the AHA Instructor Network (News &
Archives section) to review the document, “2018 Focused Updates:
Implications for Training ACLS and PALS Providers,” and the FAQ. International
users also may view translated tools at cprverify.org.
To
view the 2018 Focused Updates and the highlights of the 2018 Focused
Updates, please visit the ECC Guidelines website.
Thank
you for everything you do to contribute to the mission of saving
lives.
Sincerely,
AHA CPR & ECC
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