The International Liaison Committee on Resuscitation has published the last guidelines for advanced cardiac life support (ACLS) on resuscitation ILCOR in 2015. Usually, these statements are updated every five years, but 'Circulation' has now published an AHA (American Heart Association) focused update due to an increased number of studies looking at ACLS-specific interventions.
These updates are focused on three specific areas:
No News in regards to Vasopressors and ECPR
Vasopressors in Cardiac Arrest
The bottom line: Great, these recommendations are no real news and do not change current guidelines at all.
Extracorporeal Cardiopulmonary Resucitation ECPR
The bottom line: ECPR is not for on the roads and remains an exception in general.
Advanced Airway Management
Taking recent evidence into account the updated guidelines 2019 conclude:
We Suggest: Put the Supraglottic Airway First!
In regards to these updated guidelines, the necessity of optimal cardiopulmonary resuscitation (CPR) during resuscitation and practical considerations, it seems reasonable to put the supraglottic airway (SGA) to the very top of airway management!
Here is why:
On the other hand
It, therefore, seems plausible to put the supraglottic airway first. Not only first as a choice of airway management, but also one of the first things to do:
The International Liaison Committee on Resuscitation (ILCOR) has again carried together all evidence and recently published more than 50 new ILCOR treatment recommendations and scoping reviews. You can find these documents right here: https://costr.ilcor.org
This website provides an excellent systematic review of the Advanced Airway Management during Adult Cardiac Arrest, containing references to all relevant evidence available.
Based on this and given the experience from everyday clinical practice, it would be worth considering supplementing the recommendations as follows.
- For resuscitation performed by health care professionals (physicians, nurses, paramedics), the use of a supraglottic airway (ideally non-inflatable) as soon as possible is recommended.
2019 AHA Focused Updated on Adult Cardiovascular Life Support