Mouth-to-mouth ventilation is only used in ACLS if other means are unavailable. Ventilation can be performed using mouth-to-mouth breaths, bag-mask ventilation or ventilator. Nasopharyngeal tube (“trumpet”) Supraglottic airway. The risk of epistaxis (nosebleed) is significant and may render airway management more difficult.īag-mask ventilation. Nasopharyngeal airways (“trumpets”) should be inserted carefully.The effect of cricoid pressure and gastric insufflation remains uncertain ( Panchal et al).Airway management should not interrupt compressions for more than 5 seconds.An advanced airway (tracheal tube, supraglottic airway) should be established as early as possible.Nasopharyngeal airways may cause complications in patients with skull fractures (risk of intracranial malposition of the tube) or coagulopathy (risk of bleeding). A supraglottic airway is a reasonable alternative if a tracheal tube cannot be established. Endotracheal (tracheal) intubation is considered the most reliable airway provided that it is placed by experienced staff. No large study has compared oropharyngeal and nasopharyngeal airways in cardiac arrest. Jaw thrust is preferred if there is suspicion of cervical spine injury, in which scenario head tilt-chin lift should only be used if other methods fail to open the airway. However, the optimal method for opening the airway remains unknown ( Guildner et al). The head tilt-chin lift method is effective in opening the airway. If it is not feasible to provide effective CPR due to the position of the victim, it is necessary to relocate the victim to a position where CPR can be performed adequately (e.g a firm surface). Guidelines for in-hospital cardiac arrest recommend that CPR should be started immediately and defibrillation should be performed within 180 seconds (for shockable rhythms) after confirmed cardiac arrest. transcutaneous pacing), reevaluating the prognosis, and determining whether additional interventions or examinations are required. ACLS involves placing an advanced airway, defibrillating shockable rhythms, administering antiarrhythmic drugs, considering targeted interventions (e.g. In out-of-hospital cardiac arrest (OHCA) ACLS is performed by paramedics, nurses or physicians, depending on the design of the pre-hospital system. ALS = Advanced life support.Īdvanced cardiopulmonary resuscitation (ACLS) should be initiated as early as possible. ECMO = Extracorporeal membrane oxygenation. If an intervention has an NNT of 10, then 10 people must be treated to save 1.ĪED = automatic external defibrillator. The Number Needed to Treat (NNT) is the number of patients needed to treat to save one. The number needed to treat (NNT) for interventions in out-of-hospital cardiac arrest. Tracheal intubation vs bag-mask ventilation Table 1 shows the number needed to treat (NNT) for various interventions involved in BLS and ACLS. Indeed, the greatest opportunities for survival exist during the first few minutes from collapse. Although ACLS is more advanced and costly than the interventions available in BLS, the number needed to treat (NNT) for the ACLS-specific interventions is much higher or uncertain, meaning that the efficacy of these interventions is much lower or uncertain. While basic life support (BLS) can be delivered by virtually anyone, advanced cardiopulmonary resuscitation (ACLS) is provided by healthcare professionals with the skills and equipment required. This chapter discusses interventions and evaluations performed during advanced cardiovascular life support (ACLS).
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