2018 Focused Update on Palm Desert Resuscitation Education LLC (PDRE) and American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

On November 5, 2018, American Heart Association (AHA) provided our Palm Desert Resuscitation Education LLC (PDRE) Training Network and Instructors evidenced-based guidelines for the new 2018 Focused Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

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 AHA and PDRE’s 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:

  1. 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.
  2. Lidocaine has been added to the ACLS Cardiac Arrest Algorithm and the ACLS Cardiac Arrest Circular Algorithm for treatment of shock-refractory VF/pVT.
  3. 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).
  4. 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).
  5. 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.
  6. 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:

  • Palm Desert Resuscitation Education LLC (PDRE) and American Heart Association (AHA) 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, PDRE and AHA Instructors will continue to use the ACLS and PALS Skills Testing Checklists and the Skills Testing Critical Skills Descriptors.

For more information, PDRE and AHA Instructors and our valued guests should view the 2018 Focused Updates and visit the ECC Guidelines website

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