2010 ACLS Guidelines

[leviathan]

Advertisement - Members don't see this ad

Any word when these are coming out? Any idea what the changes will be?

 

[VeerTheTIGuy]

ILCOR's recommendations are meant to be published in October, i believe - the international consensus on science meetings have been done, i think, and are just awaiting development of the guidelines themselves

 

[DoctorMedic]

ILCOR's recommendations are meant to be published in October, i believe - the international consensus on science meetings have been done, i think, and are just awaiting development of the guidelines themselves

Well if they are anything like the 2005 guidelines we'll see them in 2012. Guess that works well for me, I just re-certified mine last week.

 

[njac]

I've heard rumors of removing Amiodarone and Vasopressin.

But that's hearsay.

 

[DoctorMedic]

I've heard rumors of removing Amiodarone and Vasopressin.

But that's hearsay.

funny because Amiodarone sponsored this big AHA study to help it get listed in the ACLS guidelines. Guess they stopped paying the bill or something.

 

[Paseo Del Norte]

funny because Amiodarone sponsored this big AHA study to help it get listed in the ACLS guidelines. Guess they stopped paying the bill or something.

However, AHA clearly stated that no anti-arrhythmic improved survival to discharge, but amiodarone only improved survival to admit. While amiodarone was on the guidelines, it was placed with this well established caveat.

I believe there will be a conference this November to cover the new guidelines with a rollout of the new material to occur following that conference. Realistically, I think it will be next year or so before we see the recommendations proliferate.

 

[Kubed]

Amio is out, leeches are back in. Count on it.

 

[deleted109597]

Guess they need to take oxygen off the list too. And intubation.
Hell, for studied stuff, they need to take everything off. Just watch them after the shock. If they recover, then good. Otherwise, call it.

 

[gutonc]

Guess they need to take oxygen off the list too. And intubation.
Hell, for studied stuff, they need to take everything off. Just watch them after the shock. If they recover, then good. Otherwise, call it.

That's my kind of ACLS.

Hell, I'm an oncologist. When we run codes, we usually don't even bother to take the paper off the pads...just kind of lay them on, maybe with some silk tape to hold them in place so it looks good. If somebody on the code team gets all antsy and hooks it up right, we just "accidentally" unplug the leads.

 

[southerndoc]

Guess they need to take oxygen off the list too. And intubation.

The current ACLS guidelines discourage early intubation. It's acceptable now to run a code without ever intubating a patient.

 

[deleted109597]

Discourage and remove are not equal.
Of course, the studies that show intubated patients do worse might be intuitive (sicker people, etc).
Randomizing a code environment would be difficult.

 

[rmbsstock]

:cry:

 

[Paseo Del Norte]

Discourage and remove are not equal.
Of course, the studies that show intubated patients do worse might be intuitive (sicker people, etc).
Randomizing a code environment would be difficult.

I am not sure about discourage or remove, the literature suggests that the emphasis should be on good compressions and interruption avoidance. I believe the exact wording is advanced airway placement can be "deferred."

That suggests that it has not been replaced or removed, just not a priority in the initial management of an arrest.

 

[leviathan]

When I took ACLS at the end of 2008 they were already getting us to do codes with just King airways and were downplaying any importance of intubation.

 

[xaelia]

Most of the codes I run these days are to make sure any residents who need procedures get them. And so the ANAs get enough exercise.

I was doing a literature search trying to see if there was a downtime duration associated with a lack of neurologically significant remaining function, and it appears that good CPR seems to work even in relatively prolonged doses. Anyone found anything to cite to justify that breakpoint in a code where you feel like anything you get back is just going to tie up an ICU bed for a few days waiting for family to fly in to withdraw?

 

[Stitch]

Guess they need to take oxygen off the list too. And intubation.
Hell, for studied stuff, they need to take everything off. Just watch them after the shock. If they recover, then good. Otherwise, call it.

I promise in the next few years, neonatal protocols will recommend resuscitation without oxygen. Different scenario, I know, but still.

 

[leviathan]

Most of the codes I run these days are to make sure any residents who need procedures get them. And so the ANAs get enough exercise.

I was doing a literature search trying to see if there was a downtime duration associated with a lack of neurologically significant remaining function, and it appears that good CPR seems to work even in relatively prolonged doses. Anyone found anything to cite to justify that breakpoint in a code where you feel like anything you get back is just going to tie up an ICU bed for a few days waiting for family to fly in to withdraw?

It's been a few years since I was a medic, but I'm pretty sure our protocol allowed us to call the EP after 30 mins of continuous resuscitation with no ROSC to ask for approval to terminate....sooo 30 mins seems like a good number.

 

[Dwindlin]

It's been a few years since I was a medic, but I'm pretty sure our protocol allowed us to call the EP after 30 mins of continuous resuscitation with no ROSC to ask for approval to terminate....sooo 30 mins seems like a good number.

Ours isn't even 30. Definitive airway in place confirmed by wave form. Some form of access (IV, Subclavian, or IO). And 3 rounds of epi/atropine/anti-arrhythmic with no change.

This generally works out to about 15 - 20 minutes if everything goes smoothly.

 

[doctorFred]

Ours isn't even 30. Definitive airway in place confirmed by wave form. Some form of access (IV, Subclavian, or IO). And 3 rounds of epi/atropine/anti-arrhythmic with no change.

This generally works out to about 15 - 20 minutes if everything goes smoothly.

that seems a lot more reasonable and more in line with my experiences. unless you're talking about a hypothermic arrest, i'm not sure what you're attempting to "resuscitate" after half an hour.

 

[VeerTheTIGuy]

Came out today:

http://www.ilcor.org/en/news/news-archive/new-guidelines-2010-now-available - link to ILCOR's various component organization guidelines