EvidenceAlerts

Panchal AR, Berg KM, Hirsch KG, et al. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019 Dec 10;140(24):e881-e894. doi: 10.1161/CIR.0000000000000732. Epub 2019 Nov 14. (Evidence-based guideline)
Abstract

The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.

Ratings
Discipline Area Score
Emergency Medicine 7 / 7
Intensivist/Critical Care 7 / 7
Hospital Doctor/Hospitalists 6 / 7
Internal Medicine 6 / 7
Cardiology 6 / 7
Comments from MORE raters

Cardiology rater

This article is very important for me indeed as I am ACLS and BLS veteran instructor. What I saw in the article is considered as re-enforcement of 2015 ACLS guidelines and nearly no significant changes have been made to 2015 guidelines. Thus, I selected the option that most practitioners already know this as no changes have been actually made in the current practice settings. However, we (as life support instructors) were feeling that nothing will change in 2020 the years of launching the 2020 guidelines due to continuous flow of information from various studies that we review as they reach us in various journals specially the journal of resuscitation. However, the value of this article is great as it represents the nucleus for the 2020 guidelines; and also answered a very important concern of mine and other colleagues regarding the unnecessary rush towards intubation of patients with cardiac arrest while bag mask ventilation can offer similar benefit.

Emergency Medicine rater

This is key to know for any ED doc. It's difficult for me to 'rate' this article - this is The Protocol by which we (or our patients) live or die. We assume it is research driven, and we follow it.

Internal Medicine rater

As a internist, I find the recommendations important for in hospital cardiac arrest as we also do formulate our guideline for in hospital protocol.
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