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Europace 2007 9(1):2-9; doi:10.1093/europace/eul126
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

SUDDEN CARDIAC DEATH

Acute management of sudden cardiac death in adults based upon the new CPR guidelines

Demetris Yannopoulos1,* and Tom Aufderheide2

1 Department of Medicine, Division of Cardiology, University of Minnesota, 2800 Hamline Avenue North No. 211, Roseville, MN 55113, USA; 2 Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

Purpose of the review The aim of this article is to provide a comprehensive description of interventions that can improve outcomes in adults with sudden cardiac death. The new American Heart Association 2005 Guidelines introduced a number of changes for the initial management of cardiorespiratory arrest based on new data that accumulated over the last 5 years.

Acute management of sudden cardiac death Appropriate interventions targeting the three phases of cardiopulmonary resuscitation (CPR) (electrical, circulatory, and metabolic) should be implemented. Early defibrillation in early witnessed arrest with one shock is very effective and can improve survival outcomes. When resuscitation efforts are delayed and CPR is performed by paramedics, 2 min of CPR before shock is recommended. Emphasis has been placed on fast and forceful continuous compressions with minimal interruptions, adequate decompression, and decrease in the rate of ventilations to 8–10/min for intubated patients with two rescuers and a universal increase in compression to ventilation ratio to 30:2 for lone rescuers. Mechanical adjuncts to improve circulation have been adapted in the recommendations. The inspiratory impedance threshold device that enhances negative intrathoracic pressure and improves venous preload has been recommended for application in intubated and bag-mask ventilated patients. Owing to the difficulty of endotracheal intubation, airway management devices (Combitube and Laryngeal Mask Airway) can be used as alternatives with minimal extra training.

Conclusion The new guidelines for CPR have focused on early defibrillation, uninterrupted compressions, complete decompression, fewer ventilations, and simplification and uniformity of the process.

Key Words: Sudden cardiac death, Cardiopulmonary resuscitation, Circulation, Ventilation

* Corresponding author. Tel: +1 612 616 7575; fax: + 1 651 636 0271. E-mail address: yanno001{at}umn.edu


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