Interpretation of the updates in the adults cardiopulmonary resuscitation in <i>2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations</i>_West China Medical Journal

Authors：

HE Yarong ^1,2 , YAO Peng ^1,2 , XIANG Xinjie ^1,2 , ZHOU Tingyuan ^1,2 , WANG Zhiyuan ^1,2 ,  CAO Yu ^1,2 ,  YU Haifang ^1,2

1. Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: yuyuer@126.com; YU Haifang, Email: yuhaifang163@163.com

Keywords：

Cardiopulmonary resuscitation; international consensus; basic life support; advanced life support; training

DOI：

10.7507/1002-0179.202212055

Video：

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The International Liaison Committee on Resuscitation published the 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations in Circulation, Resuscitation, and Pediatrics in November 2022. This consensus updates and recommends important aspects of cardiopulmonary resuscitation based on recently published resuscitation evidence. Herein, we interpret the consensus focusing on adult cardiopulmonary resuscitation including basic life support (ventilation techniques, compressions pause, transport strategies during resuscitation, and resuscitation procedures in drowning), advanced life support (target temperature management, point-of-care ultrasound as a diagnostic tool during cardiac arrest, vasopressin and corticosteroids for cardiac arrest, and post-cardiac arrest coronary angiography), cardiopulmonary resuscitation education/implementation/team (survival prediction after resuscitation of patients with in-hospital cardiac arrest, basic life support training, advanced life support training, blended learning for life support education, and faculty development approaches for life support courses) and recovery positions on rescue scene. This consensus provides important guidance for clinical practice and clear hints for the development of clinical research.

Citation： HE Yarong, YAO Peng, XIANG Xinjie, ZHOU Tingyuan, WANG Zhiyuan, CAO Yu, YU Haifang. Interpretation of the updates in the adults cardiopulmonary resuscitation in 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. West China Medical Journal, 2023, 38(11): 1632-1639. doi: 10.7507/1002-0179.202212055 Copy

1.	Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation, 2022, 146(25): e483-e557.
2.	Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation, 2022, 181: 208-288.
3.	Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics, 2022, 3: 2022-060463.
4.	Yu H, Qing H, Min Y. Continuous passive oxygen insufflation for out-of-hospital cardiac arrest: a systemic review of clinical studies. Resuscitation, 2013, 84(1): e9-e10.
5.	Bobrow BJ, Ewy GA, Clark L, et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med, 2009, 54(5): 656-662.e1.
6.	付阳阳, 徐军, 朱华栋, 等. 心肺复苏中通气策略的研究进展. 临床急诊杂志, 2019, 20(1): 13-18.
7.	谈定玉, 付阳阳, 徐军, 等. 心肺复苏中通气的研究进展. 中华危重病急救医学, 2016, 28(7): 661-665.
8.	Saïssy JM, Boussignac G, Cheptel E, et al. Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest. Anesthesiology, 2000, 92(6): 1523-1530.
9.	Bertrand C, Hemery F, Carli P, et al. Constant flow insufflation of oxygen as the sole mode of ventilation during out-of-hospital cardiac arrest. Intensive Care Med, 2006, 32(6): 843-851.
10.	Jost D, Degrange H, Verret C, et al. DEFI 2005: a randomized controlled trial of the effect of automated external defibrillator cardiopulmonary resuscitation protocol on outcome from out-of-hospital cardiac arrest. Circulation, 2010, 121(14): 1614-1622.
11.	Beesems SG, Berdowski J, Hulleman M, et al. Minimizing pre- and post-shock pauses during the use of an automatic external defibrillator by two different voice prompt protocols. A randomized controlled trial of a bundle of measures. Resuscitation, 2016, 106: 1-6.
12.	Nichol G, Leroux B, Wang H, et al. Trial of continuous or interrupted chest compressions during CPR. N Engl J Med, 2015, 373(23): 2203-2214.
13.	Matsuura TR, Bartos JA, Tsangaris A, et al. Early effects of prolonged cardiac arrest and ischemic postconditioning during cardiopulmonary resuscitation on cardiac and brain mitochondrial function in pigs. Resuscitation, 2017, 116: 8-15.
14.	Segal N, Matsuura T, Caldwell E, et al. Ischemic postconditioning at the initiation of cardiopulmonary resuscitation facilitates functional cardiac and cerebral recovery after prolonged untreated ventricular fibrillation. Resuscitation, 2012, 83(11): 1397-1403.
15.	Havel C, Schreiber W, Riedmuller E, et al. Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene. Resuscitation, 2007, 73(2): 264-270.
16.	Putzer G, Braun P, Zimmermann A, et al. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. Am J Emerg Med, 2013, 31(2): 384-389.
17.	Olasveengen TM, Wik L, Steen PA. Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. Resuscitation, 2008, 76(2): 185-190.
18.	Ødegaard S, Olasveengen T, Steen PA, et al. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation, 2009, 80(8): 843-848.
19.	Roosa JR, Vadeboncoeur TF, Dommer PB, et al. CPR variability during ground ambulance transport of patients in cardiac arrest. Resuscitation, 2013, 84(5): 592-595.
20.	Russi CS, Myers LA, Kolb LJ, et al. A comparison of chest compression quality delivered during on-scene and ground transport cardiopulmonary resuscitation. West J Emerg Med, 2016, 17(5): 634-639.
21.	Cheskes S, Byers A, Zhan C, et al. CPR quality during out-of-hospital cardiac arrest transport. Resuscitation, 2017, 114: 34-39.
22.	Sunde K, Wik L, Steen PA. Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model. Resuscitation, 1997, 34(3): 235-242.
23.	Thomassen O, Skaiaa SC, Assmuss J, et al. Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation. Emerg Med J, 2017, 34(9): 573-577.
24.	Abrams T, Torfason L. Evaluation of the quality of manual, compression-only cardiopulmonary resuscitation in a moving ski patrol toboggan. High Alt Med Biol, 2020, 21(1): 52-61.
25.	Stone CK, Thomas SH. Can correct closed-chest compressions be performed during prehospital transport?. Prehosp Disaster Med, 1995, 10(2): 121-123.
26.	Grunau B, Kime N, Leroux B, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA, 2020, 324(11): 1058-1067.
27.	Bierens J, Abelairas-Gomez C, Barcala Furelos R, et al. Resuscitation and emergency care in drowning: a scoping review. Resuscitation, 2021, 162: 205-217.
28.	Szpilman D, Soares M. In-water resuscitation-is it worthwhile?. Resuscitation, 2004, 63(1): 25-31.
29.	Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33℃ versus 36℃ after cardiac arrest. N Engl J Med, 2013, 369(23): 2197-2206.
30.	Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med, 2021, 384(24): 2283-2294.
31.	Le May M, Osborne C, Russo J, et al. Effect of moderate vs mild therapeutic hypothermia on mortality and neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest: the CAPITAL CHILL randomized clinical trial. JAMA, 2021, 326(15): 1494-1503.
32.	Sandroni C, Nolan JP, Andersen LW, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Intensive Care Med, 2022, 48(3): 261-269.
33.	Lascarrou JB, Merdji H, Le Gouge A, et al. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med, 2019, 381(24): 2327-2337.
34.	Nishikimi M, Ogura T, Nishida K, et al. Outcome related to level of targeted temperature management in postcardiac arrest syndrome of low, moderate, and high severities: a nationwide multicenter prospective registry. Crit Care Med, 2021, 49(8): e741-e750.
35.	Duan J, Zhai Q, Shi Y, et al. Optimal time of collapse to return of spontaneous circulation to apply targeted temperature management for cardiac arrest: a bayesian network meta-analysis. Front Cardiovasc Med, 2022, 8: 784917.
36.	Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2020, 142(Suppl 2): S366-S468.
37.	Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation, 2021, 161: 220-269.
38.	Kirkegaard H, Søreide E, de Haas I, et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA, 2017, 318(4): 341-350.
39.	Ramadanov N, Arrich J, Klein R, et al. Intravascular versus surface cooling in patients resuscitated from cardiac arrest: a systematic review and network meta-analysis with focus on temperature feedback. Crit Care Med, 2022, 50(6): 999-1009.
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1. Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation, 2022, 146(25): e483-e557.
2. Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation, 2022, 181: 208-288.
3. Wyckoff MH, Greif R, Morley PT, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics, 2022, 3: 2022-060463.
4. Yu H, Qing H, Min Y. Continuous passive oxygen insufflation for out-of-hospital cardiac arrest: a systemic review of clinical studies. Resuscitation, 2013, 84(1): e9-e10.
5. Bobrow BJ, Ewy GA, Clark L, et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med, 2009, 54(5): 656-662.e1.
6. 付阳阳, 徐军, 朱华栋, 等. 心肺复苏中通气策略的研究进展. 临床急诊杂志, 2019, 20(1): 13-18.
7. 谈定玉, 付阳阳, 徐军, 等. 心肺复苏中通气的研究进展. 中华危重病急救医学, 2016, 28(7): 661-665.
8. Saïssy JM, Boussignac G, Cheptel E, et al. Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest. Anesthesiology, 2000, 92(6): 1523-1530.
9. Bertrand C, Hemery F, Carli P, et al. Constant flow insufflation of oxygen as the sole mode of ventilation during out-of-hospital cardiac arrest. Intensive Care Med, 2006, 32(6): 843-851.
10. Jost D, Degrange H, Verret C, et al. DEFI 2005: a randomized controlled trial of the effect of automated external defibrillator cardiopulmonary resuscitation protocol on outcome from out-of-hospital cardiac arrest. Circulation, 2010, 121(14): 1614-1622.
11. Beesems SG, Berdowski J, Hulleman M, et al. Minimizing pre- and post-shock pauses during the use of an automatic external defibrillator by two different voice prompt protocols. A randomized controlled trial of a bundle of measures. Resuscitation, 2016, 106: 1-6.
12. Nichol G, Leroux B, Wang H, et al. Trial of continuous or interrupted chest compressions during CPR. N Engl J Med, 2015, 373(23): 2203-2214.
13. Matsuura TR, Bartos JA, Tsangaris A, et al. Early effects of prolonged cardiac arrest and ischemic postconditioning during cardiopulmonary resuscitation on cardiac and brain mitochondrial function in pigs. Resuscitation, 2017, 116: 8-15.
14. Segal N, Matsuura T, Caldwell E, et al. Ischemic postconditioning at the initiation of cardiopulmonary resuscitation facilitates functional cardiac and cerebral recovery after prolonged untreated ventricular fibrillation. Resuscitation, 2012, 83(11): 1397-1403.
15. Havel C, Schreiber W, Riedmuller E, et al. Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene. Resuscitation, 2007, 73(2): 264-270.
16. Putzer G, Braun P, Zimmermann A, et al. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. Am J Emerg Med, 2013, 31(2): 384-389.
17. Olasveengen TM, Wik L, Steen PA. Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. Resuscitation, 2008, 76(2): 185-190.
18. Ødegaard S, Olasveengen T, Steen PA, et al. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation, 2009, 80(8): 843-848.
19. Roosa JR, Vadeboncoeur TF, Dommer PB, et al. CPR variability during ground ambulance transport of patients in cardiac arrest. Resuscitation, 2013, 84(5): 592-595.
20. Russi CS, Myers LA, Kolb LJ, et al. A comparison of chest compression quality delivered during on-scene and ground transport cardiopulmonary resuscitation. West J Emerg Med, 2016, 17(5): 634-639.
21. Cheskes S, Byers A, Zhan C, et al. CPR quality during out-of-hospital cardiac arrest transport. Resuscitation, 2017, 114: 34-39.
22. Sunde K, Wik L, Steen PA. Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model. Resuscitation, 1997, 34(3): 235-242.
23. Thomassen O, Skaiaa SC, Assmuss J, et al. Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation. Emerg Med J, 2017, 34(9): 573-577.
24. Abrams T, Torfason L. Evaluation of the quality of manual, compression-only cardiopulmonary resuscitation in a moving ski patrol toboggan. High Alt Med Biol, 2020, 21(1): 52-61.
25. Stone CK, Thomas SH. Can correct closed-chest compressions be performed during prehospital transport?. Prehosp Disaster Med, 1995, 10(2): 121-123.
26. Grunau B, Kime N, Leroux B, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA, 2020, 324(11): 1058-1067.
27. Bierens J, Abelairas-Gomez C, Barcala Furelos R, et al. Resuscitation and emergency care in drowning: a scoping review. Resuscitation, 2021, 162: 205-217.
28. Szpilman D, Soares M. In-water resuscitation-is it worthwhile?. Resuscitation, 2004, 63(1): 25-31.
29. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33℃ versus 36℃ after cardiac arrest. N Engl J Med, 2013, 369(23): 2197-2206.
30. Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med, 2021, 384(24): 2283-2294.
31. Le May M, Osborne C, Russo J, et al. Effect of moderate vs mild therapeutic hypothermia on mortality and neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest: the CAPITAL CHILL randomized clinical trial. JAMA, 2021, 326(15): 1494-1503.
32. Sandroni C, Nolan JP, Andersen LW, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Intensive Care Med, 2022, 48(3): 261-269.
33. Lascarrou JB, Merdji H, Le Gouge A, et al. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med, 2019, 381(24): 2327-2337.
34. Nishikimi M, Ogura T, Nishida K, et al. Outcome related to level of targeted temperature management in postcardiac arrest syndrome of low, moderate, and high severities: a nationwide multicenter prospective registry. Crit Care Med, 2021, 49(8): e741-e750.
35. Duan J, Zhai Q, Shi Y, et al. Optimal time of collapse to return of spontaneous circulation to apply targeted temperature management for cardiac arrest: a bayesian network meta-analysis. Front Cardiovasc Med, 2022, 8: 784917.
36. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2020, 142(Suppl 2): S366-S468.
37. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation, 2021, 161: 220-269.
38. Kirkegaard H, Søreide E, de Haas I, et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA, 2017, 318(4): 341-350.
39. Ramadanov N, Arrich J, Klein R, et al. Intravascular versus surface cooling in patients resuscitated from cardiac arrest: a systematic review and network meta-analysis with focus on temperature feedback. Crit Care Med, 2022, 50(6): 999-1009.
40. Reynolds JC, Nicholson T, O’Neil B, et al. Diagnostic test accuracy of point-of-care ultrasound during cardiopulmonary resuscitation to indicate the etiology of cardiac arrest: a systematic review. Resuscitation, 2022, 172: 54-63.
41. Huis In’t Veld MA, Allison MG, Bostick DS, et al. Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation, 2017, 119: 95-98.
42. Clattenburg EJ, Wroe P, Brown S, et al. Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: a prospective cohort study. Resuscitation, 2018, 122: 65-68.
43. Clattenburg EJ, Wroe PC, Gardner K, et al. Implementation of the cardiac arrest sonographic assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks. Resuscitation, 2018, 131: 69-73.
44. Gaspari R, Harvey J, DiCroce C, et al. Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - a prospective cohort study. Resusc Plus, 2021, 6: 100094.
45. Teran F. Resuscitative cardiopulmonary ultrasound and transesophageal echocardiography in the emergency department. Emerg Med Clin North Am, 2019, 37(3): 409-430.
46. Andersen LW, Isbye D, Kjærgaard J, et al. Effect of vasopressin and methylprednisolone vs placebo on return of spontaneous circulation in patients with in-hospital cardiac arrest: a randomized clinical trial. JAMA, 2021, 326(16): 1586-1594.
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West China Medical Journal

Interpretation of the updates in the adults cardiopulmonary resuscitation in 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

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