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Resuscitation (2005)
67S1
, S1—S2
Preface
Thissupplementof
Resuscitation
containstheEuro-pean Resuscitation Council (ERC) Guidelines forResuscitation 2005. It is derived from the 2005International Consensus Conference on Cardiopul-monary Resuscitation and Emergency Cardiovascu-lar Care Science with Treatment Recommendationsproduced by the International Liaison Committeeon Resuscitation (ILCOR) published simultaneouslyin an issue of
Resuscitation
.The European representatives at that Confer-ence, held in Dallas in January 2005, more thanpulled their weight in the process of producing theConsensus on Science conclusions arising as a resultof presentations and debate. Their names are listedat the end of this Foreword, and the resuscitationcommunity in Europe and beyond is most gratefulto them for their talent, dedication and selflesshard work. In addition, they, and many others fromEurope, also produced worksheets addressing theevidence for and against every conceivable detailof resuscitation theory and practice.The ERC Guidelines contain recommendationsthat,byconsensusoftheEuropeanrepresentatives,are suitable for European practice in the light oftoday’s conclusions agreed in the Consensus on Sci-ence. As with the Consensus on Science document,they represent an enormous amount of work bymany people who have worked against the clockto produce the Guidelines for Europe. Each sectionof the Guidelines has been masterminded and coor-dinated by the leaders of the ERC working groupsand areas of special interest.Such ventures do not happen without leader-ship, and we are grateful to Vinay Nadkarni, BillMontgomery, Peter Morley, Mary Fran Hazinski, ArnoZaritsky, and Jerry Nolan for guiding the Consensuson Science process through to completion. It wouldnot be invidious to single out Jerry Nolan, the ILCORco-chairman, for thanks and praise. He is univer-sally respected and popular, and has proved to bea wonderful ambassador for Europe. His scientificcredibility and understanding are beyond doubt andhis integrity, dedication, sheer hard work, patienceand meticulous attention to detail and sensitivitieshave won the admiration of all. He has led the Con-sensus on Science process on our behalf, and hasbeen the lead co-ordinator in producing the Euro-pean Guidelines.Finallywethankourpublishers,Elsevier,throughthe Publishing Editor for
Resuscitation,
Anne Lloydand her colleagues, for their professionalism, tol-erance and patience in these endeavours.
Representatives from Europe at theInternational Consensus Conferenceheld in Dallas, USA, in January 2005
Hans-Richard Arntz (Germany), Dennis Azzopardi(UK), Jan Bahr (Germany), Gad Bar-Joseph (Israel),Peter Baskett (UK), Michael Baubin (Austria),Dominique Biarent (Belgium), Bob Bingham (UK),Bernd B¨ottiger (Germany), Leo Bossaert (Belgium),Steven Byrne (UK), Pierre Carli (France), PascalCassan (France), Sian Davies (UK), Charles Deakin(UK), Burkhard Dirks (Germany), Volker Doerges(Germany), Hans Domanovits (Austria), ChristophEich (Germany), Lars Ekstrom (Sweden), PeterFenici (Italy), F. Javier Garcia-Vega (Spain), Hen-rik Gervais (Germany) Anthony Handley (UK), JohanHerlitz (Sweden), Fulvio Kette (Italy), RudolphKoster (Netherlands), Kristian Lexow (Norway),Perttu Lindsberg (Finland), Freddy Lippert (Den-mark), Vit Marecek (Czech Republic), KoenraadMonsieurs (Belgium), Jerry Nolan (UK), Narcisco
0300-9572/$ — see front matter © 2005 European Resuscitation Council. All Rights Reserved. Published by Elsevier Ireland Ltd.doi:10.1016/j.resuscitation.2005.10.001
 
S2 PrefacePerales (Spain), Gavin Perkins (UK), Sam Rich-mond (UK), Antonio Rodriquez Nunez (Spain), StenRubertsson (Sweden), Sebastian Russo (Germany),Jas Soar (UK), Eldar Soreide (Norway), Petter Steen(Norway), Benjamin Stenson (UK), Kjetil Sunde(Norway), Caroline Telion (France), Andreas Thier-bach (Germany), Christian Torp Pederson (Den-mark), Volker Wenzel (Austria), Lars Wik (Norway),Benno Wolke (Germany), Jonathan Wyllie (UK),David Zideman (UK).Peter BaskettDavid Zideman
 
Resuscitation (2005)
67S1
, S7—S23
European Resuscitation Council Guidelines forResuscitation 2005Section 2. Adult basic life support and use of automated external defibrillators
Anthony J. Handley, Rudolph Koster, Koen Monsieurs, Gavin D. Perkins,Sian Davies, Leo Bossaert
Basic life support (BLS) refers to maintaining airwaypatency and supporting breathing and the circula-tion, without the use of equipment other than aprotective device.
1
This section contains the guide-lines for adult BLS by lay rescuers and for the useof an automated external defibrillator (AED). Italso includes recognition of sudden cardiac arrest,the recovery position and management of choking(foreign-body airway obstruction). Guidelines forin-hospital BLS and the use of manual defibrillatorsmay be found in Sections 3 and 4b.
Introduction
Sudden cardiac arrest (SCA) is a leading cause ofdeath in Europe, affecting about 700,000 individ-uals a year.
2
At the time of the first heart rhythmanalysis, about 40% of SCA victims have ventricularfibrillation (VF).
3—6
It is likely that many more vic-tims have VF or rapid ventricular tachycardia (VT)at the time of collapse but, by the time the firstECG is recorded, their rhythm has deteriorated toasystole.
7,8
VF is characterized by chaotic, rapiddepolarisation and repolarisation. The heart losesits coordinated function and stops pumping bloodeffectively.
9
Many victims of SCA can survive ifbystandersactimmediatelywhileVFisstillpresent,but successful resuscitation is unlikely once therhythm has deteriorated to asystole.
10
The opti-mum treatment for VF cardiac arrest is immediatebystander CPR (combined chest compression andrescue breathing) plus electrical defibrillation. Thepredominantmechanismofcardiacarrestinvictimsof trauma, drug overdose, drowning, and in manychildren is asphyxia; rescue breaths are critical forresuscitation of these victims.The following concept of the Chain of Survivalsummarises the vital steps needed for success-ful resuscitation (Figure 1.1). Most of these linksare relevant for victims of both VF and asphyxialarrest.
11
1. Early recognition of the emergency and call-ing for help: activate the emergency medicalservices (EMS) or local emergency response sys-tem, e.g. ‘‘phone 112’’.
12,13
An early, effectiveresponse may prevent cardiac arrest.2. Early bystander CPR: immediate CPR can doubleor triple survival from VF SCA.
10,14—17
3. Early defibrillation: CPR plus defibrillationwithin 3—5min of collapse can produce survivalrates as high as 49—75%.
18—25
Each minute of
0300-9572/$ — see front matter © 2005 European Resuscitation Council. All Rights Reserved. Published by Elsevier Ireland Ltd.doi:10.1016/j.resuscitation.2005.10.007
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