SPECIAL CIRCUMSTANCES 2021

5 TOP MESSAGES

1. CHECK
• Follow the ABCDE approach
• Take safety measures where needed

2. TREAT
• Follow the ALS algorithm
• Minimise no-flow time
• Optimise oyxgenation
• Use your resources

3. PRIORITISE
• Reversible causes
• 4 Hs
• 4 Ts

4. MODIFY
• Modify ALS algorithm
• Special causes
• Special settings
• Special patient groups

5. CONSIDER
• Transfer
• ECPR
SPECIAL CIRCUMSTANCES 2021

CORONARY THROMBOSIS

KEY EVIDENCE

STEMI patients sustained ROSC

Cardiovascular immediate PCI if < 120min
prevention reduces Fibrinolysis if > 120min
the risk of acute
events

Early reperfusion
improves outcomes No-STEMI patients sustained ROSC
following CA individualise decision to perform
coronary angiography

KEY RECOMMENDATIONS

Enhance Resuscitate and

cardiovascular choose reperfusion
prevention & strategy considering
BLS training Detect Activate setting and patient
parameters STEMI conditions
suggesting network
coronary immediately
thrombosis
SPECIAL CIRCUMSTANCES 2021

CARDIAC ARREST FOLLOWING

CARDIAC SURGERY

KEY EVIDENCE

Adequate training and protocols

improve outcomes

Modifications to the standard ALS algorithm include

immediate correction of reversible causes and
emergent resternotomy

In patients with VF/pVT defibrillation with up to

three stacked shocks might restore perfusion

In case of asystole or extreme bradycardia, epicardial

or transcutaneous pacing might restore perfusion

KEY RECOMMENDATIONS

• Apply 3 consecutive shocks

• Apply early pacing
• Correct reversible causes
• Perform early resternotomy
SPECIAL CIRCUMSTANCES 2021

TRAUMATIC CARDIAC ARREST

KEY EVIDENCE

TCA is different Ultrasound helps to

from CA due to identify the underlying
medical causes reason(s)

Treating
reversible causes
simultaneously Hypovolaemia from
takes priority over blood loss is a leading
chest compressions cause for TCA

KEY RECOMMENDATIONS

If appropriate:
perform
resuscitative
Control
Treat thoracotomy or
haemorrhage
reversible REBOA early
and restore
causes blood volume
immediately

Don’t pump Use ultrasound to

an empty target resuscitative
heart interventions
SPECIAL CIRCUMSTANCES 2021

PULMONARY EMBOLISM

KEY EVIDENCE

Clinical history, Thrombolytic treatment,

capnography and surgical embolectomy or
echocardiography percutaneous mechanical
help to recognise thrombectomy might
PE during CPR restore pulmonary
perfusion
Initial PEA and
low CO2 readings
support diagnosis

KEY RECOMMENDATIONS

Suspected PE =>
thrombolytics if CA or Known PE =>
severe instability thrombolytics or
Perform surgical embolectomy
emergency or percutaneous
echocardiography thrombectomy

Consider ECPR as a
Use capnography rescue therapy for
selected patients
SPECIAL CIRCUMSTANCES 2021

ACCIDENTAL HYPOTHERMIA

KEY EVIDENCE

Vital signs should be Arrested hypothermic

checked for 1 minute patients should, where
by clinical examination, possible, be directly
ECG, EtCO2 and transferred to an ECLS
ultrasound centre for rewarming

In-hospital prognostication of
successful ECLS rewarming
should be based on the HOPE
or ICE score, serum potassium
prognostication is less reliable

KEY RECOMMENDATIONS

Use HOPE or ICE score

for prognostication

Check for In hypothermic

presence of vital CA use ECLS
signs for up to rewarming
1 minute