Based on current evidence in the medical literature, the International Liaison Committee on Resuscitation (ILCOR) has provided their consensus on various aspects of cardiopulmonary resuscitation (CPR) and emergency cardiovascular care in patients with cardiac arrest in a recent issue of Circulation.
In adults with suspected out-of-hospital cardiac arrest, the ILCOR investigators strongly recommended that dispatchers provide chest compression-only CPR instructions to callers (strong recommendation, low quality of evidence). This recommendation was made based on numerous randomized trials with varying levels of evidence quality and during a period when the ratio of chest compressions to ventilations was 15:2 vs today’s recommended 30:2 ratio. In this review, the investigators recommended the 30:2 compression-to-ventilation ratio in patients with cardiac arrest based on very-low-quality evidence.
In addition, the investigators recommended that all bystanders who are trained and able to provide rescue breaths and chest compressions perform CPR on adult patients in cardiac arrest (weak recommendation, very-low-quality evidence). The ILCOR investigators also mentioned that this scenario is best practiced during exceptionally long intervals of emergency medical services response or when asphyxia is the main cause of cardiac arrest. In infants and children with out-of-hospital cardiac arrest, the investigators recommended that bystanders perform CPR with ventilation (weak recommendation, very-low-quality evidence).
With regard to emergency medical services, the investigators recommended that providers perform CPR using 30 compressions to 2 ventilations or continuous chest compressions with positive-pressure ventilation and without chest compression pausing (strong recommendation, high-quality evidence). This should be continued until placement of a supraglottic device or tracheal tube has been achieved.
The researchers acknowledged that some of their recommendations were based on low- or very-low-quality evidence and suggested the need for more high-quality studies to compare compression-only CPR and CPR with ventilation.
One of the main points the panel emphasized was regarding bystander CPR: “recommendations should strive to enhance ease of CPR implementation and CPR effectiveness” for individuals who are able to help in an emergency situation.
Olasveengen TM, de Caen AR, Mancini ME, et al; on behalf of the ILCOR Collaborators. 2017 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Circulation. 2017;136(23):e424-e440.