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Latest and Greatest: Overview 2015 American Heart Association Emergency Cardiovascular Care Updates

New ACLS Team-based Resuscitation Information

  To effectively resuscitate a patient from cardiac arrest, there must be a team of proficient caregivers that would execute the necessary steps in the management of the situation. While the team can be composed of different individuals with varying levels of expertise, they should operate as a single team. In addition, there must be an assigned leader that would oversee the whole process. The leader of the team organizes and synchronizes all the components of the resuscitation process- initial patient evaluation, activation of the emergency system, cardiopulmonary resuscitation, AED, and the termination of resuscitation. Through this, overlapping of tasks is eliminated, interruption of cardiopulmonary resuscitation is minimized, adequate depth and frequency of compressions are delivered, and every step in the protocol is properly executed.

  The current updates released by the American Heart Association included new information on the advanced cardiac life support team-based resuscitation.

In the 2010 guidelines on early warning systems, rapid response and medical emergency team systems, the recommendation was that there should be a systematic identification of patients who may develop cardiac arrest. In addition, there must be an organized approach in responding to these patients as well as assessment of the results so that quality is maintained. Current updates added that for adult patients, a rapid response team (RRT) or a medical emergency team (MET) may be utilized to decrease the occurrence of cardiac arrest in the general wards. The same principle can be applied to facilities that cater the needs of pediatric patients in high-risk conditions. Early warning sign systems should be put up for both adult and pediatric patients.

These RRTs and METs should be operational in order to provide early interference among those patients who are at risk for in-hospital cardiac arrest. The team made up of physicians, nurses, and therapists work together to provide monitoring, therapeutic intervention, and resuscitation to identified patient. In a survey done, 93% of hospitals employed a hospital-wide public address system, 53% paged or called team members, and 11% used a local alarm to prompt their team of emergency. Resuscitation teams also function more effectively if each member knows his role, communicates well, and execute cross-check for the welfare of both the patient and the team, such as prior to defibrillation. Also suggested is the inclusion of a debriefing session immediately done after resuscitation (also known as “hot debriefing”) in order to create a venue for dialogues on team issues, personal and professional subjects, and performance assessment. A “cold debriefing”, done at a later period, may also be proposed as it has the advantage of giving the team members enough time to prepare for the discussion. Also, cold debriefing allows the opportunity to invite a debriefing expert or other members of the unit so that learning is maximized.

In addition to the team-based resuscitation updates, the 2015 AHA guidelines also focus on education, with implementation and teams being included in other parts of the 2015 Guidelines Updates. The 2015 guidelines emphasize the value of research-based training courses that should be undertaken by team members. These include key recommendations on trainings such as use of high quality training equipment, blended learning formats, targeted training, teamwork and leadership skills training, and life support trainings.

 

References:

American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 4: Systems of Care and Continuous Quality Improvement. ECCguidelines.heart.org.

American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality. ECCguidelines.heart.org.

American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 4: Systems of Care and Continuous Quality ImprovementECCguidelines.heart.org.