Pocket_Book_of_the_European_Resuscitation_Council_Guidelines_for_Resuscitation_2005__0723434239_.pdf

Resuscitation (2005) 67S1 , S1—S2

Preface

contains the Euro-

pean Resuscitation Council (ERC) Guidelines for

Resuscitation 2005. It is derived from the 2005

International Consensus Conference on Cardiopul-

monary Resuscitation and Emergency Cardiovascu-

lar Care Science with Treatment Recommendations

produced by the International Liaison Committee

on Resuscitation (ILCOR) published simultaneously

in an issue of

Resuscitation

co-chairman, for thanks and praise. He is univer-

sally respected and popular, and has proved to be

a wonderful ambassador for Europe. His scientiﬁc

credibility and understanding are beyond doubt and

his integrity, dedication, sheer hard work, patience

and meticulous attention to detail and sensitivities

have won the admiration of all. He has led the Con-

sensus on Science process on our behalf, and has

been the lead co-ordinator in producing the Euro-

pean Guidelines.

Finally we thank our publishers, Elsevier, through

the Publishing Editor for

The European representatives at that Confer-

ence, held in Dallas in January 2005, more than

pulled their weight in the process of producing the

Consensus on Science conclusions arising as a result

of presentations and debate. Their names are listed

at the end of this Foreword, and the resuscitation

community in Europe and beyond is most grateful

to them for their talent, dedication and selﬂess

hard work. In addition, they, and many others from

Europe, also produced worksheets addressing the

evidence for and against every conceivable detail

of resuscitation theory and practice.

The ERC Guidelines contain recommendations

that, by consensus of the European representatives,

are suitable for European practice in the light of

today’s conclusions agreed in the Consensus on Sci-

ence. As with the Consensus on Science document,

they represent an enormous amount of work by

many people who have worked against the clock

to produce the Guidelines for Europe. Each section

of the Guidelines has been masterminded and coor-

dinated by the leaders of the ERC working groups

and areas of special interest.

Such ventures do not happen without leader-

ship, and we are grateful to Vinay Nadkarni, Bill

Montgomery, Peter Morley, Mary Fran Hazinski, Arno

Zaritsky, and Jerry Nolan for guiding the Consensus

on Science process through to completion. It would

not be invidious to single out Jerry Nolan, the ILCOR

Anne Lloyd

and her colleagues, for their professionalism, tol-

erance and patience in these endeavours.

Representatives from Europe at the

International Consensus Conference

held 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 Bottiger (Germany), Leo Bossaert (Belgium),

Steven Byrne (UK), Pierre Carli (France), Pascal

Cassan (France), Sian Davies (UK), Charles Deakin

(UK), Burkhard Dirks (Germany), Volker Doerges

(Germany), Hans Domanovits (Austria), Christoph

Eich (Germany), Lars Ekstrom (Sweden), Peter

Fenici (Italy), F. Javier Garcia-Vega (Spain), Hen-

rik Gervais (Germany) Anthony Handley (UK), Johan

Herlitz (Sweden), Fulvio Kette (Italy), Rudolph

Koster (Netherlands), Kristian Lexow (Norway),

Perttu Lindsberg (Finland), Freddy Lippert (Den-

mark), Vit Marecek (Czech Republic), Koenraad

Monsieurs (Belgium), Jerry Nolan (UK), Narcisco

doi:10.1016/j.resuscitation.2005.10.001

This supplement of

Resuscitation

Resuscitation,

Preface

Perales (Spain), Gavin Perkins (UK), Sam Rich-

mond (UK), Antonio Rodriquez Nunez (Spain), Sten

Rubertsson (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 Baskett

David Zideman

Resuscitation (2005) 67S1 , S3—S6

European Resuscitation Council Guidelines for

Resuscitation 2005

Section 1. Introduction

Jerry Nolan

It is ﬁve years since publication of the Guide-

lines 2000 for Cardiopulmonary Resuscitation (CPR)

and Emergency Cardiovascular Care (ECC). 1 The

European Resuscitation Council (ERC) based its

own resuscitation guidelines on this document,

and these were published as a series of papers

in 2001. 2—7 Resuscitation science continues to

advance, and clinical guidelines must be updated

regularly to reﬂect these developments and advise

healthcare providers on best practice. In between

major guideline updates (about every ﬁve years),

interim advisory statements can inform the health-

care provider about new therapies that might inﬂu-

ence outcome signiﬁcantly; 8 we anticipate that

further advisory statements will be published in

response to important research ﬁndings.

The guidelines that follow do not deﬁne the

only way that resuscitation should be achieved;

they merely represent a widely accepted view of

how resuscitation can be undertaken both safely

and effectively. The publication of new and revised

treatment recommendations does not imply that

current clinical care is either unsafe or ineffective.

sus on treatment recommendations. The process

for the latest resuscitation guideline update began

in 2003, when ILCOR representatives established

six task forces: basic life support; advanced car-

diac life support; acute coronary syndromes; pae-

diatric life support; neonatal life support; and an

interdisciplinary task force to address overlapping

topics, such as educational issues. Each task force

identiﬁed topics requiring evidence evaluation, and

appointed international experts to review them.

To ensure a consistent and thorough approach, a

worksheet template was created containing step-

by-step directions to help the experts document

their literature review, evaluate studies, determine

levels of evidence and develop recommendations. 10

A total of 281 experts completed 403 worksheets on

276 topics; 380 people from 18 countries attended

the 2005 International Consensus Conference on

ECC and CPR Science with Treatment Recommen-

dations (C2005), which took place in Dallas in

January 2005. 11 Worksheet authors presented the

results of their evidence evaluations and pro-

posed summary scientiﬁc statements. After discus-

sion among all participants, these statements were

reﬁned and, whenever possible, supported by treat-

ment recommendations. These summary science

statements and treatment recommendations have

been published in the 2005 International Consensus

on Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care Science with Treatment Rec-

ommendations (CoSTR). 12

Consensus on science

The International Liaison Committee on Resuscita-

tion (ILCOR) was formed in 1993. 9 I ts mission is

to identify and review international science and

knowledge relevant to CPR, and to offer consen-

doi:10.1016/j.resuscitation.2005.10.002

Jerry Nolan

From science to guidelines

Table 1.1 Out-of-hospital cardiopulmonary arrests

(21,175) by aetiology. 19

The resuscitation organisations forming ILCOR will

publish individual resuscitation guidelines that are

consistent with the science in the consensus docu-

ment, but will also consider geographic, economic

and system differences in practice, and the avail-

ability of medical devices and drugs. These 2005

ERC Resuscitation Guidelines are derived from the

CoSTR document but represent consensus among

members of the ERC Executive Committee. The

ERC Executive Committee considers these new rec-

ommendations to be the most effective and eas-

ily learned interventions that can be supported

by current knowledge, research and experience.

Inevitably, even within Europe, differences in the

availability of drugs, equipment, and personnel will

necessitate local, regional and national adaptation

of these guidelines.

Aetiology

Number (%)

Presumed cardiac disease

17451 (82.4)

Non-cardiac internal aetiologies

1814 (8.6)

Lung disease

901 (4.3)

Cerebrovascular disease

457 (2.2)

Cancer

190 (0.9)

Gastrointestinal haemorrhage

71 (0.3)

Obstetric/paediatric

50 (0.2)

Pulmonary embolism

38 (0.2)

Epilepsy

36 (0.2)

Diabetes mellitus

30 (0.1)

Renal disease

23 (0.1)

Non-cardiac external aetiologies

1910 (9.0)

Trauma

657 (3.1)

Asphyxia

465 (2.2)

Drug overdose

411 (1.9)

Drowning

105 (0.5)

Other suicide

194 (0.9)

Other external

50 (0.2)

Demographics

Electric shock/lightning

28 (0.1)

Ischaemic heart disease is the leading cause of

death in the world. 13—17 S udden cardiac arrest is

responsible for more than 60% of adult deaths

from coronary heart disease. 18 B ased on data from

Scotland and from ﬁve cities in other parts of

Europe, the annual incidence of resuscitation for

out-of-hospital cardiopulmonary arrest of cardiac

aetiology is 49.5—66 per 100,000 population. 19,20

The Scottish study includes data on 21,175 out-

of-hospital cardiac arrests, and provides valuable

information on aetiology ( Table 1.1 ). The incidence

of in-hospital cardiac arrest is difﬁcult to assess

because it is inﬂuenced heavily by factors such as

the criteria for hospital admission and implementa-

tion of a do-not-attempt-resuscitation (DNAR) pol-

icy. In a general hospital in the UK, the incidence

of primary cardiac arrest (excluding those with

DNAR and those arresting in the emergency depart-

ment) was 3.3/1000 admissions; 21 u sing the same

exclusion criteria, the incidence of cardiac arrest

in a Norwegian University hospital was 1.5/1000

admissions. 22

includes prevention of conditions leading to the

cardiopulmonary arrest, early CPR, early activa-

tion of the emergency services and early advanced

life support. In hospital, the importance of early

recognition of the critically ill patient and activa-

tion of a medical emergency team (MET) is now well

accepted. 23 P revious resuscitation guidelines have

provided relatively little information on treatment

of the patient during the post-resuscitation care

phase. There is substantial variability in the way

comatose survivors of cardiac arrest are treated

in the initial hours and ﬁrst few days after return

of spontaneous circulation (ROSC). Differences in

treatment at this stage may account for some of

the interhospital variability in outcome after car-

diac arrest. 24 T he importance of recognising crit-

ical illness and/or angina and preventing cardiac

arrest (in- or out-of-hospital), and post resuscita-

tion care has been highlighted by the inclusion of

these elements in a new four-ring Chain of Sur-

vival. The ﬁrst link indicates the importance of

recognising those at risk of cardiac arrest and call-

ing for help in the hope that early treatment can

prevent arrest. The central links in this new chain

depict the integration of CPR and deﬁbrillation as

the fundamental components of early resuscitation

in an attempt to restore life. The ﬁnal link, effec-

tive post resuscitation care, is targeted at preserv-

ing function, particularly of the brain and heart

( Figure 1.1 ). 25,26

The Chain of Survival

The actions linking the victim of sudden cardiac

arrest with survival are called the Chain of Sur-

vival. They include early recognition of the emer-

gency and activation of the emergency services,

early CPR, early deﬁbrillation and early advanced

life support. The infant-and-child Chain of Survival

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