ARC Frequently Asked Questions
To become a subscriber to the Australian Resuscitation Council you need to purchase a copy of the Manual of Guidelines for $77 and take out the yearly subscription of $66 to receive the new and/or updated guidelines which are issued three times per year (when required) with the Newsletter.
Please email arc@surgeons.org
When the 'authentication' box pops up, make sure you enter your username and password EXACTLY as supplied. These details are case-sensitive. If you still can't get your password to work then please contact the Head Office.
The Australian Resuscitation Council is a voluntary co-ordinating body which represents all major groups involved in the teaching and practice of resuscitation. It is sponsored by the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists.
The Australian Resuscitation Council produces Policy Statements to meet its objectives in fostering uniformity and simplicity in resuscitation techniques and terminology. Policies are produced after consideration of all available scientific and published material and are only issued after acceptance by all member organisations. This does not imply, however, that methods other then those recommended are ineffective.
It is the policy of the Australian Resuscitation Council to respect the autonomy of member organisations.
Click here to go to the membership page. There are links here to most of our members web sites.
The Australian Resuscitation Council meets three times a year
The End of CPR as We Knew it?
In a recent email from the USA, it was quoted: “In what may prove to be the
biggest shift in emergency care of cardiac arrest in 40 years, cities across the
country are leading a move away from the familiar practice of using
mouth-to-mouth resuscitation. (Related Story: Many 911 dispatchers eliminating
mouth-to-mouth) In its place, the cities are recommending simple chest
compressions pushing down repeatedly on the victim’s chest – to mimic a steady
heartbeat. The emergency medical directors who are behind the shift say research
in Seattle and Richmond, Va, suggests it will save many lives. (Related story:
People die in just a few seconds lost). The movement became a full-fledged
national trend last week at a meeting of emergency medical services (EMS)
medical directors from 21 of the nation’s largest cities. Doctors from a dozen
cities, including New York, Los Angeles and Chicago, decided to make the switch.
They join at least seven other cities that are already advising 911callers to do
chest compressions without mouth-to-mouth “rescue breathing””.
This issue has received media attention in the USA following a recent meeting of
EMS medical directors. There has also been a recent article in the Weekend
Australian newspaper. It mainly results from a study by Dr Hallstrom and
published in the Critical Care Medicine in 2000. In this study, callers to EMS
reporting a cardiac arrest and did not know CPR, were asked if they wanted to be
instructed on how to do CPR. Those agreeing were randomised to receive
instructions over the phone to either do full CPR or just chest compressions.
This is often referred to ‘dispatcher assisted CPR’. The results of the study
showed that the number of survivors in each group to be similar (14.6% for
compression only vs 10.4% for full CPR)
It is important to note that the findings of this study refer only to situations
where no trained bystanders were performing CPR. It shows that giving minimal
telephone instructions (ie compressions only) seems to be as effective in terms
of survival as giving full CPR instructions over the phone. However, this study
does not compare the outcomes of untrained rescuers who receive dispatcher
assisted CPR with that of CPR being performed by trained rescuers.
As such, inferring that mouth to mouth is not required when doing CPR is not
supported by any clinical evidence. Furthermore, it ignores other causes of
cardiac arrest such as drowning, and cardiac arrest in children, where
ventilation (ie mouth to mouth) is vital.
Readers should be aware that the recommendations of the EMS directors were that
“compression only” CPR advice should be given to callers receiving assistance
from EMS dispatchers. It did not recommend removing mouth to mouth ventilation
from CPR training or practice, as has been generally presented in the media.
Futher Reading:
Hallstrom AP. Dispatcher-assisted "phone" cardiopulmonary
resuscitation by chest compression alone or with mouth-to-mouth ventilation.
Crit Care Med 2000;28(11 Suppl):N190-N192.
VASOPRESSINS
A recently published study in the New England Journal of Medicine, and an
accompanying editorial have thrown down the gauntlet to those organisations that
produce guidelines for cardiac arrest management. In this large European study,
the investigators evaluated the potential role of vasopressin as the initial
vasopressor in the management of out-of-hospital cardiac arrests. Two doses of
either vasopressin (40 Units) or adrenaline (1 mg) were administered to patients
who required vasopressor support (in accord with European Resuscitation Council
guidelines). Across the board, there were no differences in rates of hospital
admission or hospital discharge but two post-hoc observations did however raise
some interesting points. Firstly, there was a small but significant increase in
the hospital discharge rates with vasopressin when the initial cardiac rhythm
was asystole. Secondly, the benefits associated with vasopressin seemed to be
associated with patients who did not respond to vasopressin alone, but required
additional management with adrenaline.
This study was performed in a pre-hospital setting with physician–staffed
emergency medical service units. The time intervals to administration of drugs
were long (mean of 8 minutes of untreated [no BLS] cardiac arrest, then 10
minutes more until administration of first dose of study drug). There were some
disturbing trends towards increased likelihood of adverse neurological outcomes
(eg. coma, and severe cerebral disability) in the survivors from the vasopressor
group, and this study contradicts the earlier out-of-hospital study of
ventricular fibrillation that found dramatically improved short-term survival
advantage with a single dose (40 Units) vasopressin.
The ARC is in the process of completing an evidence-based review, but at this
stage no change in management or algorithms are required.
Further reading:
· Lindner KH, Dirks B, Strohmenger HU, Prengel AW, Lindner IM,
Lurie KG. Randomised comparison of epinephrine and vasopressin in patients with
out-of-hospital ventricular fibrillation. Lancet 1997;349(9051):535-7.
· Stiell IG, Hebert PC, Wells GA, Vandemheen KL, Tang AS, Higginson LA, et al.
Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised
controlled trial. Lancet 2001;358(9276):105-9.
· Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH. A
comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary
resuscitation. N Engl J Med 2004;350(2):105-13.
· McIntyre KM. Vasopressin in asystolic cardiac arrest. N Engl J Med
2004;350(2):179-81.
Crystalloids
Versus Colloids: Is Albumin safe?
The age-old debate about which fluids are best for the resuscitation of
patients was thrown into chaos by the meta-analysis published in the BMJ in 1998
by the Cochrane group [1]. This review suggested a 6%
increase in mortality for those patients treated with albumin (one additional
death for every 17 patients treated).
Much discussion ensued, and further meta-analyses were published, but the major
factor lacking was a well-conducted trial to actually answer the question “is
albumin safe?”
The Australian and New Zealand Intensive Care Society Clinical Trials Group
recently published a definitive study, which comes closer to help us answer this
question. This study [2], published with an editorial3 in
the prestigious New England Journal of Medicine in May this year, was a
multicenter, randomised, double-blind trial to compare the effect of fluid
resuscitation with albumin or saline on mortality in a heterogeneous population
of patients in the ICU. They randomly assigned 6997 patients who had been
admitted to the ICU to receive intravascular-fluid resuscitation with either 4
percent albumin or normal saline for the next 28 days.
There were no significant differences between the groups with regard to
mortality, numbers of days spent in the ICU, days spent in the hospital, days of
mechanical ventilation or days of renal-replacement therapy. Two pre-specified
subsets raised some additional interest when albumin administration was
associated with better outcomes in one (“severe sepsis”), but was associated
with a trend toward worse outcomes in the other (“trauma”). Again, as with many
studies, this publication has probably raised more questions than it answered,
but it seems that we can at least answer the question “is albumin safe?” Yes!
1. Human albumin administration in critically ill patients: systematic review of
randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ
1998;317(7153):235-40.
2. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A
comparison of albumin and saline for fluid resuscitation in the intensive care
unit. N Engl J Med 2004;350(22):2247-56.
3. Cook D. Is albumin safe? N Engl J Med 2004;350(22):2294-6.
© copyright 2004 Australian Resuscitation Council