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ERC Newsletter January 2020

General News:
New ILCOR Reviews for Public Comment

ILCOR has published numerous new systematic reviews and scoping reviews for public comment. These reviews are instrumental to the creation of our ERC Guidelines. Go visit the ILCOR website and leave a comment!

Visit the ILCOR Review Website
Congress News:
Register now for Resuscitation 2020!

Get there early! Registrations for our 2020 Guidelines congress in Manchester are now open. By registering now, you will be sure to be the first in line when the new Guidelines are introduced and save over €70. 

Register now

Abstract submission now open

You can now submit your abstract for Resuscitation 2020. Abstract submission will be open until 15 May 2020.

Submit your abstract

Peter Baskett Bursary for ERC Instructors

Are you an ERC Instructor looking to attend Resuscitation 2020? The Peter Baskett Bursary provides financial aid for ERC instructors with limited financial means to attend the ERC Congress. Applications are open until 10 May 2020.

Apply here


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Interesting Reading:
This section of the newsletter is to highlight articles that we found interesting. If you are an ERC member you can access the entire texts of Resuscitation journal articles by first logging in on CoSy and then following the links below. With thanks to
Walter Renier for providing the selection.
Each month you can download one free Article of the Month and an Editorial of the Month from Resuscitation.

Editorial of the Month:
Chest compression components — What do we really know?

Article of the Month
Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest
What is the place of rescue breathing in out-of-hospital cardiac arrest (OHCA) due to drowning? 

The effect of bystander-initiated conventional (with rescue breathing) versus compression-only (without rescue breathing) CPR was examined. Only 19% of victims received conventional CPR but neurologically favorable outcome was statistically not different from the compression-only CPR. 

Comments: In the same Resuscitation volume, Handley T wrote a very nice editorial on CPR in case of drowning. If not trained, rescuers should only deliver chest compression-only CPR. Will this be a new argument to withhold rescue breaths? Some instructors ask whether they should first deliver 5 initial rescue breaths. Based on this article, we can conclude that this is not necessary (we are not talking about children!): a classical CPR 30:2 as in a cardiac arrest in adults is what professionals should do. Until prove otherwise, we must follow the ERC guidelines and rescuers should give rescue breaths if they have learned it.

Fukuda T, Ohashi-Fukuda N, Hayashida K, Kondo Y, Kukita I. Bystander-initiated conventional vs compression-only cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest due to drowning. Resuscitation. 2019 Dec; 145:166-74.

Read the full article
How effective are chest compressions in a moving ambulance?

CPR in ambulances is often initiated or maintained. The position of the paramedics poses safety risks by standing unsecured in a moving ambulance. Comparison of simulated chest compressions between an unsecured standing position and a seated secured position gave no difference in total number of chest compressions an compression rate, but mean depth was significantly greater in the unsecured position. Participants also believed that chest compressions delivered when standing were more effective than those delivered when seated.

Comment: As authors wrote: there is a need for research on how training, technologies, and ambulance design can impact the quality of chest compressions. This study does not give an incentive to use the unsecure position, but requires further investigation. It is also possible that the participants exerted more strength because they stood up. A new study should e.g. measure the difference between the quality of CPR (and outcome of the patient?) in a standing and a sitting position in a moving and stationary ambulance.

Mullin S, Lydon S, O'Connor P. The Effect of Operator Position on the Quality of Chest Compressions Delivered in a Simulated Ambulance. Prehosp Disaster Med. 2019 Dec;9:1-6.

Read the full article
Are AEDs safe to use for infants younger than 12 months?

Frequently  in courses candidates ask if the use of automated external defibrillators (AEDs) is safe in infants less than one year of age. Authors report a case with successful AED use in a 31-day-old previously healthy infant with out-of-hospital cardiac arrest. Chest compressions began immediately, paediatric AED pads were applied within less than 5 minutes and the initial rhythm was ventricular fibrillation. Two 50 J shocks resulted in the return of spontaneous circulation. Although the child received two shocks of more than 11 J/kg each, there was no apparent myocardial damage at hospital presentation.

Comments: The safety of the use of an AED in infants is unknown and this case seems to be a unique one to demonstrate a possible safety in infants. However, more research is needed to confirm the safety. Pro: the delivered energy is the minimal dose in AEDs adapted for children. Ventricular fibrillation (FV) occurs only in about 24% of cardiac arrest of primary cardiac origin (Nordseth T., read here) and is consequently the best indication for defibrillation. Studies to discover the initial cardiac rhythm are very rare, especially in the period of 1 minute CPR before applying the AED, as recommended in children with a non-witnessed collapse. 

Hoyt WJ Jr, Fish FA, Kannankeril PJ. Automated external defibrillator use in a previously healthy 31-day-old infant with out-of-hospital cardiac arrest due to ventricular fibrillation. J Cardiovasc Electrophysiol. 2019 Nov;30(11):2599-2602.

Read the full article here
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