European Resuscitation Council Guidelines for Resuscitation 2010 ...

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1226 J.P. Nolan et al. / Resuscitation 81 (2010) 1219–1276 Fig. 1.3. Adult foreign-body airway obstruction (choking) sequence. © 2010 ERC. Table 1.1 Differentiation between mild and severe foreign body airway obstruction (FBAO) a Sign Mild obstruction Severe obstruction “Are you choking?” “Yes” Unable to speak, may nod Other signs Can speak, cough, breathe Cannot breathe/wheezy breathing/silent attempts to cough/unconsciousness a General signs of FBAO: attack occurs while eating; victim may clutch his neck. the head dependent, and with no pressure on the chest to impair breathing. 95 Foreign-body airway obstruction (choking) Foreign-body airway obstruction (FBAO) is an uncommon but potentially treatable cause of accidental death. 96 The signs and symptoms enabling differentiation between mild and severe airway obstruction are summarised in Table 1.1. The adult foreignbody airway obstruction (choking) sequence is shown in Fig. 1.3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing Automated external defibrillators Automated external defibrillators (AEDs) are safe and effective when used by either laypeople or healthcare professionals (in- or out-of-hospital). Use of an AED by a layperson makes it possible to defibrillate many minutes before professional help arrives. Sequence for use of an AED The ERC AED algorithm is shown in Fig. 1.4. 1. Make sure you, the victim, and any bystanders are safe. 2. Follow the Adult BLS sequence: • if the victim is unresponsive and not breathing normally, send someone for help and to find and bring an AED if available; • if you are on your own, use your mobile phone to alert the ambulance service – leave the victim only when there is no other option. 3. Start CPR according to the adult BLS sequence. If you are on your own and the AED is in your immediate vicinity, start with applying the AED. 4. As soon as the AED arrives: • switch on the AED and attach the electrode pads on the victim’s bare chest; • if more than one rescuer is present, CPR should be continued while electrode pads are being attached to the chest; • follow the spoken/visual directions immediately; • ensure that nobody is touching the victim while the AED is analysing the rhythm. 5a. If a shock is indicated: • ensure that nobody is touching the victim; • push shock button as directed; • immediately restart CPR 30:2; • continue as directed by the voice/visual prompts. 5b. If no shock is indicated: • immediately resume CPR, using a ratio of 30 compressions to 2 rescue breaths; • continue as directed by the voice/visual prompts. 6. Continue to follow the AED prompts until: • professional help arrives and takes over; • the victim starts to wake up: moves, opens eyes and breathes normally; • you become exhausted. Public access defibrillation programmes Automated external defibrillator programmes should be actively considered for implementation in public places such as airports, 52 sport facilities, offices, in casinos 55 and on aircraft, 53 where cardiac arrests are usually witnessed and trained rescuers are quickly on scene. Lay rescuer AED programmes with very rapid response times, and uncontrolled studies using police officers as first responders, 97,98 have achieved reported survival rates as high as 49–74%.
J.P. Nolan et al. / Resuscitation 81 (2010) 1219–1276 1227 Fig. 1.4. AED algorithm. © 2010 ERC. The full potential of AEDs has not yet been achieved, because they are used mostly in public settings, yet 60–80% of cardiac arrests occur at home. Public access defibrillation (PAD) and first responder AED programmes may increase the number of victims who receive bystander CPR and early defibrillation, thus improving survival from out-of-hospital SCA. 99 Recent data from nationwide studies in Japan and the USA 33,100 showed that when an AED was available, victims were defibrillated much sooner and with a better chance of survival. Programmes that make AEDs publicly available in residential areas have not yet been evaluated. The acquisition of an AED for individual use at home, even for those considered at high risk of sudden cardiac arrest, has proved not to be effective. 101 In-hospital use of AEDs At the time of the 2010 Consensus on CPR Science Conference, there were no published randomised trials comparing in-hospital use of AEDs with manual defibrillators. Two lower-level studies of adults with in-hospital cardiac arrest from shockable rhythms showed higher survival-to-hospital discharge rates when defibrillation was provided through an AED programme than with manual defibrillation alone. 102,103 Despite limited evidence, AEDs should be considered for the hospital setting as a way to facilitate early defibrillation (a goal of
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