Recent discussions
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Bryan Fischberg
Is there anything in the evidence for this CoSTR to support the current good practice recommendation to avoid placing defibrillation pads over or close to implanted devices? Or, should this be included as a good practice statement? Thank you. Bryan
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ILCOR Staff
Thank you for this comment. The ILCOR task force considers first aid for life threatening and resuscitative conditions as a part of a continuum of care, initiated by anyone to save lives and reduce suffering, and involving engagement with more advanced healthcare providers whenever necessary. We also take into account the wide range of resources and emergency care systems around the globe. For people experiencing postpartum hemorrhage, this ranges from individuals in higher-resource settings and immediate access to advanced professional care, as well as people in settings with no access to formal or highly trained obstetrical and birthing providers. Our recommendation to provide external uterine massage as a first aid intervention accounts for these diverse contexts. It does not in any way suggest that this first aid intervention alone should be considered sufficient or definitive management of postpartum hemorrhage. The scope of our review concerned the effects of external uterine massage on morbidity and mortality. However, we also agree and recognize that implementation of that intervention would require education and knowledge translation efforts beyond the scope of this review.
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Ansari Shabnam Ateeq
Many women who identify as practising Muslims would choose DNR or resuscitation without bra removal. That's because the person is clinically dead and required to be buried as soon as possible, rather than be subjected to a violation of modesty. A few women may want to have a second chance at life because of vulnerable dependants. However, as per faith, the responsibility of a person towards living individuals ceases upon death. Persons with out-of-body experiences report being sent back to life due to pending responsibilities. But that is a matter between them and the Almighty. Healthcare professionals do not have the ability to know who wants to be resuscitated or not. Hence, it may be relevant to empower women with DNR and DNUDR (do not uncover during resuscitation) tags to wear around the neck. As a Muslim woman of 55 years, I want to do this but not sure if caregivers will look for it and comply.
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Denise Welsby
I read with concern the potential recommendation to move away from ABC to CAB for both children and Adults. I believe that further clarification, is required as to when it is acceptable to applying the CAB over ABC and would suggest that in the monitored or cardiac paediatric patients where the evidence of cardiac arrest is undoubted this will be a good first step, to manage the low flow no flow states and buy time.
However, in the vast majority of paediatric patients, cardiac disease is not the primary cause, respiratory support remains the primary focus to prevention hypoxia and a resulting cardiac arrest, so by maintaining respiratory support, chest compressions will be avoided. It appears that low evidence manikin/simulation studies appear to be driving this change and not paediatric studies
Removal of the pulses check in adults was great step in 2021 but to recommend this for the paediatric patients, I believe a negative step given the primary cause is usually hypoxia in children and the heart is still beating i many cases.
The effect of the 2021 the recommendation to commence chest compressions if no signs of life, has resulted in our UK organisation paediatric patients receiving unnecessary CPR for 10+5 and staff de skilling .
In addition, this suggestion to apply CAB over ABC will cause further false cardiac arrest declarations in the UK (NCAA guidance of 1 chest compression = cardiac arrest) in paediatrics, and further de-skill staff by encouraging them to pounce first and check later.
I would recommend teach staff CAB for all cardiac monitored patients' adult and paed.
ABC remains in Europe at least so staff remain focused on hypoxia as the main cause of collapse and to be prepared. BMV's are as cheap as chips and can be kept at the bed side.
Don't underestimate the power of ABC and don't compromise quality prevent of cardiac arrest over speed to preform compressions.
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James Menegazzi
Based on the extant literature, I believe that this recommendation is sound and defensible.
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James Menegazzi
This review has misinterpreted the results of the Niederberger, et al. of which I am the senior author. The potential benefit is for patients with initial ECG rhythms of PEA and asystole. Since we have nothing else to offer these patients other than repeated doses of adrenaline, bicarb administration makes sense. To rule out its potential benefit for patients with these ECG rhythms is misleading.
James J. Menegazzi
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Sebastian Schnaubelt
Dear TF,
This is a very important topic, thank you for addressing it!
We regularly see problems in bra removal due to uncertainty whether to do it or not, and pads being partly placed on parts of the bra instead of fully on bare skin.
There is currently no evidence (concerning bras) assessing whether not vs. fully placing the pads on bare skin results in changed outcomes (all outcomes ranging from energies to patient outcomes), and I would not see the study on pigs as transferrable to real-life conditions in humans.
Therefore, in doubt, I would suggest to (instead of practically recommending against removing it) recommend either removing the bra or push it to the side / up / down or else, so that it is ensured that pads are placed on bare skin only. Also, there is the other issue of chest compression being potentially hindered by bra parts lying on the pressure point.
I fear that if left as it is now, the recommendation will lead to guidelines either not mentioning the topic or just saying it is not necessary to remove a bra (and then being interpreted as “just leave it it doesn't matter”).
Thank you for considering this!
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David Fredman
Locked AED cabinets is an effective way to reduce the efficiency of AEDs, be it in public locations or anywhere. In Sweden, and likely other countries as well, insurances are offered that will replace an AED if it´s stolen or vandalized, and in some instances even replace electrodes and batteries if the AED instead is used.
I´d encourage more insurance companies in more countries to move in this direction, to increase the likelihood of AED use and the chance to survival.
I believe fear of theft can be mitigated through insurances and thus more AEDs could be available in public. But I would also encourage researchers and other entities (national resuscitation councils etc.) to dig a bit deeper in to the sources around theft. Currently in Sweden the media boosts stories on stolen AEDs more than stories on successful rescuing with an available public AED. Another angle on the story could be if theft of AEDs are a big problem on societal level or is it a big problem on an individual level. The individual level issue could be mitigated through insurances, and if the theft issue is big on a national level I´d encourage AED vendors and producers to work with police and second-hand sales platforms to block sales of electrodes and batteries to AEDs that were reported stolen. If we work together to stop that “second hand” market, the theft of AEDs would likely decrease. And I´m looking at the big fishes here, the serial number of an AED could be used for so much more than it is today, and theft prevention is one thing. We need to work together to make sure that AEDs can reach their full potential in public locations, and locking them in is not the way to go.
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Janet Bray
Thank you for your comments, which will be considered by the BLS Task Force. Animal studies are excluded and ETCO2 was not a prespecified outcome included in the review protocol. We plan to publish the systematic review, and this evidence will likely be highlighted there. Janet Bray (BLS Task Force Chair)
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Janet Bray
The review followed proper systematic review processes. The CoSTR presents a summary of the methods and results, the full SR is being prepared for publication.