If you hadn’t noticed, the American Heart Association released its latest guidelines for emergency resuscitation on October 15.
While I was reviewing them, I thought about the days when sodium bicarbonate was a first line medication and three stacked shocks were absolutely critical to better outcomes.
Tincture of time revealed that neither of these were effective and eventually were relegated to the “tried it, didn’t work” pile. That’s nature of medicine; our task is to improve the lives of those we serve.
Over the past forty years we have shifted away from expert opinion and tradition as a basis for practice, and moved to improved scientific inquiry adapted for the intricacies of community-based field medicine.
I feel there are three current overarching trends in the current iteration of the ECC guidelines:
1. More of the same
It feels like 2015 is “more of the same” from 2010. It points to the maturing trend of resuscitation science. It’s become very clear that prompt, high-quality CPR is a fundamental key to successful outcomes. And yes, we knew that back in the 1950s, but we strayed afar. The last decade of research has fundamentally verified that the public is truly the first responder in sudden cardiac arrest, and anything that can fine tune that cog will result in substantially better outcomes.
2. There is no magic bullet
The 2015 guidelines are finally encapsulating what has also been known for some time — that it is a system of practices that will optimize survival to discharge neurologically intact. There is no magic bullet, no panacea to resuscitation success. Each link in the chain of survival has to be carefully calibrated to maximize its effectiveness, in order for the whole chain to function in favor of the patient.
3. Optimizing the basics
There is a lot of mention of field care. A fair amount points to middling results on some of the treatments being utilized at the moment. Rather than being disappointed I think a better way to interpret this is that our strengths continue to be in optimizing the basics and building the strong foundation for successful outcomes.
As you read the guidelines what are your first impressions? Share your thoughts in the comments.
