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Cardio Diabetes Medicine 2017 485

Summary of Key Issues and Major Changes: References:
Key issues and major changes in the 2015 Guidelines 1. Neumar RW, Shuster M, Callaway CW, et al. Part 1: executivesumma-
Update recommendations for advanced cardiac life ry: 2015 American Heart Association Guidelines Updatefor Cardiopul-
monary Resuscitation and Emergency CardiovascularCare. Circulation.
support include the following: 2015;132(18)(suppl 2).
The combined use of vasopressin and epinephrine 2. Hazinski MF, Nolan JP, Aicken R, et al. Part 1: executive summary:2015
offers no advantage to using standard-dose epineph- International Consensus on Cardiopulmonary Resuscitationand Emergency
rine in cardiac arrest. Also, vasopressin does not of- Cardiovascular Care Science With Treatment Recommendations. Circula-
tion. 2015;132(16)(suppl 1).
fer an advantage over the use of epinephrine alone.
Therefore, to simplify the algorithm, vasopressin has 3. Nolan JP, Hazinski MF, Aicken R, et al. Part 1: executive summary:2015
been removed from the Adult Cardiac Arrest Algo- International Consensus on Cardiopulmonary Resuscitationand Emergency
Cardiovascular Care Science With TreatmentRecommendations. Resusci-
rithm– 2015 Update. tation. In press.
Low end-tidal carbon dioxide (ETCO2) in intubated
patients after 20 minutes of CPR is associated with
a very low likelihood of resuscitation. While this pa-
rameter should not be used in isolation for decision
making, providers may consider low ETCO2 after 20
minutes of CPR in combination with other factors to
help determine when to terminate resuscitation.

Steroids may provide some benefit when bundled
with vasopressinand epinephrine in treating IHCA.
While routine use is notrecommended pending fol-
low-up studies, it would be reasonablefor a provider
to administer the bundle for IHCA.
When rapidly implemented, ECPR can prolong viabil-
ity, as it mayprovide times to treat potentially revers-
ible conditions or arrange for cardiac transplantation
for patients who are not resuscitated byconventional
CPR.
In cardiac arrest patients with nonshockable rhythm
and who areotherwise receiving epinephrine, the ear-
ly provision of epinephrineis suggested.
Studies about the use of lidocaine after ROSC are
conflicting, androutine lidocaine use is not recom-
mended. However, the initiation orcontinuation of li-
docaine may be considered immediately after ROSC-
from VF/pulseless ventricular tachycardia (pVT) car-
diac arrest.
One observational study suggests that ß-blocker
use after cardiacarrest may be associated with bet-
ter outcomes than whenß-blockers are not used. Al-
though this observational study is notstrong-enough
evidence to recommend routine use, the initiationor
continuation of an oral or intravenous (IV) ß-block-
er may beconsidered early after hospitalization from
cardiac arrest due to VF/pVT.

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