Actualización de las recomendaciones de soporte vital cardiovascular avanzado de adultos y pediatría de la AHA 2018. El documento se encuentra en inglés. Puedes ver una traducción aquí
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...Gastrolearning
Gastrolearning III lezione
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Prof. C. Cammà (Università di Palermo)
www.gastrolearning.it
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...Gastrolearning
Gastrolearning III lezione
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Prof. C. Cammà (Università di Palermo)
www.gastrolearning.it
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Associ...María Camila Pineda López
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Association Guidelines Update for ardiopulmonary. Resuscitation and Emergency Cardiovascular Care.
This is a 2.5 hour update/preview of the 2010 ECC guidelines for CPR and ACLS. It does not include "special situations" and does not include the PALS/NRP stuff (both of these presentations are coming later). It is in its final draft but has been ran through a paramedic refresher course with good reception.
DISCLAIMER: It does not contstitute a formal ACLS refresher course, nor is it intended too.
Also it incudes much content from my importance of CPR lecture, also on here.
Actualización en Fibrilación Auricular: de la evidencia a la práctica clínica.
10 de Junio de 2014, 16:30h
http://www.secardiologia.es/directos/actualizacionFA.html
Introducción: de la investigación a la práctica. ¿Qué cambia en la vida real?
Dr. José Ramón González-Juanatey
Complejo Hospitalario Universitario de Santiago de Compostela. Presidente SEC
Twitter: @JoseJuanatey
Salud y podcast: otra herramienta para la comunicación de contenidos sanitariosElena Plaza Moreno
Os dejo mi ponencia en la #JIenferSUMMA112, la Jornada Internacional de Enfermería SUMMA112 que se llevó a cabo los días 7 y 8 de noviembre del 2019 en Madrid. Fui invitada a las mismas como participante de la Mesa: Investigación y formación en el ámbito de Urgencias.
En la ponencia intento acercar a la gente el mundo del podcast y del podcasting para mostrar que es un excelente medio divulgativo y formativo. Podemos usarlo para realizar formación en nuestro ámbito o para realizar educación para la salud con los pacientes.
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Associ...María Camila Pineda López
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Association Guidelines Update for ardiopulmonary. Resuscitation and Emergency Cardiovascular Care.
This is a 2.5 hour update/preview of the 2010 ECC guidelines for CPR and ACLS. It does not include "special situations" and does not include the PALS/NRP stuff (both of these presentations are coming later). It is in its final draft but has been ran through a paramedic refresher course with good reception.
DISCLAIMER: It does not contstitute a formal ACLS refresher course, nor is it intended too.
Also it incudes much content from my importance of CPR lecture, also on here.
Actualización en Fibrilación Auricular: de la evidencia a la práctica clínica.
10 de Junio de 2014, 16:30h
http://www.secardiologia.es/directos/actualizacionFA.html
Introducción: de la investigación a la práctica. ¿Qué cambia en la vida real?
Dr. José Ramón González-Juanatey
Complejo Hospitalario Universitario de Santiago de Compostela. Presidente SEC
Twitter: @JoseJuanatey
Salud y podcast: otra herramienta para la comunicación de contenidos sanitariosElena Plaza Moreno
Os dejo mi ponencia en la #JIenferSUMMA112, la Jornada Internacional de Enfermería SUMMA112 que se llevó a cabo los días 7 y 8 de noviembre del 2019 en Madrid. Fui invitada a las mismas como participante de la Mesa: Investigación y formación en el ámbito de Urgencias.
En la ponencia intento acercar a la gente el mundo del podcast y del podcasting para mostrar que es un excelente medio divulgativo y formativo. Podemos usarlo para realizar formación en nuestro ámbito o para realizar educación para la salud con los pacientes.
Gel de ultrasonidos y gel para desfibrilación. A propósito de un cuasi evento...Elena Plaza Moreno
MONTERO-PÉREZ FJ, ROMERO BRAVO A, LUCENA AGUILERA C, ARMENTEROS ORTIZ PJ, MEDINA CANALES JJ, CALDERÓN DE LA BARCA GÁZQUEZ JM
Emergencias 2015;27(5): 354-354
Tipo artículo: Cartas al director
Infografía sobre los fármacos en la anafilaxia. Elaboración propia con información obtenida de Cardona Dahl V, Cabañes Higuero N, Chivato Pérez T, Guardia Martínez P, Fernández Rivas MM, Freijó Martín C, et al. GALAXIA: Guía de actuación en anafilaxia. Madrid: SEAIC; 2016.
RECOMENDACION DE LA SOCIEDAD ESPAÑOLA DE ENFERMERIA DE URGENCIAS Y EMERGENCIAS SOBRE INSERCIÓN, CUIDADOS, USO Y MANTENIMIENTO DE LA VÍA INTRAÓSEA PARA LOS PROFESIONALES DE LOS EQUIPOS DE URGENCIAS Y EMERGENCIAS.
Autores.-
*Diego Melgarejo Ávila, ** Mónica García Montes, *** Beatriz González Pelegrín
* Enfermero Unidad Medicalizada Emergencias Azuaga. Servicio Extremeño de Salud.
** Enfermera Unidad Medicalizada Emergencias Elgoibar (Ambulancias Guipúzcoa). Servicio Vasco de Salud
*** Enfermera Unidad de cuidados intensivos del Hospital de Barbastro. Servicio Aragonés de Salud
Síndrome Coronario Agudo. ¿Existen diferencias entre el hombre y la mujer?Elena Plaza Moreno
Diferencias entre el hombre y la mujer en el SCA. Se describen las diferencias biológicas, fisiopatológicas, psicosociales, factores de riesgo y en los síntomas.
Rev Esp Cardiol. 2017;70(12):1082.e1-e61.
Comentarios a la guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST.
Disponible en: http://www.revespcardiol.org/es/comentarios-guia-esc-2017-sobre/articulo/90461837/
Guías originales: https://www.slideshare.net/elenuskienf/nuevas-guas-2017-para-el-manejo-del-sndrome-coronario-agudo-con-elevacin-del-st-de-la-sociedad-europea-de-cardiologa-sec
AHA 2017: actualización RCP básica adultos y pediatríaElena Plaza Moreno
Traducción no oficial extractada de los artículos “2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care ” y “2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”. Circulation, 2017.
Traducción realizada por C. Alonso Blas. Coordinador Nacional del Programa de Formación SEMES-RCP de la Sociedad Española de Medicina de Urgencias y Emergencias.
- Adultos: http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000539
- Pediatría: http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000540
Nuevas guías 2017 para el manejo del Síndrome Coronario Agudo con Elevación d...Elena Plaza Moreno
Nuevas guías 2017 para el manejo del Síndrome coronario Agudo con elevación del ST de la Sociedad Europea de Cardiología (SEC). // 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
Disponible en:
- European Heart Journal. 2017. doi 10.1093/eurheartj/ehx393 y
- Web de la SEC: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Myocardial-Infarction-in-patients-presenting-with-ST-segment-elevation-Ma
Infografía sobre la hiperpotasemia, tratamiento, causas, manifestaciones.
FUENTE: De Sequera Ortíz P, Alcazar Arroyo R, Albalate Ramon M. Alteraciones del potasio. En: Lorenzo V, López Gómez JM (Eds) Nefrología al Día. http://www.revistanefrologia.com/es-monografias-nefrologia-dia-articulo-trastornos-del-potasio-20
Actuación de enfermería ante una alteración electrocardiográfica (5º parte)Elena Plaza Moreno
Enferm Cardiol. 2016; 23 (67): 58-65.
Autor: Juan Carlos Rubio Sevilla.
Eje, onda P y complejo QRS. Quinta entrega de una serie de artículos que tratan sobre la actuación de enfermería ante una alteración electrocardiográfica.
Actuación de enfermería ante una alteración electrocardiográfica (4º parte)Elena Plaza Moreno
Enferm Cardiol. 2015; 22 (66): 17-27.
Autor: Juan Carlos Rubio Sevilla.
Taquicardias de QRS ancho. Cuarta entrega de una serie de artículos que tratan sobre la actuación de enfermería ante una alteración electrocardiográfica.
Actuación de enfermería ante una alteración electrocardiográfica (3º parte)Elena Plaza Moreno
Enferm Cardiol. 2015; Año XXII (65): 21-32.
Autor: Juan Carlos Rubio Sevilla
Taquicardias de QRS estrecho. Tercera entrega de una serie de artículos que tratan sobre la actuación de enfermería ante una alteración electrocardiográfica.
Errores y artefactos más comunes en la obtención del electrocardiogramaElena Plaza Moreno
AUTOR: JAVIER GARCÍA NIEBLA. Capítulo 10 del curso "Actualización online en electrocardiografía" de la Sociedad Interamericana de Cardiología disponible en http://www.siacardio.com/educacion/cursos-siac/electrocardiografia/
Comunicación durante el traspaso de pacientes. Recomendación de la JCI: técni...Elena Plaza Moreno
Recomendación de la Joint Comissión International sobre la "Comunicación durante el traspaso de pacientes". Recomienda un enfoque estandarizado para la comunicación entre el personal en el momento del traspaso, los cambios de turno y entre distintas unidades de atención al paciente en el transcurso de la transferencia de un paciente. Entre los elementos sugeridos para este enfoque se incluye el uso de la técnica SBAR (Situación, Antecedentes, Evaluación y Recomendación).
Transferencia del paciente según el método IDEAS de 061 AragónElena Plaza Moreno
Parte del Documento sobre el Método IDEAS para la transferencia del paciente del Grupo de seguridad clínica y gestión del riesgo sanitario y calidad asistencial 061 Aragón.
Monográfico completo en: https://www.sinasp.es/comunidadSiNASP/061ARAGON/5._MONOGRAFICO_N2.pdf
Algoritmos (en inglés) de PCR, taquicardia, bradicardia, recuperación espontánea de la circulación, síndrome coronario agudo y soporte vital básico para profesionales de la salud.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Actualización AHA 2018 de ACLS y PALS (Highlights)
1. Highlightsof the 2018 Focused
Updates to the American
Heart Association
Guidelines for CPR
and ECC: Advanced
Cardiovascular Life
Support and Pediatric
Advanced Life Support
The American Heart Association thanks the
following people for their contributions to the
development of this publication: Jonathan P.
Duff, MD; Ashish R. Panchal, MD, PhD;
Mary Fran Hazinski, RN, MSN, FAHA;
and the AHA Guidelines Focused Updates
Highlights Project Team.
In 2015, the International Liaison Committee on Resuscitation (ILCOR) began
a continuous evidence evaluation (CEE) process. This process is designed to
enable rapid analysis of peer-reviewed published resuscitation studies and de-
velopment of International Consensus on Cardiopulmonary Resuscitation
(CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment
Recommendations (CoSTR) statements. The goal of continuous evidence eval-
uation is to shorten the interval between publication of resuscitation evidence
and translation into guidelines recommendations by ILCOR member councils,
such as the American Heart Association (AHA). On the basis of these annual
ILCOR CoSTR summary statements, the AHA ECC Committee will publish an-
nual guidelines focused updates on CPR and ECC. These Highlights summarize
the changes included in the 2018 AHA Guidelines Focused Updates published by
the advanced cardiovascular life support (ACLS) and pediatric advanced life sup-
port (PALS) writing groups.
The ILCOR systematic reviews are performed to answer specific resuscitation
questions prioritized by the expert members of the ILCOR task forces. The question
prioritized for review this year addressed the use of antiarrhythmic drugs for the
treatment of shock-refractory ventricular fibrillation (VF) or pulseless ventricular
tachycardia (pVT) during or immediately after cardiac arrest. The ILCOR Advanced
Life Support and the Pediatric Task Forces then analyzed, discussed, and debated
the studies identified and analyzed by the systematic reviewers. These task forces
developed draft CoSTR statements that were posted online for public comment on
the ILCOR website (www.ilcor.org), and the final joint ILCOR CoSTR summary was
published simultaneously in Circulation and Resuscitation.
The AHA ACLS and PALS writing groups considered the ILCOR consensus
recommendations very carefully to determine the appropriate recommendations in
light of the structure and resources of the out-of-hospital and in-hospital resuscitation
systems as well as the resources and training of lay rescuers and healthcare providers
who use AHA guidelines. Each AHA ECC clinical strategy, intervention, treatment,
or testing recommendation was linked with a class of recommendation (Class) and
a level of evidence (LOE), using the most recent language approved by the AHA
and the American College of Cardiology. The criteria and language are depicted in
Figure 1.
2. 2 American Heart Association
AHA Classification System for Recommendations and Level of Evidence*
Figure 1. Criteria and language for class of recommendation and level of evidence.
CLASS (STRENGTH) OF RECOMMENDATION
CLASS I (STRONG) Benefit Risk
Suggested phrases for writing recommendations:
„„ Is recommended
„„ Is indicated/useful/effective/beneficial
„„ Should be performed/administered/other
„„ Comparative-Effectiveness Phrases†:
○○ Treatment/strategy A is recommended/indicated in
preference to treatment B
○○ Treatment A should be chosen over treatment B
CLASS IIa (MODERATE) Benefit Risk
Suggested phrases for writing recommendations:
„„ Is reasonable
„„ Can be useful/effective/beneficial
„„ Comparative-Effectiveness Phrases†:
○○ Treatment/strategy A is probably recommended/indicated in
preference to treatment B
○○ It is reasonable to choose treatment A over
treatment B
CLASS IIb (WEAK) Benefit ≥ Risk
Suggested phrases for writing recommendations:
„„ May/might be reasonable
„„ May/might be considered
„„ Usefulness/effectiveness is unknown/unclear/uncertain
or not well established
CLASS III: No Benefit (MODERATE) Benefit = Risk
(Generally, LOE A or B use only)
Suggested phrases for writing recommendations:
„„ Is not recommended
„„ Is not indicated/useful/effective/beneficial
„„ Should not be performed/administered/other
CLASS III: Harm (STRONG) Risk Benefit
Suggested phrases for writing recommendations:
„„ Potentially harmful
„„ Causes harm
„„ Associated with excess morbidity/mortality
„„ Should not be performed/administered/other
LEVEL (QUALITY) OF EVIDENCE‡
LEVEL A
„„ High-quality evidence‡ from more than 1 RCTs
„„ Meta-analyses of high-quality RCTs
„„ One or more RCTs corroborated by high-quality registry studies
LEVEL B-R (Randomized)
„„ Moderate-quality evidence‡ from 1 or more RCTs
„„ Meta-analyses of moderate-quality RCTs
LEVEL B-NR (Nonrandomized)
„„ Moderate-quality evidence‡ from 1 or more well-designed,
well-executed nonrandomized studies, observational
studies, or registry studies
„„ Meta-analyses of such studies
LEVEL C-LD (Limited Data)
„„ Randomized or nonrandomized observational or registry
studies with limitations of design or execution
„„ Meta-analyses of such studies
„„ Physiological or mechanistic studies in human subjects
LEVEL C-EO (Expert Opinion)
Consensus of expert opinion based on clinical experience
COR and LOE are determined independently (any COR may be paired with any LOE).
A recommendation with LOE C does not imply that the recommendation is weak.
Many important clinical questions addressed in guidelines do not lend themselves to
clinical trials. Although RCTs are unavailable, there may be a very clear clinical
consensus that a particular test or therapy is useful or effective.
* The outcome or result of the intervention should be specified (an improved clinical
outcome or increased diagnostic accuracy or incremental prognostic information).
† For comparative-effectiveness recommendations (CORI and Ila; LOE A and B only),
studies that support the use of comparator verbs should involve direct comparisons
of the treatments or strategies being evaluated.
‡ The method of assessing quality is evolving, including the application of
standardized, widely used, and preferably validated evidence grading tools; and
for systematic reviews, the incorporation of an Evidence Review Committee.
COR indicates Class of Recommendation; EO, expert opinion; LD, limited data; LOE,
Level of Evidence; NR, nonrandomized; R, randomized; and RCT, randomized controlled trial.
The following question was asked of the systematic reviewers:
In adults and children in any setting (in-hospital or out-of-hospital)
with cardiac arrest and a shockable rhythm (VF/pVT) at any time
during CPR or immediately after return of spontaneous circulation
(ROSC), is there evidence that administering (intravenous or
intraosseous) an antiarrhythmic drug during CPR or immediately
(within 1 hour) after ROSC compared with administering any
other antiarrhythmic drug or placebo or no drug during CPR or
immediately (within 1 hour) after ROSC affects outcomes? These
outcomes include survival to hospital discharge with good neurologic
outcome and survival to hospital discharge; ROSC was rated as an
important outcome. For antiarrhythmic drug use within 1 hour after
ROSC, rearrest was also evaluated as an important outcome. The
literature search included in this systematic review was updated to
include all publications identified through August 15, 2017.
It is important for clinicians to note that this review did not
examine the optimal sequence of advanced life support interventions
for VF/pVT cardiac arrest, such as ideal timing of administering
a vasopressor or antiarrhythmic or the timing of medication
administration in relation to CPR or shock delivery. The optimal
sequence is not known. In addition, the timing of recommended
ACLS and PALS interventions should consider the individual patient
and the environment of care.
The following content summarizes the updated recommendations
and algorithms contained in the 2018 AHA Guidelines Focused
Updates on ACLS and PALS.
3. 3
Advanced Cardiovascular Life Support
Use of Antiarrhythmic Drugs During Resuscitation
From Adult VF/pVT Cardiac Arrest
Amiodarone and Lidocaine Recommendation
2018 (Updated): Amiodarone or lidocaine may be considered for
VF/pVT that is unresponsive to defibrillation. These drugs may
be particularly useful for patients with witnessed arrest, for whom
time to drug administration may be shorter (Class IIb, LOE B-R).
2015 (Old): Amiodarone may be considered for VF/pVT that is un-
responsive to CPR, defibrillation, and a vasopressor therapy (Class
IIb, LOE B-R).
Lidocaine may be considered as an alternative to amiodarone for
VF/pVT that is unresponsive to CPR, defibrillation, and vasopressor
therapy (Class IIb, LOE C-LD).
Why: The 2018 CoSTR summary and systematic review consid-
ered the use of amiodarone or lidocaine during VF/pVT cardiac
arrest refractory after at least 1 shock. The writing group evalu-
ated a new large, out-of-hospital randomized controlled trial that
compared a Captisol-based formulation of amiodarone with lido-
caine or placebo for patients with refractory VF/pVT. Although
the available studies did not demonstrate an improvement in sur-
vival to hospital discharge (or neurologically intact survival to
discharge) associated with either drug, ROSC was higher in pa-
tients receiving lidocaine compared with placebo, and survival
to hospital admission was higher with either drug compared with
placebo. As a result, lidocaine is now recommended as an alterna-
tive to amiodarone and has now been added to the ACLS Cardiac
Arrest Algorithm for treatment of shock-refractory VF/pVT (see
the Figure 2 and ACLS Cardiac Arrest Algorithm Update section).
Magnesium Recommendations
2018 (Updated): The routine use of magnesium for cardiac arrest
is not recommended in adult patients (Class III: No Benefit, LOE
C-LD).
Magnesium may be considered for torsades de pointes (ie,
polymorphic VT associated with long QT interval) (Class IIb, LOE
C-LD). The wording of this recommendation is consistent with the
AHA’s 2010 ACLS guidelines.
2015 (Old): The routine use of magnesium for VF/pVT is not rec-
ommended in adult patients (Class III: No Benefit, LOE B-R).
2010 (Old): When VF/pVT cardiac arrest is associated with torsades
de pointes, providers may administer IV/IO bolus of magnesium
sulfate at a dose of 1 to 2 g diluted in 10 mLD5W (Class IIb, LOE C).
Why: The 2018 CoSTR summary and systematic review con-
sidered the use of magnesium during resuscitation from cardiac
arrest. No new studies were reviewed for this topic, and only a
handful of small, nonrandomized studies have been identified in
past reviews. The current recommendation reaffirms that magne-
sium should not be routinely used for cardiac arrest and notes that
it may be considered for the treatment of torsades de pointes (ie,
polymorphic VT associated with long QT interval).
Antiarrhythmic Drugs Immediately After ROSC
Following Adult Cardiac Arrest
β-Blocker Recommendation
2018 (Updated): There is insufficient evidence to support or refute
the routine use of a β-blocker early (within the first hour) after
ROSC.
2015 (Old): There is inadequate evidence to support the routine
use of a β-blocker after cardiac arrest. However, the initiation or
continuation of an oral or intravenous β-blocker may be consid-
ered early after hospitalization from cardiac arrest due to VF/pVT
(Class IIb, LOE C-LD).
Why: The 2018 CoSTR summary and systematic review consid-
ered the use of prophylactic antiarrhythmic drugs immediately
(within the first hour) after ROSC. Although no new studies were
reviewed for this topic, detailed evaluation of the literature led to
the simplification of the recommendation. There is no Class or
LOE listed because the writing group agreed that there was insuf-
ficient evidence to make any recommendation.
Lidocaine Recommendations
2018 (Updated): There is insufficient evidence to support or re-
fute the routine use of lidocaine early (within the first hour) after
ROSC.
In the absence of contraindications, the prophylactic use of
lidocaine may be considered in specific circumstances (such as during
emergency medical services transport) when treatment of recurrent
VF/pVT might prove to be challenging (Class IIb, LOE C-LD).
2015 (Old): There is inadequate evidence to support the routine use
of lidocaine after cardiac arrest. However, the initiation or contin-
uation of lidocaine may be considered immediately after ROSC
from cardiac arrest due to VF/pVT (Class IIb, LOE C-LD).
Why: The 2018 CoSTR summary and systematic review consid-
ered the use of prophylactic antiarrhythmic drugs immediately
(within the first hour) after ROSC. Although no new studies were
reviewed for this topic, the writing group acknowledged that while
there is insufficient evidence to support the routine use of lido-
caine, there are situations for which recurrence of VF/pVT would
be logistically challenging to manage (eg, during emergency med-
ical services transport); in such situations, lidocaine administration
may be considered.
4. 4 American Heart Association
Figure 2. Adult Cardiac Arrest Algorithm.
5. 5
ACLS Cardiac Arrest Algorithm Update
The ACLS Adult Cardiac Arrest Algorithm and the ACLS Adult
Cardiac Arrest Circular Algorithm were updated to include lido-
caine as an alternative antiarrhythmic to amiodarone for treatment
of shock-refractory VF/pVT. The lidocaine dose was added within
the algorithm’s Drug Therapy box, and a minor edit was made in
the CPR Quality box as detailed in the next sections.
Changes to the Adult Cardiac Arrest Algorithm—2018 Update.
Within the VF/pVT branch of the algorithm, lidocaine was add-
ed as an alternative to amiodarone in Box 8. In the algorithm’s
CPR Quality box, the fourth bullet text was changed from “Rotate
compressor every 2 minutes, or sooner if fatigued” to “Change
compressor every 2 minutes, or sooner if fatigued.” Within the al-
gorithm’s Drug Therapy box, the lidocaine dose was added as an
alternative to amiodarone in the second bullet text.
Changes to the Adult Cardiac Arrest Circular Algorithm—2018
Update (Figure 3). Within the circle, under “Drug Therapy,” the
last drug was changed from “Amiodarone for refractory VF/VT”
to “Amiodarone or lidocaine for refractory VF/pVT.” Within the
algorithm’s CPR Quality box, the fourth bullet text was changed
from “Rotate compressor every 2 minutes, or sooner if fatigued”
to “Change compressor every 2 minutes, or sooner if fatigued.”
Within the algorithm’s Drug Therapy box, the lidocaine dose was
added as an alternative to amiodarone in the second bullet text.
Figure 3. Adult Cardiac Arrest Circular Algorithm.
6. 6 American Heart Association
Pediatric Advanced Life Support
Use of Antiarrhythmic Drugs During Resuscitation From Pediatric VF/pVT
Cardiac Arrest
Amiodarone and Lidocaine Recommendation
2018 (Unchanged): For shock-refractory VF/pVT, either amiodarone or lidocaine may be
used (Class IIb, LOE C-LD).
2015 (Old): For shock-refractory VF/pVT, either amiodarone or lidocaine may be used (Class
IIb, LOE C-LD).
Why: The 2018 CoSTR Summary and systematic review considered the use of antiarrhyth-
mic drugs for shock-refractory VF/pVT. Unlike in previous reviews, only pediatric-specific
studies were considered in 2018. There were no studies identified to address the use of
antiarrhythmic drugs after resuscitation from cardiac arrest. Only one registry study of an-
tiarrhythmic drug administration during resuscitation was identified. This study compared
outcomes associated with the use of amiodarone or lidocaine for in-hospital resuscitation
from cardiac arrest; it found no significant difference in survival to hospital discharge in pa-
tients who received amiodarone vs lidocaine.
PALS Cardiac Arrest Algorithm Update
The PALS Pediatric Cardiac Arrest Algorithm is unchanged in the depiction of sequences
and therapies from the version of the algorithm updated in 2015. The minor edits made are
detailed below.
Changes to the Pediatric Cardiac Arrest Algorithm—2018 Update (Figure 4): The only
changes within the algorithm itself were minor edits to eliminate wording differences between
this algorithm and the ACLS Adult Cardiac Arrest Algorithm. Within the Asystole/PEA branch
of the algorithm, in Box 10, the third bullet text was changed from “Consider advanced airway”
to “Consider advanced airway, capnography.” In Box 12, the first bullet text was changed from
“Asystole/PEA → 10 or 11” to “If no signs of return of spontaneous circulation (ROSC), go to
10 or 11.” The second and third bullets, “Organized rhythm → check pulse” and “Pulse present
(ROSC) → post-cardiac arrest care,” were combined into a single bullet reading, “If ROSC, go
to Post–Cardiac Arrest Care.”
Within the algorithm’s CPR Quality box, the fourth bullet text was changed from “Rotate
compressor every 2 minutes, or sooner if fatigued” to “Change compressor every 2 minutes, or
sooner if fatigued.” Within the algorithm’s Drug Therapy box, the word OR was added between
the amiodarone and lidocaine doses, and the 2 bullets were combined to emphasize that either
one drug or the other may be used.
The goal of continuous
evidence evaluation is to
shorten the interval between
publication of resuscitation
evidence and translation into
guidelines recommendations
by ILCOR member councils,
such as the AHA.