The document summarizes the main changes in resuscitation guidelines from 2010 compared to 2005. Key changes include an increased focus on high-quality chest compressions with minimal interruptions, continuing compressions when charging a defibrillator to reduce delays, and removing recommendations for a specified period of CPR before defibrillation for unwitnessed arrests. The guidelines emphasize the importance of early defibrillation and avoiding long pause times both before and after shocks.

1. euRopean
ReSuScitation
council
Summary
of the main
changes in the
Resuscitation
Guidelines
eRc GuidelineS 2010

2. 2
European
Resuscitation
Council
To p r e s e r v e h u m a n l i f e b y m a k i n g
high quality resuscitation available to all
The Network of National Resuscitation Councils
Published by:
european Resuscitation council Secretariat vzw,
Drie Eikenstraat 661 - BE 2650 Edegem - Belgium
Website: www.erc.edu
Email: info@erc.edu
Tel: +32 3 826 93 21
©
European Resuscitation Council 2010.
All rights reserved. We encourage you to send this document to
other persons as a whole in order to disseminate the ERC Guidelines.
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Version1.2
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use or operation of any methods, products, instructions or ideas
contained in the material herein.

3. 3
Summary of main changes since 2005 Guidelines
Basic life support improve the quality of CPR perform-
ance and provide feedback to pro-
Changes in basic life support (BLS) since fessional rescuers during debriefing
the 2005 guidelines include:
sessions.
♦♦ Dispatchers should be trained to
interrogate callers with strict protocols electrical therapies:
to elicit information. This information automated external defi-
should focus on the recognition of brillators, defibrillation,
unresponsiveness and the quality of cardioversion and pacing
breathing. In combination with unre-
sponsiveness, absence of breathing or The most important changes in the 2010
any abnormality of breathing should ERC Guidelines for electrical therapies
start a dispatch protocol for suspect- include:
ed cardiac arrest. The importance of
gasping as sign of cardiac arrest is
emphasised. ♦♦ The importance of early, uninter-
rupted chest compressions is empha-
sised throughout these guidelines.
♦♦ All rescuers, trained or not, should
provide chest compressions to victims
of cardiac arrest. A strong empha- ♦♦ Much greater emphasis on mini-
sis on delivering high quality chest mising the duration of the pre-shock
compressions remains essential. The and post-shock pauses; the continua-
aim should be to push to a depth of tion of compressions during charging
at least 5 cm at a rate of at least 100 of the defibrillator is recommended.
compressions min-1, to allow full chest
recoil, and to minimise interruptions
in chest compressions. Trained rescu- ♦♦ Immediate resumption of chest
ers should also provide ventilations compressions following defibrillation
with a compression–ventilation (CV) is also emphasised; in combination
ratio of 30:2. Telephone-guided chest with continuation of compressions
compression-only CPR is encouraged during defibrillator charging, the
for untrained rescuers. delivery of defibrillation should be
achievable with an interruption in
chest compressions of no more than 5
♦♦ The use of prompt/feedback devic- seconds.
es during CPR will enable immediate
feedback to rescuers and is encour-
aged. The data stored in rescue equip- ♦♦ Safety of the rescuer remains par-
ment can be used to monitor and amount, but there is recognition in

4. 4
Adult Basic Life Support
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 112*
30 chest compressions
2 rescue breaths
30 compressions
*or national emergency number

5. 5
Automated External Defibrillation
Unresponsive?
Call for help
Open airway
Not breathing normally
Send or go for AED
Call 112*
* or national emergency number
CPR 30:2
Until AED is attached
AED
assesses
rhythm
Shock No shock
advised advised
1 Shock
Immediately resume: Immediately resume:
CPR 30:2 CPR 30:2
for 2 min for 2 min
Continue until the victim starts
to wake up: to move, opens
eyes and to breathe normally

6. In Hospital Resuscitation
Collapsed/sick patient
Shout for HELP & assess patient
No Signs of life? Yes
Call resuscitation team
Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access
CPR 30:2
with oxygen and airway adjuncts
Call resuscitation team
Apply pads/monitor If appropriate
Attempt defibrillation if appropriate
Advanced Life Support Handover to resuscitation team
when resuscitation team arrives
6

7. 7
these guidelines that the risk of harm adult advanced life
to a rescuer from a defibrillator is very support
small, particularly if the rescuer is
The most important changes in the 2010
wearing gloves. The focus is now on a
ERC Advanced Life Support (ALS) Guide-
rapid safety check to minimise the pre- lines include:
shock pause.
♦♦ Increased emphasis on the
♦♦ When treating out-of-hospital car- importance of minimally interrupt-
diac arrest, emergency medical serv- ed high-quality chest compressions
ices (EMS) personnel should provide throughout any ALS intervention:
good-quality CPR while a defibrillator chest compressions are paused briefly
is retrieved, applied and charged, but only to enable specific interventions.
routine delivery of a pre-specified peri-
od of CPR (e.g., two or three minutes)
before rhythm analysis and a shock is ♦♦ Increased emphasis on the use of
delivered is no longer recommended. ‘track and trigger systems’ to detect
For some EMS that have already fully the deteriorating patient and enable
implemented a pre-specified period of treatment to prevent in-hospital car-
chest compressions before defibrilla- diac arrest.
tion, given the lack of convincing data
either supporting or refuting this strat-
egy, it is reasonable for them to con- ♦♦ Increased awareness of the warn-
tinue this practice. ing signs associated with the poten-
tial risk of sudden cardiac death out of
hospital.
♦♦ The use of up to three-stacked
shocks may be considered if VF/VT
occurs during cardiac catheterisation ♦♦ Removal of the recommendation
or in the early post-operative period for a pre-specified period of cardiop-
following cardiac surgery. This three- ulmonary resuscitation (CPR) before
shock strategy may also be considered out-of-hospital defibrillation following
for an initial, witnessed VF/VT cardiac cardiac arrest unwitnessed by the EMS.
arrest when the patient is already con-
nected to a manual defibrillator.
♦♦ Continuation of chest compres-
sions while a defibrillator is charged -
♦♦ Further development of AED pro- this will minimise the pre-shock pause.
grammes is encouraged – there is a
need for further deployment of AEDs
in both public and residential areas. ♦♦ The role of the precordial thump is
de-emphasised.

8. 8
Advanced Life Support
Unresponsive?
Not breathing or only occasional
gasps
Call
Resuscitation Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock spontaneous
circulation
Immediately resume: Immediate post cardiac Immediately resume:
CPR for 2 min arrest treatment CPR for 2 min
• Use ABCDE approach
Minimise interruptions Minimise interruptions
• Controlled oxygenation and
ventilation
• 12-lead ECG
• Treat precipitating cause
•Temperature control / therapeu-
tic hypothermia
During CPR Reversible causes
• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Consider advanced airway and capnography • Hypothermia
• Continuous chest compressions when advanced airway in place
• Thrombosis
• Vascular access (intravenous, intraosseous)
• Tamponade - cardiac
• Give adrenaline every 3-5 min
• Toxins
• Correct reversible causes
• Tension pneumothorax

9. Tachycardia (with pulse)
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 ,record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Assess for evidence of adverse signs
Synchronised DC Shock* Unstable 1. Shock 2. Syncope Stable Is QRS narrow (< 0.12 sec)?
Up to 3 attempts
3. Myocardial ischaemia 4. Heart failure
Broad Narrow
• Amiodarone 300 mg IV over
10-20 min and repeat shock;
followed by:
• Amiodarone 900 mg over 24 h
Irregular Broad QRS Regular Regular Narrow QRS Irregular
Is QRS regular? Is rhythm regular?
Seek expert help Irregular Narrow Complex
• Use vagal manoeuvres
Tachycardia
• Adenosine 6 mg rapid IV bolus;
Probable atrial fibrillation
if unsuccessful give 12 mg;
Control rate with:
if unsuccessful give further 12 mg.
• ß-Blocker or diltiazem
• Monitor ECG continuously
• Consider digoxin or amiodarone if
evidence of heart failure
Anticoagulate if duration > 48h
If Ventricular Tachycardia Normal sinus rhythm restored? Seek expert help
Possibilities include: No
(or uncertain rhythm):
• AF with bundle branch block
• Amiodarone 300 mg IV over 20-60
treat as for narrow complex
min; then 900 mg over 24 h
• Pre-excited AF Yes
consider amiodarone
If previously confirmed
• Polymorphic VT
SVT with bundle branch block:
(e.g. torsades de pointes -
• Give adenosine as for regular
give magnesium 2 g over 10 min)
narrow complex tachycardia
Probable re-entry PSVT: Possible atrial flutter
• Record 12-lead ECG in sinus rhythm • Control rate (e.g. ß-Blocker)
• If recurs, give adenosine again &
*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia consider choice of anti-arrhythmic
9
prophylaxis

10. 10
Bradycardia
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 ,record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Assess for evidence of adverse signs:
1 Shock
Yes 2 Syncope No
3 Myocardial ischaemia
4 Heart failure
Atropine
500 mcg IV
Satisfactory
Yes
Response?
No Risk of asystole?
• Recent asystole
Yes • Möbitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s
Interim measures:
• Atropine 500 mcg IV repeat
to maximum of 3 mg
• Isoprenaline 5 mcg min-1
• Adrenaline 2-10 mcg min-1
• Alternative drugs* No
OR
• Transcutaneous pacing
Seek expert help Observe
Arrange transvenous pacing
* Alternatives include:
• Aminophylline
• Dopamine
• Glucagon (if beta-blocker or calcium channel
blocker overdose)
• Glycopyrrolate can be used instead of atropine

11. 11
♦♦ The use of up to three quick suc-
cessive (stacked) shocks for ventricular ♦♦ The potential role of ultrasound
fibrillation/pulseless ventricular tachy- imaging during ALS is recognised.
cardia (VF/VT) occurring in the cardiac
catheterisation laboratory or in the
immediate post-operative period fol- ♦♦ Recognition of the potential harm
lowing cardiac surgery. caused by hyperoxaemia after ROSC is
achieved: once ROSC has been estab-
lished and the oxygen saturation of
♦♦ Delivery of drugs via a tracheal tube arterial blood (SaO2) can be moni-
is no longer recommended – if intrave- tored reliably (by pulse oximetry and/
nous access cannot be achieved, drugs or arterial blood gas analysis), inspired
should be given by the intraosseous oxygen is titrated to achieve a SaO2 of
(IO) route. 94 – 98%.
♦♦ When treating VF/VT cardiac arrest, ♦♦ Much greater detail and emphasis
adrenaline 1 mg is given after the third on the treatment of the post-cardiac
shock once chest compressions have arrest syndrome.
restarted and then every 3-5 min-
utes (during alternate cycles of CPR).
Amiodarone 300 mg is also given after ♦♦ Recognition that implementation
the third shock. of a comprehensive, structured post
resuscitation treatment protocol may
improve survival in cardiac arrest vic-
♦♦ Atropine is no longer recommend- tims after ROSC.
ed for routine use in asystole or pulse-
less electrical activity (PEA).
♦♦ Increased emphasis on the use
of primary percutaneous coronary
♦♦ Reduced emphasis on early tra- intervention in appropriate (includ-
cheal intubation unless achieved by ing comatose) patients with sustained
highly skilled individuals with minimal ROSC after cardiac arrest.
interruption to chest compressions.
♦♦ Revision of the recommendation
♦♦ Increased emphasis on the use of for glucose control: in adults with sus-
capnography to confirm and continu- tained ROSC after cardiac arrest, blood
ally monitor tracheal tube placement, glucose values >10 mmol l-1 (>180 mg
quality of CPR and to provide an early dl-1) should be treated but hypoglycae-
indication of return of spontaneous mia must be avoided.
circulation (ROSC).

12. 12
ACS
Patient with clinical signs and symptoms of ACS
12 lead ECG
ST elevation
≥ 0.1 mV in ≥ 2 adjacent limb leads and/ Other ECG alterations
or ≥ 0.2 mV in ≥ adjacent chest leads (or normal ECG)
or (presumably) new LBBB
= NSTEMI if troponins = UAP if troponins
(T or I) positive remain negative
STEMI
non-STEMI-ACS
High risk
• dynamic ECG changes
• ST depression
• haemodynamic/rhythm instability
• diabetes mellitus
ECG
ECG
Pain relief Nitroglycerin sl if systolic BP > 90 mmHg
± Morphine (repeated doses) of 3-5 mg until pain free
Antiplatelet treatment 160-325mg Acetylsalicylic acid chewed tablet (or iv)
75 – 600 mg Clopidogrel according to strategy*
STEMI Non-STEMI-ACS
Thrombolysis preferred if PCI preferred if Early invasive strategy# Conservative
no contraindications and • timely and available in a high UFH or delayed invasive strategy#
inappropriate delay to PCI volume center
Enoxaparin or bivalirudin may be UFH (fondaparinux or bivalirudin
• contraindications for fibrinolysis
cardiogenic shock (or severe left considered may be considered in pts with high
Adjunctive therapy: ventricular failure) bleeding risk)
UFH, enoxaparin or fondaparinux Adjunctive therapy:
UFH, enoxaparin or bivalirudin may
be considered
# According to risk stratification

13. 13
♦♦ Use of therapeutic hypothermia to ♦♦ The role of chest pain observation
include comatose survivors of cardiac units (CPUs) is to identify, by using
arrest associated initially with non- repeated clinical examinations, ECG
shockable rhythms as well shockable and biomarker testing, those patients
rhythms. The lower level of evidence who require admission for invasive
for use after cardiac arrest from non- procedures. This may include provoca-
shockable rhythms is acknowledged. tive testing and, in selected patients,
imaging procedures such as cardiac
computed tomography, magnetic res-
♦♦ Recognition that many of the onance imaging etc.
accepted predictors of poor outcome
in comatose survivors of cardiac arrest
are unreliable, especially if the patient ♦♦ Non-steroidal anti-inflammatory
has been treated with therapeutic drugs (NSAIDs) should be avoided.
hypothermia.
♦♦ Nitrates should not be used for
initial management of diagnostic purposes.
acute coronary syndromes
Changes in the management of acute ♦♦ Supplementary oxygen is to be giv-
coronary syndrome since the 2005 en only to those patients with hypox-
guidelines include: aemia, breathlessness or pulmonary
congestion. Hyperoxaemia may be
♦♦ The term non-ST-elevation myo- harmful in uncomplicated infarction.
cardial infarction-acute coronary syn-
drome (non-STEMI-ACS) has been
introduced for both NSTEMI and ♦♦ Guidelines for treatment with
unstable angina pectoris because the acetyl salicylic acid (ASA) have been
differential diagnosis is dependent on made more liberal: ASA may now be
biomarkers that may be detectable given by bystanders with or without
only after several hours, whereas deci- EMS dispatcher assistance.
sions on treatment are dependent on
the clinical signs at presentation.
♦♦ Revised guidance for new anti-
platelet and anti-thrombin treatment
♦♦ History, clinical examinations, for patients with STEMI and non-STE-
biomarkers, ECG criteria and risk scores MI-ACS based on therapeutic strategy.
are unreliable for the identification of
patients who may be safely discharged
early.

14. 14
♦♦ Gp IIb/IIIa inhibitors before angiog- - Angiography and, if necessary, PCI
raphy/percutaneous coronary inter- may be reasonable in patients with
vention (PCI) are discouraged. return of spontaneous circulation
(ROSC) after cardiac arrest and may
be part of a standardised post-cardi-
♦♦ The reperfusion strategy in ac arrest protocol.
ST-elevation myocardial infarction has
been updated: - To achieve these goals, the creation
of networks including EMS, non PCI
- Primary PCI (PPCI) is the preferred capable hospitals and PCI hospitals
reperfusion strategy provided it is is useful.
performed in a timely manner by an
experienced team.
♦♦ Recommendations for the use
- A nearby hospital may be bypassed of beta-blockers are more restrict-
by emergency medical services ed: there is no evidence for routine
(EMS) provided PPCI can be achieved intravenous beta-blockers except in
without too much delay. specific circumstances such as for
the treatment of tachyarrhythmias.
- The acceptable delay between start Otherwise, beta-blockers should be
of fibrinolysis and first balloon infla- started in low doses only after the
tion varies widely between about 45 patient is stabilised.
and 180 minutes depending on inf-
arct localisation, age of the patient,
and duration of symptoms. ♦♦ Guidelines on the use of prophy-
lactic anti-arrhythmics angiotensin,
- ‘Rescue PCI’ should be undertaken converting enzyme (ACE) inhibitors/
if fibrinolysis fails. angiotensin receptor blockers (ARBs)
and statins are unchanged.
- The strategy of routine PCI imme-
diately after fibrinolysis (‘facilitated
PCI’) is discouraged.
paediatric life support
- Patients with successful fibrinolysis
but not in a PCI-capable hospital Major changes in these new guidelines
should be transferred for angiog- for paediatric life support include:
raphy and eventual PCI, performed
optimally 6 – 24 hours after fibri- ♦♦ Recognition of cardiac arrest -
nolysis (the ‘pharmaco-invasive’ Healthcare providers cannot reliably
approach). determine the presence or absence
of a pulse in less than 10 seconds in

15. 15
infants or children. Healthcare provid- minimise no-flow time. Compress
ers should look for signs of life and if the chest to at least 1/3 of the ante-
they are confident in the technique, rior-posterior chest diameter in all
they may add pulse palpation for children (i.e., approximately 4 cm in
diagnosing cardiac arrest and decide infants and approximately 5 cm in chil-
whether they should begin chest com- dren). Subsequent complete release is
pressions or not. The decision to begin emphasised. For both infants and chil-
CPR must be taken in less than 10 dren, the compression rate should be
seconds. According to the child’s age, at least 100 but not greater than 120
carotid (children), brachial (infants) or min-1. The compression technique for
femoral pulse (children and infants) infants includes two-finger compres-
checks may be used. sion for single rescuers and the two-
thumb encircling technique for two
or more rescuers. For older children,
♦♦ The compression ventilation (CV) a one- or two-hand technique can be
ratio used for children should be based used, according to rescuer preference.
on whether one, or more than one
rescuer is present. Lay rescuers, who
usually learn only single-rescuer tech- ♦♦ Automated external defibrillators
niques, should be taught to use a ratio (AEDs) are safe and successful when
of 30 compressions to 2 ventilations, used in children older than one year
which is the same as the adult guide- of age. Purpose-made paediatric pads
lines and enables anyone trained in or software attenuate the output of
BLS to resuscitate children with mini- the machine to 50–75 J and these are
mal additional information. Rescuers recommended for children aged 1-8
with a duty to respond should learn years. If an attenuated shock or a man-
and use a 15:2 CV ratio; however, they ually adjustable machine is not avail-
can use the 30:2 ratio if they are alone, able, an unmodified adult AED may
particularly if they are not achieving be used in children older than 1 year.
an adequate number of compressions. There are case reports of successful
Ventilation remains a very important use of AEDs in children aged less than
component of CPR in asphyxial arrests. 1 year; in the rare case of a shockable
Rescuers who are unable or unwilling rhythm occurring in a child less than
to provide mouth-to-mouth ventila- 1 year, it is reasonable to use an AED
tion should be encouraged to perform (preferably with dose attenuator).
at least compression-only CPR.
♦♦ To reduce the no flow time, when
♦♦ The emphasis is on achieving using a manual defibrillator, chest
quality compressions of an adequate compressions are continued while
depth with minimal interruptions to applying and charging the paddles or

16. 16
Paediatric Basic Life Support
Health professionals with a duty to respond
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
5 rescue breaths
NO SIGNS OF LIFE?
15 chest compressions
2 rescue breaths
15 compressions
Call cardiac arrest team or Paediatric ALS team

17. 17
Paediatric Advanced Life Support
Unresponsive?
Not breathing or only occasional gasps
CPR (5 initial breaths then 15:2) Call Resuscitation
Attach defibrillator/monitor Team
Minimise interruptions (1 min CPR first, if alone)
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock 4 J/Kg spontaneous
circulation
Immediately resume: Immediate post cardiac Immediately resume:
CPR for 2 min arrest treatment CPR for 2 min
Minimise interruptions • Use ABCDE approach Minimise interruptions
• Controlled oxygenation and
ventilation
• Investigations
• Treat precipitating cause
• Temperature control
• Therapeutic hypothermia?
During CPR Reversible causes
• Hypoxia
• Ensure high-quality CPR: rate, depth, recoil
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Vascular access (intravenous, intraosseous) • Hypothermia
• Give adrenaline every 3-5 min
• Consider advanced airway and capnography • Tension pneumothorax
• Continuous chevvst compressions when advanced airway • Toxins
in place • Tamponade - cardiac
• Correct reversible causes • Thromboembolism

18. 18
Newborn Life Support
AT ALL STAGES ASK: DO YOU NEED HELP? Dry the baby Birth
Remove any wet towels and cover
Start the clock or note the time
Assess (tone), 30 sec
breathing and heart rate
If gasping or not breathing
Open the airway
Give 5 inflation breaths
Consider SpO2 monitoring 60 sec
Re-assess
If no increase in heart rate
Look for chest movement
Acceptable*
If chest not moving
pre-ductal SpO2
Recheck head position
Consider two-person airway control 2 min : 60%
or other airway manoeuvres 3 min : 70%
Repeat inflation breaths 4 min : 80%
Consider SpO2 monitoring
5 min : 85%
Look for a response
10 min : 90%
If no increase in heart rate
Look for chest movement
When the chest is moving
If the heart rate is not detectable or slow (< 60)
Start chest compressions
3 compressions to each breath
Reassess heart rate
every 30 seconds
If the heart rate is not detectable or slow (< 60)
Consider venous access and drugs

19. 19
self-adhesive pads (if the size of the ♦♦ Implementation of a rapid
child’s chest allows this). Chest com- response system in a paediatric in-
pressions are paused briefly once the patient setting may reduce rates of
defibrillator is charged to deliver the cardiac and respiratory arrest and in-
shock. For simplicity and consistency hospital mortality.
with adult BLS and ALS guidance, a
single-shock strategy using a non-
escalating dose of 4 J kg-1 (preferably ♦♦ New topics in the 2010 guidelines
biphasic, but monophasic is accepta- include channelopathies and several
ble) is recommended for defibrillation new special circumstances: trauma,
in children. single ventricle pre and post 1st stage
repair, post Fontan circulation, and
pulmonary hypertension.
♦♦ Cuffed tracheal tubes can be used
safely in infants and young children.
The size should be selected by apply- Resuscitation of babies at
ing a validated formula. birth
The following are the main changes that
♦♦ The safety and value of using cricoid have been made to the guidelines for re-
pressure during tracheal intubation is suscitation at birth in 2010:
not clear. Therefore, the application of
cricoid pressure should be modified or ♦♦ For uncompromised babies, a
discontinued if it impedes ventilation delay in cord clamping of at least one
or the speed or ease of intubation. minute from the complete delivery of
the infant, is now recommended. As
yet there is insufficient evidence to
♦♦ Monitoring exhaled carbon diox- recommend an appropriate time for
ide (CO2), ideally by capnography, is clamping the cord in babies who are
helpful to confirm correct tracheal severely compromised at birth.
tube position and recommended dur-
ing CPR to help assess and optimise its
quality. ♦♦ For term infants, air should be used
for resuscitation at birth. If, despite
effective ventilation, oxygenation (ide-
♦♦ Once spontaneous circulation is ally guided by oximetry) remains unac-
restored, inspired oxygen should be ceptable, use of a higher concentration
titrated to limit the risk of hyperoxa- of oxygen should be considered.
emia.

20. 20
♦♦ Preterm babies less than 32 weeks start mask ventilation, particularly if
gestation may not reach the same there is persistent bradycardia.
transcutaneous oxygen saturations in
air as those achieved by term babies.
Therefore blended oxygen and air ♦♦ If adrenaline is given then the
should be given judiciously and its use intravenous route is recommended
guided by pulse oximetry. If a blend using a dose of 10-30 microgram kg-1.
of oxygen and air is not available use If the tracheal route is used, it is likely
what is available. that a dose of at least 50-100 micro-
gram kg-1 will be needed to achieve
a similar effect to 10 microgram kg-1
♦♦ Preterm babies of less than 28 intravenously.
weeks gestation should be completely
covered in a food-grade plastic wrap or
bag up to their necks, without drying, ♦♦ Detection of exhaled carbon diox-
immediately after birth. They should ide in addition to clinical assessment
then be nursed under a radiant heater is recommended as the most reliable
and stabilised. They should remain method to confirm placement of a tra-
wrapped until their temperature has cheal tube in neonates with spontane-
been checked after admission. For ous circulation.
these infants delivery room tempera-
tures should be at least 26°C.
♦♦ Newly born infants born at term or
near-term with evolving moderate to
♦♦ The recommended compression: severe hypoxic – ischaemic encepha-
ventilation ratio for CPR remains at 3:1 lopathy should, where possible, be
for newborn resuscitation. treated with therapeutic hypother-
mia. This does not affect immediate
resuscitation but is important for post-
♦♦ Attempts to aspirate meconium resuscitation care.
from the nose and mouth of the
unborn baby, while the head is still on
the perineum, are not recommended.
If presented with a floppy, apnoeic
baby born through meconium it is rea-
sonable to rapidly inspect the orophar-
ynx to remove potential obstructions.
If appropriate expertise is available,
tracheal intubation and suction may
be useful. However, if attempted intu-
bation is prolonged or unsuccessful,

21. 21
principles of education in ♦♦ Basic and advanced life support
resuscitation knowledge and skills deteriorate in as
little as three to six months. The use
The key issues identified by the Educa- of frequent assessments will identify
tion, Implementation and Teams (EIT)
those individuals who require refresh-
task force of the International Liaison
Committee on Resuscitation (ILCOR) er training to help maintain their
during the Guidelines 2010 evidence knowledge and skills.
evaluation process are:
♦♦ CPR prompt or feedback devices
♦♦ Educational interventions should improve CPR skill acquisition and
be evaluated to ensure that they retention and should be considered
reliably achieve the learning objec- during CPR training for laypeople and
tives. The aim is to ensure that learn- healthcare professionals.
ers acquire and retain the skills and
knowledge that will enable them to
act correctly in actual cardiac arrests ♦♦ An increased emphasis on non-
and improve patient outcomes. technical skills (NTS) such as leader-
ship, teamwork, task management
and structured communication will
♦♦ Short video/computer self-instruc- help improve the performance of CPR
tion courses, with minimal or no and patient care.
instructor coaching, combined with
hands-on practice can be considered
as an effective alternative to instruc- ♦♦ Team briefings to plan for resusci-
tor-led basic life support (CPR and tation attempts, and debriefings based
AED) courses. on performance during simulated or
actual resuscitation attempts should
be used to help improve resuscitation
♦♦ Ideally all citizens should be trained team and individual performance.
in standard CPR that includes com-
pressions and ventilations. There are
circumstances however where train- ♦♦ Research about the impact of
ing in compression-only CPR is appro- resuscitation training on actual patient
priate (e.g., opportunistic training outcomes is limited. Although manikin
with very limited time). Those trained studies are useful, researchers should
in compression-only CPR should be be encouraged to study and report the
encouraged to learn standard CPR. impact of educational interventions
on actual patient outcomes.

22. 22
Edited by Jerry Nolan
Authors
Jerry P. Nolan Charles Deakin
Jasmeet Soar Rudolph W. Koster
David A. Zideman Jonathan Wyllie
Dominique Biarent Bernd Böttiger
Leo L. Bossaert on behalf of the ERC Guidelines
Writing Group
Acknowledgements: The ERC staff members Annelies Pické, Christophe Bostyn,
Jeroen Janssens, Hilary Phelan and Bart Vissers for their administrative support. Het
Geel Punt bvba, Melkouwen 42a, 2590 Berlaar, Belgium (hgp@hetgeelpunt.be) for
creating the algorithms and Griet Demesmaeker (grietdemesmaeker@gmail.com)
for the cover design.

23. 23
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If you are already a member of one of these organisations, please contact
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24. www.erc.edu
www.cpRguidelines.eu