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Introduction

These Web-based Integrated Guidelines incorporate the relevant recommendations from 2010 and the new or updated recommendations from 2015.

Conventional cardiopulmonary resuscitation (CPR) consisting of manual chest compressions with rescue breaths is inherently inefficient with respect to generating cardiac output. A variety of alternatives and adjuncts to conventional CPR have been developed, with the aim of enhancing perfusion during resuscitation from cardiac arrest. Since the publication of the 2010 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care (ECC),1 a number of clinical trials have provided additional data on the effectiveness of these alternatives and adjuncts. Compared with conventional CPR, many of these techniques and devices require specialized equipment and training. Some have only been tested in highly selected subgroups of cardiac arrest patients; this context must be considered when rescuers or healthcare systems are considering implementation.

The 2010 Guidelines add these cautions:

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Methodology - Updated

The updated or new recommendations in the 2015 AHA Guidelines Update for CPR and ECC are based on an extensive evidence review process that was begun by the International Liaison Committee on Resuscitation (ILCOR) after the publication of the ILCOR 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations2,3 and was completed in February 2015.4,5

In this in-depth evidence review process, the ILCOR Advanced Life Support (ALS) Task Force examined topics and then generated a prioritized list of questions for systematic review. Questions were first formulated in PICO (population, intervention, comparator, outcome) format,6 search strategies and criteria for inclusion and exclusion of articles were defined, and then a search for relevant articles was performed. The evidence was evaluated by the ILCOR ALS Task Force by using the standardized methodological approach proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group.7

The quality of the evidence was categorized based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). Then, where possible, consensus-based treatment recommendations were created.

To create the 2015 AHA Guidelines Update for CPR and ECC, the AHA formed 15 writing groups, with careful attention to manage conflicts of interest, to assess the ILCOR treatment recommendations, and to write AHA Guidelines and treatment recommendations by using the AHA Class of Recommendation and Level of Evidence (LOE) system. The recommendations made in the 2015 AHA Guidelines Update for CPR and ECC are informed by the ILCOR recommendations and GRADE classification, in the context of the delivery of medical care in North America. Throughout the online version of this publication, live links are provided so the reader can connect directly to the systematic reviews on the ILCOR Scientific Evidence Evaluation and Review System (SEERS) website. These links are indicated by a superscript combination of letters and numbers (eg, ALS 579). We encourage readers to use the links and review the evidence and appendixes, such as the GRADE tables. For further information, please see Part 2 of this supplement, “Evidence Evaluation and Management of Conflicts of Interest.”

The following CPR techniques and devices were last reviewed in 2010 2,3: open-chest CPR, interposed abdominal compression, “cough” CPR, prone CPR, precordial thump, percussion pacing, and devices to assist ventilation. The reader is referred to the 2010 Guidelines for details of those recommendations.1 A listing of all of the recommendations in this 2015 Guidelines Update and the recommendations from “Part 7: CPR Techniques and Devices” of the 2010 Guidelines can be found in the Appendix. The 2010 recommendations are included below in this Web-based Integrated Guideline document.

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References

  1. Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF. Part 7: CPR tech- niques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S720–S728. doi: 10.1161/ CIRCULATIONAHA.110.970970.
  2. Shuster M, Lim SH, Deakin CD, Kleinman ME, Koster RW, Morrison LJ, Nolan JP, Sayre MR; CPR Techniques and Devices Collaborators. Part 7: CPR techniques and devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(suppl 2):S338–S344. doi: 10.1161/CIRCULATIONAHA.110.971036.
  3. Lim SH, Shuster M, Deakin CD, Kleinman ME, Koster RW, Morrison LJ, Nolan JP, Sayre MR; CPR Techniques, Devices Collaborators. Part 7: CPR techniques and devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2010;81 suppl 1:e86–e92. doi: 10.1016/j.resuscitation.2010.08.026.
  4. Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J; on behalf of the Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132 (suppl 1):S84–S145. doi: 10.1161/CIR.0000000000000273.
  5. Soar J, Callaway CW, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J; on behalf of the Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2015. In press.
  6. The Cochrane Collaboration. Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. http://handbook.cochrane.org/. Accessed May 6, 2015.
  7. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE Handbook. 2013. http://www.guidelinedevelopment.org/handbook/. Accessed May 6, 2015.
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