Publish date: 20 May 2021
The Resuscitation Council UK has published updated guidelines for 2021, covering best practice and clinical excellence in resuscitation across all age groups.
These guidelines will replace the last update in 2015 and will be applied to the resuscitation training sessions and clinical practice, once the training material has been released. We expect it to be July for adults and August for paediatrics.
A summary of the Guidelines
Adult basic life support
There are no major changes in the 2021 Basic Life Support Guidelines.
Cardiac arrest recognition remains a key priority as it is the first step in triggering the emergency response to cardiac arrest.
When ringing 999, the ambulance call handler will assist with instructions for confirming cardiac arrest, starting compression-only CPR, and locating, retrieving and using an AED (automated external defibrillator).
Chest compressions should commence as soon as possible after cardiac arrest is confirmed. Someone must fetch an AED and bring it to the scene of the cardiac arrest. The British Heart Foundation database, “The Circuit”, serves as a national resource for the location of AEDs.
Adult Advance Life Support
There are no major changes in the 2021 Adult ALS Guidelines. High-quality chest compressions with minimal interruption and early defibrillation remain a priority. There is a greater recognition that patients with both in- and out-of-hospital cardiac arrest have premonitory signs, and that many of these arrests may be preventable.
If, following a stepwise approach to airway management an advanced airway is required only rescuers with a high tracheal intubation success rate should use tracheal intubation. The expert consensus is that a high success rate is over 95% within two attempts at intubation
Paediatric basic Life Support
This guideline applies to all infants and children except newborn babies (unless there is no other option at birth). There are no major changes for 2021.
In the paediatric basic life support sequence, rescuers should perform assessment for signs of life (circulation) simultaneously with breathing assessment and during the delivery of rescue breaths. If there are no signs of life, chest compressions should be started immediately after rescue breaths have been delivered.
Use of mobile phones with speaker function is emphasised to facilitate bystander access to dispatcher guided cardiopulmonary resuscitation (CPR), and to summon emergency medical services (EMS), without leaving the child or infant. Ensuring high quality CPR is emphasised.
Paediatric Advance Life Support
This guideline applies to all infants and children except newborn babies and includes a number of changes of which the following are the most important.
During the management of a paediatric cardiorespiratory arrest, once a tracheal tube is in place, continuous chest compressions should be given. In this case, ventilations should approximate to the lower limit of normal rate for age:
- Infants: 25 breaths per minute
- Children 1-8 years old: 20 breaths per minute
- Children 8-12 years old: 15 breaths per minute
- Children > 12 years old: 10-12 breaths per minute
Capnography should be used in all intubated children and infants for early detection of mal- or displacement of the tracheal tube.
In children and infants with shock, use a 10 mL kg-1 fluid bolus. There is an emphasis on smaller bolus volume with careful re-assessment after each bolus to enable early identification of signs and symptoms of fluid overload (hepatomegaly, bilateral basal lung crackles, and jugular venous distention). Use balanced isotonic crystalloids as first choice of fluid bolus, if available. If not, normal saline (0.9%) is an acceptable alternative. In haemorrhagic shock, keep crystalloid boluses to a minimum (max 20 mL kg-1). Consider early blood products in children and infants with severe trauma and circulatory failure, using a strategy that focuses on improving coagulation.
Children and infants with a febrile illness and no signs of shock should not receive fluid bolus therapy. In children and infants with persistent decompensated circulatory failure after multiple fluid boluses, vasoactive drugs should be started early, as a continuous infusion via either a central or peripheral line.
Use either noradrenaline or adrenaline as first line vasoactive drugs (dopamine is no longer recommended but can be used if adrenaline and noradrenaline are not available). Paediatric ALS providers should be competent in the use of these drugs during the first hour of stabilisation of a child or infant in circulatory failure.
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