![Page 1: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/1.jpg)
New ACLS/Post Arrest Guidelines:
For Everyone?
Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael’s Hospital,
University of Toronto
![Page 2: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/2.jpg)
COI Declaration
Industry and ROC
ALS Taskforce ILCOR
Author – AHA Guidelines
2005, 2010 and 2015
![Page 3: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/3.jpg)
![Page 4: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/4.jpg)
Scope of Work
OHCA and IHCA
![Page 5: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/5.jpg)
• CPR saves lives
• Everyone should do it
• Focus on continuous high quality
• Minimize interruptions
• Careful with ventilation
Critical CPR Concepts
2005 Guidelines
![Page 6: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/6.jpg)
New Defibb Toys
![Page 7: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/7.jpg)
© 2010 American Heart Association. All rights reserved.
2010 Guidelines
![Page 8: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/8.jpg)
MedicineUNIVERSITY OF TORONTO
Perfusion pressure indicator
Defibrillator dashboard with CPR process measures
ALS Responder
CPR Process
![Page 9: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/9.jpg)
Use of ET CO2 During CPR
© 2010 American Heart Association. All rights reserved.
Confirming Intubation
Physiological Monitoring Quality of CPR
![Page 10: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/10.jpg)
Rapid increase in ETCO2 predicts ROSC
Rapid decline in ETCO2 during ROSC predicts re-arrest
Case 103817
0
10
20
30
40
50
60
70
80
90
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
0 500 1000 1500 2000 2500 3000
ET
CO
2 (m
mH
g)
De
pth
(in
ch
es
*10
0)
Time (s)
Depth
ETCO2
Feedback Tool
![Page 11: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/11.jpg)
PSP of 20 seconds or longer associated with mortalityOR of 0.47 (0.27-0.82)
![Page 12: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/12.jpg)
No Pulse
Check
One shock
Only
Manual vs AutoCapacitor auto charges
Anatomy of the Pre-Shock Pause
Optimize Hands On time
No Analysis
Post Shock Pause
![Page 13: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/13.jpg)
AED pre-shock pause duration – automatic mode
MedicineUNIVERSITY OF TORONTO
Device Minimum Interruption, secs Maximum Interruption, secs
(Mean + SD) (Mean + SD)
A 5.2 + 0.1 8.1 + 0.1
B 12.3 + 0.2 15.7 + 0.3
C 15.6 + 0.1 16.9 + 0.1
D 16.9 + 0.1 18.1 + 0.2
E 17.1 + 0.2 18.3 + 0.1
F 19.7 + 0.1 22.1 + 0.3
G 26.3 + 0.1 28.4 + 0.1
analysis
![Page 14: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/14.jpg)
Shortest PSP in Toronto
08:54:06 08:54:08
analysis
![Page 15: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/15.jpg)
CPR Process – Personal Feedback
![Page 16: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/16.jpg)
CPR Process – Service Feedback – Sept 2015
AHA
Guidelines
Mins of CPR
that meet
Guidelines
(%)
Mean SD 90th % tile
Mins of
CPR 769
Comp
Rate 100-120 72% 105 10.33 118
Comp
Fraction ≥ 0.6 89% 0.82 0.11 0.93
Comp
Depth
≥ 5.039% 5.01 1.38 6.52
![Page 17: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/17.jpg)
Summary of Changes
• Improve CPR quality
• Monitor CPR quality
• Feedback
– Audio Visual Feedback
– Audit and Feedback
• Reduce Peri-Shock Pause
![Page 18: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/18.jpg)
MedicineUNIVERSITY OF TORONTO
YearTreated
(N=)
Alive to
discharge (N=)
Alive to
discharge (%)
95% Confidence
Limit (%)
2006 234 40 17.1 12.3-21.9
2007 329 79 24.0 19.4-28.6
2008 404 86 21.3 17.3-25.3
2009 372 76 20.4 16.3-24.5
2010 353 99 28.0 23.4-32.7
2011 370 111 30.0 25.3-34.7
2012 359 104 29.0 24.3-33.7
2013 376 124 33.0 28.2-37.7
2014 394 137 30.2 25.8–34.6
Survival RatesOut-of-Hospital VF Cardiac Arrest in Epistry at Rescu
(Urban and rural regions of Southern Ontario)
![Page 19: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/19.jpg)
MedicineUNIVERSITY OF TORONTO
2006 2010
30%
20%
5%
SU
RV
IVA
L
VT VF Bystander
VT VF
EMS treated all
PEA
Asystole
![Page 20: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/20.jpg)
MedicineUNIVERSITY OF TORONTO
2010 Guidelines
2015 Guidelines Update
![Page 21: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/21.jpg)
MedicineUNIVERSITY OF TORONTO
274 completed in 2010
391 potential
165 completed in 2015
![Page 22: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/22.jpg)
• 100-120 compressions/min
• Minimize interruptions
– Compression fraction >0.6
– Preferably >0.8
– Rhythm check 5 seconds
– Pulse check – organized rhythm
• Deep to 5-6 cm
• Audio Visual Feedback
![Page 23: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/23.jpg)
• Just use epinephrine
• Vasopressin offers no advantage
• ETCO2 waveform capnography is the
gold standard
• US in the hands of experts may be....
• Epi within 1-3 mins in non shockable
rhythms – ROSC adv with IHCA
• Titrate to O2 sat with sustained
ROSC
• May be considered.....lots of caveats
![Page 24: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/24.jpg)
Effect of 1 mg Epi Bolus During CPR
Dorian et al unpublished
Aortic Pressures
% o
f pre
ep
ile
vel
100%
Carotid Blood Flow
Epi
Courtesy of Paul Dorian’s Lab 2014
![Page 25: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/25.jpg)
![Page 26: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/26.jpg)
Placebo versus EPI
0.4
0.3
0.2
0.1
0.05
0
Event ROSC ED/admission 24hrs 72hrs Discharge
Cum
ula
tive P
rop
ort
ion S
urv
ival
8%
13%
25%24%
2%
epinephrine
placebo
ED
4%
![Page 27: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/27.jpg)
Japan DataStudy Subjects Date N One-Month Survival CPC 1-2
Hagihara 2012
“Epi vs. None”
OHCA 2005-2008
417,188
Propensity Matched:
26,802
VF: 15.4% vs. 21.3%NonVF: 3.8% vs. 3.4%
Propensity Matched:5.1% vs. 7.0%
VF: 6.1% vs. 13.5%NonVF: 0.6% vs. 1.3%
Propensity Matched:1.3% vs. 3.1%
Nakahara 2012
“Early Epi?”
Witnessed OHCA
2007-2008
49,165 VF: 28.2% vs. 17.7%NonVF: 4.7% vs. 2.8%
VF: 13.9% vs. 9.4%NonVF: 0.9% vs. 0.7%
Nakahara 2013
“EMS Epi?”
WitnessedOHCA
2007-2010
96,079
PropensityMatched:
22,096
VF: 16.5% vs. 28.8%NonVF: 3.9% vs. 4.2%
Propensity Matched:VF: 17.0% vs. 13.4%NonVF: 4.0% vs. 2.4%
VF: 6.9% vs. 19.8%NonVF: 0.6% vs. 1.5%
Propensity Matched:VF: 6.6% vs. 6.6%NonVF: 0.7% vs. 0.4%
Hayashi 2012
“EMS Epi?”
OHCA with AdvancedEMS
2007-2009
3,161 13.5% vs. 12.0%
VF: 29.8% vs. 36.2%NonVF: 9.3% vs. 8.1%
4.1% vs. 6.1%
VF: 14.1% vs. 25.2%NonVF: 1.5% vs. 3.0%
Goto 2013
“Epi x Rhythm?”
OHCA of cardiac cause
2009-2010
209,577 VF: 15.4% vs. 27.0%NonVF: 3.0% vs. 18.7%
VF: 7.0% vs. 18.6%NonVF: 0.59 vs. 0.62%
BIG Observational Studies>775,000 patients
Propensity matchedDuration of OHCA
prior to ROSCIndication bias confounding
No Post Arrest Care Protocol
Ø TTMØ Access to PCI
Ø Vasopressor SupportØ Neuroprognostication
VF 6.6% vs 6.6%NonVF <1% vs <1%
![Page 28: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/28.jpg)
Focus on the Rescuer
Making the RIGHT thing
the EASIEST thing to do
Focus on the Patient
One size DOES NOT fit all
in Resuscitation
![Page 29: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/29.jpg)
1989
Ann EM
Gonzalez
![Page 30: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/30.jpg)
Sutton Am J Respir Crit Care Med. 2014 Oct 16
Goal Directive Care
Guideline Care
1st EPI
1st SHOCK
![Page 31: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/31.jpg)
Further studies on the role of epinephrine in cardiac arrest
are required to determine
optimal dose and timing for drug administration
![Page 32: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/32.jpg)
![Page 33: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/33.jpg)
2014 OHCAQuality of CPR
Monitoring
![Page 34: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/34.jpg)
MedicineUNIVERSITY OF TORONTO
Fatal Flaws • To slow to recognize CA• To slow to start compressions• To slow to apply defib• To slow to shock• Training - infrequent, remote from ward• Feedback – none Point of Care, infrequent audit and feedback• Mock codes – NASCAR analogy
![Page 35: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/35.jpg)
• Optimize parameters
• TTM is ACTIVE
• Yes for STEMI• Yes for comatose• Consider for non STEMI
• WLST < 72 hours is fatal
• Donation after circulatory death
One size DOES NOT fit all
in Post Resuscitation
![Page 36: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/36.jpg)
*Rittenberger 2011; Resuscitation 82: 1399-1404
Pittsburgh Cardiac Arrest Categories
![Page 37: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/37.jpg)
Initial Category and Outcome
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Survival
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Multiple Organ Failure
Rittenberger 2011, Resuscitation
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Good Functional Recovery
50%
![Page 38: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/38.jpg)
Customize care based on expectations
Post-Arrest STEMI
Category 1
Category 2
Category 3
Category 4 CT head
Straight to Cath Lab
Discuss with Family
Limitation of Care
![Page 39: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/39.jpg)
STEMI + who else goes to cath?
STEMI
![Page 40: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/40.jpg)
STEMI + who else goes to cath?
STEMI
Primary VF
Suggestive History
Cardiogenic Shock
![Page 41: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/41.jpg)
STEMI + who else goes to cath?
STEMI
Primary VF
Echo with Focal Wall
Motion Abnormalities
Rising Troponin
Suggestive History
Cardiogenic Shock
![Page 42: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/42.jpg)
33ºC or 36ºC?
• In undifferentiated patients, neither has been shown to be superior
– In patients with <50% expected survival, consider using the more aggressive regimen
![Page 43: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/43.jpg)
GWR: Gray Matter to White Matter Ratio
![Page 44: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/44.jpg)
Progression of Cerebral Edema after Rewarming
![Page 45: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/45.jpg)
33ºC or 36ºC?• In undifferentiated patients, neither has been shown
to be superior
– In patients with <50% expected survival, consider using more aggressive regimen
– Use temperature to affect specific pathophysiology: cerebral edema, brain tissue hypoxia, seizures
Consider 33 > 36
CT with intermediate edema Consider 33 > 36
![Page 46: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/46.jpg)
33ºC or 36ºC?• In undifferentiated patients, neither has been shown
to be superior
– In patients with <50% expected survival, consider using more aggressive regimen
– Use temperature to affect specific pathophysiology: cerebral edema, brain tissue hypoxia, seizures
Consider 33 > 36
CT with intermediate edema Consider 33 > 36
Malignant EEG Consider 33 > 36
![Page 47: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/47.jpg)
Resus 2014
Impact of Guidelines
![Page 48: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/48.jpg)
Knowledge Translation or Implementation Science
Right provider
Right patient
Right treatment
Right time interval
Right outcome
![Page 49: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/49.jpg)
Implement, Implement, ImplementAudit and Feedback=
Survival
![Page 50: New ACLS/Post Arrest Guidelines: For Everyone? · COI Declaration Industry and ROC ALS Taskforce ILCOR Author –AHA Guidelines 2005, 2010 and 2015](https://reader033.vdocuments.net/reader033/viewer/2022052103/603d9032c502dd451227966a/html5/thumbnails/50.jpg)
MedicineUNIVERSITY OF TORONTO
www.heartandstroke.ca/guidelines2015