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European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing

2010; Elsevier BV; Volume: 81; Issue: 10 Linguagem: Inglês

10.1016/j.resuscitation.2010.08.008

1873-1570

Charles D. Deakin, Jerry P. Nolan, Kjetil Sunde, Rudolph W. Koster,

Restraint-Related Deaths

The most important changes in the 2010 European Resuscitation Council (ERC) guidelines for electrical therapies include: •The importance of early, uninterrupted chest compressions is emphasised throughout these guidelines. •Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses. The continuation of compressions during charging of the defibrillator is recommended. •Immediate resumption of chest compressions following defibrillation is also emphasised; in combination with continuation of compressions during defibrillator charging, the delivery of defibrillation should be achievable with an interruption in chest compressions of no more than 5 s. •Safety of the rescuer remains paramount, but there is recognition in these guidelines that the risk of harm to a rescuer from a defibrillator is very small, particularly if the rescuer is wearing gloves. The focus is now on a rapid safety check to minimise the pre-shock pause. •When treating out-of-hospital cardiac arrest, emergency medical services (EMS) personnel should provide good-quality CPR while a defibrillator is retrieved, applied and charged, but routine delivery of a pre-specified period of CPR (e.g., 2 or 3 min) before rhythm analysis and a shock is delivered is no longer recommended. For some emergency medical services that have already fully implemented a pre-specified period of chest compressions before defibrillation, given the lack of convincing data either supporting or refuting this strategy, it is reasonable for them to continue this practice. •The use of up to three-stacked shocks may be considered if ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) occurs during cardiac catheterisation or in the early post-operative period following cardiac surgery. This three-shock strategy may also be considered for an initial, witnessed VF/VT cardiac arrest when the patient is already connected to a manual defibrillator. •Electrode pastes and gels can spread between the two paddles, creating the potential for a spark and should not be used