R E SUS CI TATION


Reviewing resuscitation equipment and processes


Updated guidelines from the Resuscitation Council (UK) offer healthcare organisations across the UK an opportunity to re-evaluate their approach to resuscitation. James Swarbrick reviews the latest guidance and discusses the role of technology in ensuring the best possible outcomes.


The Resuscitation Council (UK) (RCUK) released its latest set of guidelines for the emergency treatment of critically unwell patients back in May, providing the best up-to-date evidence for clinical practice in the UK. The 2021 guidelines build on the 2015 UK guidelines and the latest recommendations from the European Resuscitation Council (ERC), with certain recommendations revealing equipment functionality that is considered important to a resuscitation attempt.


Monitoring


Both the RCUK and ERC recognise that many cardiac arrests have premonitory signs, and that many of these arrests may be preventable, with both organisations recommending a mixture of caregiver training, clear strategies, and review of cardiac event data – alongside vital signs such as ECG readings to help rescuers respond effectively.1 Anthony Freestone, RCUK regional representative for the North West and advanced clinical practitioner at Blackpool Teaching Hospitals NHS Foundation Trust, stated: “The focus must always be on preventing cardiac arrest from occurring. Greater emphasis on recognising and treating the deteriorating patient should be every NHS Trust’s responsibility, in line with other Guidelines such as NICE (CG50). “With the growing recognition that many cardiac arrests can be identified in advance, it makes sense to employ comprehensive monitoring, where possible to reduce mortality.”


The importance of monitoring is reflected in the A.B.C.D.E assessment of a peri arrest patient.2


Vital sign monitoring forms part of the initial assessment stage, incorporating recommendations from the RCUK to include electrocardiogram (ECG), blood pressure (BP), Heart Rate (HR) and SpO2


readings SEPTEMBER 2021


as well as a 12-lead ECG report.3


Data from


12-lead ECGs, in particular, has been shown to be instrumental in helping emergency medical system (EMS) teams prevent sudden cardiac arrest through the early recognition of acute coronary syndrome (ACS).4 Having this level of monitoring built into the defibrillators saves vital time and can be useful throughout the resuscitation process, “The Mindray defibrillators’ precision monitoring assist in both peri and post arrest resuscitation stages,” Mr Freestone explained. Both of Mindray manual defibrillators, the D3 and D6, can include the recommended vital parameters, as well as non-invasive BP and end-tidal carbon dioxide (etCO2


). Measuring etCO2 represents a non-


invasive way of gauging the effectiveness of CPR; assessing the CO2


that is expired


indicates perfusion levels and the potential of successful resuscitation. An increase in etCO2


during CPR may also indicate that a


return of spontaneous circulation (ROSC) has occurred, making capnography a useful tool in a resuscitation attempt. The new guidelines clarify the RCUK’s position on waveform capnography to record etCO2


,


recommending the technique more strongly than in its previous guidelines. “While defibrillation is important, we need to continue to push for high quality CPR, where the only recommendation is for capnography, which had previously always been more of a consideration. The technology does more than just tell the user to push harder, it’s an accurate display of how the resuscitation attempt is going and can provide a real insight into performance and feedback.” Mr Freestone commented. Microstream technology can be included on the Mindray D3 and D6 defibrillators to record etCO2


through capnography, offering highly accurate etCO2 readings and


crisp waveforms on both intubated and non-intubated patients, as well as oral or


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