Advanced life support and cardiac arrest

• Cardiac arrests, both in and out of hospital, for adults and children have very poor outcomes.
• The provision of good quality cardiopulmonary resuscitation (CPR) and early defibrillation is vital in achieving successful outcomes.
• Rescuers should aim to minimise interruptions to CPR during any advanced life support intervention.
• Recognising and treating potentially reversible conditions may also facilitate successful resuscitation.

Management

ECAT protocols

• Adult: Cardiorespiratory arrest
• Paediatric: Cardiorespiratory arrest

Advanced life support algorithms

Use of adult, paediatric or newborn life support algorithms is recommended for all health clinicians.

Australian and New Zealand Committee on Resuscitation algorithms

• Protocols for adult advanced life support
• Paediatric advanced life support (PALS)
• Newborn life support (PDF)

Advanced life support protocols

Familiarisation with advanced life support and resuscitation protocols is recommended for all health clinicians.

Australian and New Zealand Committee on Resuscitation protocols

• Guideline 11.2 – Protocols for adult advanced life support
• Paediatric advanced life support protocol
• Neonatal resuscitation

Other treatment

Mechanical CPR

Mechanical CPR is delivered using an automated device that provides the external chest compression component of CPR at a consistent depth and rate.

mCPR is used in the following areas of the hospital during in-hospital cardiac arrest:

• Emergency departments
• Intensive care units
• Cardiology units
• Cardiac catheter labs

The following must be considered when deploying a mCPR device:

• Good-quality manual chest compressions must remain the gold standard for the delivery of external chest compressions during CPR.
• Early defibrillation of a shockable rhythm must not be delayed.
• CPR must be commenced immediately for cardiac arrest, with no delay while waiting for a decision on the deployment of a mCPR device.

Refer to the NSW mechanical cardiopulmonary resuscitation (mCPR) clinical practice guide – adult patients

Extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) is a modified heart-lung machine that provides lung and/or heart support in patients with extreme organ dysfunction, refractory to conventional support strategies. It is a highly specialised service provided in specialist tertiary intensive care units, where clinicians with expertise in ECMO are available to support the initiation, ongoing management and post-ECMO patient care.

Extracorporeal cardiopulmonary resuscitation (ECPR) refers to the use of venoarterial ECMO during ongoing resuscitation attempts in cardiac arrest.

Intensive Care NSW provides resources for Extracorporeal membrane oxygenation (ECMO) in NSW. These resources to inform clinicians and health services about adult, neonatal and paediatric ECMO, including retrieval requests.

Other resources

• International Liaison Committee on Resuscitation
  Treatment recommendations and evidence reviews from a consensus of member organisations.
• Resuscitation: Hospital management of cardiopulmonary arrest
  Paediatric Improvement Collaborative endorsed clinical practice guideline on the assessment and management of children and infants with cardiopulmonary arrest.
  Source: The Royal Children's Hospital Melbourne
• Westmead ECMO App
  Treatment algorithms for ECMO.
  Apple store | Google play
  Source: Western Sydney Local Health District