ISA Cardiopulmonary Resuscitation Guidelines

Cardiopulmonary Resuscitation (CPR) has been published by various societies around the globe. Many of these are accepted and followed for teaching, training and real practice at many parts of the country as well. However, there remains a huge infrastructural and resource difference in various parts of the world. The single universal guideline does not exist till date that would be applicable across the globe. This is the reason the various countries have developed their own guidelines that suit to their specific requirement based on educational level, and other infrastructure and resource-related issues.

Till date, the international guidelines were accepted in India and across the other Asian countries. Based on the need of the guidelines suited to our country, Indian Association of Anesthesiologists (ISA) along with other academic societies took an initiative for developing the first Indian Cardiopulmonary Resuscitation (CPR) Guidelines. These guidelines have been published in November issue of the peer-reviewed Indexed Journal - Indian Journal of Anaesthesia.

These contain three separate stand-alone guidelines related to CPR and include:

• Compression-only Life Support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital.

Download Link: http://www.ijaweb.org/text.asp?2017/61/11/867/218099

• Basic Cardiopulmonary Life Support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital.

Download Link: http://www.ijaweb.org/text.asp?2017/61/11/874/218100

• Comprehensive Cardiopulmonary Life Support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital.

Download Link: http://www.ijaweb.org/text.asp?2017/61/11/883/218102

Compression-only Life Support (COLS):

The timely management of the victim with cardiopulmonary arrest is paramount. It may not be possible to provide immediate medical care by the trained person when victim is outside the hospital. The inclusion of common man after their proper training would be beneficial to improve the outcome of the victim. However the medical steps to be taught to a layperson should be kept simple and easy to follow and yet evidence-based.

The Compression only Life Support (COLS) provides an easy, algorithmic stepwise approach for resuscitation of victim with cardiopulmonary arrest by the lay person. COLS guideline has been formulated after considering various evidence and consensus opinion and remains a practical, uniform and acceptable resuscitation algorithm across India. The guideline emphasizes on basic three aspects of early recognition of cardiac arrest and activation, early chest compression and early transfer to the medical facility. COLS emphasize continuous chest compression (without undue interruption and with appropriate speed and depth) till victim received other medical help from trained personnel.

Basic Cardiopulmonary Life Support (BCLS):

The Basic Cardiopulmonary Life Support (BCLS) has been made for management of the adult victim with cardiopulmonary arrest outside the hospital. It would be directed to trained healthcare professionals. The BCLS has been formulated as an easy to follow, algorithmic stepwise approach. The guideline has considered the resource and infrastructure related issues.

BCLS emphasizes four main core links for optimal outcome. These links includes early recognition and activation; early high-quality CPR, early defibrillation and early transfer to the healthcare facility. In addition quality check remains essential for the process of CPR and has been emphasized appropriately in the guidelines. Conduct of BCLS requires minimum infrastructure and appears to be feasible across the country

Comprehensive Cardiopulmonary Life Support (CCLS)

The Comprehensive Cardiopulmonary Life Support (CCLS) has been made for management of the adult victim with cardiopulmonary arrest inside the hospital. Infrastructure of a health care facility may range from well equipped critical care unit to lesser equipped peripheral wards and outpatient clinics. So we need an algorithm so as to have options and suitable for all these resource constraint facilities. CCLS has accommodated these issues for easy follow up and thus would be universally acceptable for all type of health care facilities. Thus CCLS comprises all components of basic and advanced CPR steps for management of patent with cardiopulmonary arrest inside the hospital,

CCLS provides a simple, algorithmic stepwise approach for management of the adult patient with cardiopulmonary arrest. Prevention is better than cure. So the core links emphasizes the timely recognition and management of various prearrest conditions. The five core links of CCLS includes Early recognition and management of prearrest conditions; Early recognition of arrest and activation of Code blue; Early high-quality CPR; Early Defibrillation and Early comprehensive life support and post resuscitation care.

The CCLS recommends a step wise manner approach for inclusion of advanced management of the patient in addition to basic steps. The basic component of CPR includes chest compressions, airway maintenance, ventilation, and defibrillation. CCLS recommends inclusion of appropriate drug therapy and correction of the reversible causes. The pneumonic for identifying the reversible causes have been suggested. Team work is essential and thus CCLS incorporates the need of organized team approach and optimal post resuscitation care.

These three guidelines would be useful and easy to follow in various parts of the country. These guidelines are colour coded for easy identification for different target group and areas where they would be used.

References:

• Kapoor MC, Rao SC, Mishra BB. Indian Society of Anaesthesiologists cardiopulmonary resuscitation guidelines: Ushering in a new initiative. Indian J Anaesth 2017;61:865-6. Available from: http://www.ijaweb.org/text.asp?2017/61/11/865/218101

• Ahmed SM, Garg R, Divatia JV, Rao SC, Mishra BB, Kalandoor M V, Kapoor MC, Singh B. Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital. Indian J Anaesth 2017; 61:867-73. Available from: http://www.ijaweb.org/text.asp?2017/61/11/867/218099

• Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor M V, Divatia JV, Singh B. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth 2017;61:874-82. Available from: http://www.ijaweb.org/text.asp?2017/61/11/874/218100

• Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor M V, Singh B, Divatia JV. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth 2017;61:883-94. Available from: http://www.ijaweb.org/text.asp?2017/61/11/883/218102

• Trichur RV. Need for resuscitation registry in India based on Indian Society of Anaesthesiologists cardiopulmonary resuscitation guidelines. Indian J Anaesth 2017;61:895-6. Available from: http://www.ijaweb.org/text.asp?2017/61/11/895/218103

Dr. Rakesh Garg,

The author is MD, DNB, FICA, FIMSA, PGCCHM, MNAMS, CCEPC, (Anaesthesiology) and is Fellowship in Palliative Medicine Associate Professor of Anesthesiology, Dr. BRAIRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, He is a member Editorial Board, Cardiology at Specialty Medical Dialogues.