I Guideline for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Brazilian Society of Cardiology: Executive Summary

Abstract

Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.

Knowledge of the military fire brigade on cardiopulmonary resuscitation

“…Thus, the rescuer is instructed to use barrier mechanisms at the time of the procedure, performing two ventilations that promote chest elevation after the initial compressions. 5 Regarding the proper posture during chest compression, there were variations in the responses regarding the positioning of the rescuer's body, as well as the angulation of the arms. However, the correct answer, which ensures a high-quality maneuver, is to keep the rescuer's trunk above the patient's body with arms at a 90 degree angle to the patient's chest and to keep the elbows extended.…”

“…In this way, the rescuers should position themselves next to the victim with the trunk above the patient's body, hypothenar region of the hands on the intermamillary line, arms extended, forming an angle of 90º. 5,17,25 Still on the practical aspects during a CRA, the minimum depth during the chest compression was another variable investigated in this research. The most prevalent responses were in accordance with current guidelines of five centimeters, not exceeding six centimeters.…”

“…For the majority of the interviewees, the responses were consistent with the current literature, defined as: early detection of cardiopulmonary collapse, activation of the emergency medical service and intervention within four minutes with high quality CPR, increasing the chances of spontaneous circulation return(SCR). 5 However, among the other responses on this variable, some participants stated that the "Golden Time" would be the CRA detection time in ten minutes, the consequences of which are aggravated the longer the duration of time. After five minutes without care, there is already a risk of neurological damage; with eight minutes, the deficit is already installed and in ten minutes, brain death is confirmed.…”

“…This is because, in a sudden CRA, arterial oxygen content is adequate at the time of collapse, taking a few minutes to reach a critical level of hypoxemia. 5,17 Nevertheless, on this variable, some participants answered other sequences like ABCDE and ABCD. They are believed to have responded to these sequences by resembling guidelines used to treat trauma victims.…”

“…3,4 In the case of CRA victims, early care with immediate cardiopulmonary resuscitation (CPR) contributes considerably to the increase in survival rates, requiring health professionals, rescuers and lay people to have minimal knowledge in reversing the condition. 5 A survey carried out in Amsterdam, The Netherlands, concluded that these firstaiders with CPR training, that includes chest compressions and ventilation, can perform CPR effectively. 6 In Brazil, Pre-Hospital Care (PHC) before a CRA can be performed in two ways: through the Basic Life Support (BLS) with execution of the primary care sequence during the initial minutes of an occurrence; and the Advanced Life Support (ALS) with the continuity of care is done by the Emergency Medical Care Service (EMCS) performed exclusively by doctors and nurses.…”