Thoughts from a Clinician on the American Heart Association Guidelines.

With much anticipation, the 2015 American Heart Association Guidelines have graced us with their presence. Let’s examine them a little.

Ultrasound and POCUS

The best part of the new American Heart Association Guidelines is the recognition given to ultrasound. They finally confirm ultrasound as a great tool that we can use it in advanced life support. There is a big push for the use of EMS Point of Care Ultrasound (EMS POCUS) and I fully support it.

Finally, the work done by clinicians across the world with ultrasound has gained recognition. Eventually we will see ultrasound having a permanent place in the emergency medicine world and this is a good start.

Extracorporeal Membrane Oxygenation

Another shout out to the American Heart Association for including Extracorporeal Membrane Oxygenation or ECMO as a possible treatment. It is because of all of the hard work of individuals like Joe Bellezzo, MD, Zack Shinar, MD, and Scott Weingart, MD that ECMO in cardiac arrest is gaining steam.

Clinicians have used ECMO for years in the pediatric population. And now, thanks to the guys at edecmo.org, they can use it in cardiac arrest patients. These guys started the ED ECMO podcast based on using ECMO in cardiac arrest patients. The idea came from overseas and these gentleman have lit the fire here in the United States. Anything you need to know about ED ECMO can be found at www.edecmo.org.

Cardiac arrest cases

Vasopressin being pushed out of the cardiac arrest algorithm isn’t an earth shattering change, in my opinion. I feel that a lot of providers had either never used it or used it intermittently in cardiac arrest. So, not a huge culture change there. Taking vasopressin out was not the change that a lot of providers were both hoping for and expecting. For now epinephrine is still the king of all the cardiac arrest medications. For how much longer? That remains to be seen. What we know is that we still use epinephrine and if the rhythm converts to a non-shockable rhythm, use more. According to the latest guidelines, there is a thought process that we may be able to get the patient to a perfusing rhythm if we give epi quickly with conversion to non-shockable rhythm. Again, not another earth shattering move in the algorithm, but still worth noting.

We should make note of the standardizing the joule energy delivery for all phases of the ACLS algorithms. This acts as a reprieve for all who struggled to remember the escalating doses of joules for each synchronized cardioversion or defibrillation. For a long time, the services that I’ve worked with have used standard delivery of energy for every shock delivered. This is making ACLS easier without the escalating doses and more user friendly in the field management of cardiac arrest.

Summing up

All in all, there are several good changes that came along with the new guidelines. Most of the changes are things that were being practiced by some, but not are a part of the treatment algorithm. Providers continue to drive the care for chest pain, cardiac arrest, or pediatric cases. On behalf of all of my colleagues at Distance CME I want to say thank you for the passion and the drive you show every day. It is because of all of you that these changes have come to be and are going to make a difference in the very near future. Stay safe, fight the good fight, and always question the status quo.

Finally, for more info, see BoringEM for a great run down of all these changes.