The guidelines recognise the increasing role of point-of-care ultrasound (POCUS) in peri-arrest care for diagnosis, but emphasises that it requires a skilled operator, and the need to minimise interruptions during chest compression. Symptoms such as syncope (especially during exercise, while sitting or supine), palpitations, dizziness and sudden shortness of breath that are consistent with an arrhythmia should be investigated. When a mechanical chest compression device is used, minimise interruptions to chest compression during device use by using only trained teams familiar with the device. severe heart failure – manifested by pulmonary oedema (failure of the left ventricle) and/or raised jugular venous pressure (failure of the right ventricle)

If an advanced airway is required, only rescuers with a high tracheal intubation success rate should use tracheal intubation. Adult patients with non-traumatic OHCA should be considered for transport to a recognised centre of care for appropriate specialist treatment, according to local protocols. There is no evidence to express a preference for a policy of primarily transporting via ambulance (using bypass protocols) or one of secondary inter-hospital transfer. Patients should receive care in a clinical area that has the appropriate staffing, skills, and facilities for their severity of illness. Antero-lateral pad position is the position of choice for initial pad placement. Ensure that the apical (lateral) pad is positioned correctly (mid-axillary line, level with the V6 ECG electrode position) i.e. below the armpit. Do not use POCUS for assessing contractility of the myocardium as a sole indicator for terminating CPR.Emergency medical systems (EMS) should consider implementing criteria for the withholding and termination of resuscitation (TOR) taking into consideration specific local legal, organisational and cultural context ( see the Ethics Guidelines). Lidocaine 100 mg IV (IO) may be used as an alternative if amiodarone is not available or a local decision has been made to use lidocaine instead of amiodarone. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts.

myocardial ischaemia – may present with chest pain (angina) or may occur without pain as an isolated finding on the 12-lead ECG (silent ischaemia). Consider thrombolytic drug therapy when pulmonary embolus is the suspected or confirmed as the cause of cardiac arrest. the involvement of stakeholders from around the world including members of the public and cardiac arrest survivors. POCUS may be useful to diagnose treatable causes of cardiac arrest such as cardiac tamponade and pneumothorax.The guidelines reflect the increasing evidence for extracorporeal CPR (eCPR) as a rescue therapy for selected patients with cardiac arrest when conventional ALS measures are failing and to facilitate specific interventions (e.g. coronary angiography and percutaneous coronary intervention (PCI), pulmonary thrombectomy for massive pulmonary embolism, rewarming after hypothermic cardiac arrest) in settings in which it can be implemented. This is achieved by continuing chest compressions during defibrillator charging, delivering defibrillation with an interruption in chest compressions of less than 5 seconds and then immediately resuming chest compressions. During manual chest compressions, ‘hands-on’ defibrillation, even when wearing clinical gloves, is a risk to the rescuer. The damage given by each respective rank of the perk, as a proportion of weapon damage, is as follows: If the patient with tachycardia is stable (no life-threatening adverse signs or symptoms) and is not deteriorating, pharmacological treatment may be possible.

High-quality chest compressions with minimal interruption and early defibrillation remain priorities. An increase in ETCO 2 during CPR may indicate that ROSC has occurred. However, chest compression should not be interrupted based on this sign alone. The process used to produce the Resuscitation Council UK Guidelines 2021 is accredited by the National Institute for Health and Care Excellence (NICE). The guidelines process includes: For bradycardia caused by inferior myocardial infarction, cardiac transplant or spinal cord injury, consider giving aminophylline (100–200 mg slow intravenous injection). Guidelines 2021 are based on the International Liaison Committee on Resuscitation 2020 Consensus on Science and Treatment Recommendations for Advanced Life Support and the European Resuscitation Council Guidelines for Resuscitation (2021) Advanced Life Support. Refer to the ERC guidelines publications for supporting reference material.Right ventricular dilation in isolation during cardiac arrest should not be used to diagnose massive pulmonary embolism.

Hospital staff should use structured communication tools to ensure effective handover of information. Use data-driven, performance-focused debriefing of rescuers to improve CPR quality and patient outcomes. Consider mechanical chest compressions only if high-quality manual chest compression is not practical or compromises provider safety. If bradycardia is accompanied by life-threatening adverse signs, give atropine 500 mcg IV (IO) and, if necessary, repeat every 3–5 minutes to a total of 3 mg. Hospitals should train staff in the recognition, monitoring and immediate care of the acutely ill patient.

Navigation menu

Consider pacing in patients who are unstable, with symptomatic bradycardia refractory to drug therapies. Systems should define criteria for the withholding and termination of CPR, and ensure criteria are validated locally ( see the Ethics Guidelines).