Changes in Visuals and Algorithms

• Addition of a Recovery link In the IHCA and OHCA Chains of Survival
•         Modification of the Cardiac Arrest algorithm to encourage early administration of epinephrine for nonshockable rhythms
•         New lay-rescuer Opioid-Associated Arrest Algorithm
•         New trained rescuer Opioid-Associated Arrest Algorithm
•         Modification of the Post-Cardiac Arrest Care algorithm to encourage the need to prevent hypoxemia, hypotension, and hyperoxia
•         New Cardiac Arrest in Pregnancy algorithm
•         New visual with information about neuroprognostication after ROSC

Key Changes

In addition to the new algorithms and modifications to the existing algorithms, additional changes to the guidelines include:

•         Lay-rescuer initiation of CPR: AHA and ILCOR recommend that lay rescuers perform CPR on any patient with presumed cardiac arrest. The risk of harm from CPR on a patient without a cardiac arrest is low.
•         Early administration of epinephrine: For patients in nonshockable cardiac arrest rhythms, epinephrine should be administered as soon as possible. For those with a shockable rhythm, epinephrine may be administered after defibrillation has failed.
•         Use of audiovisual feedback devices: The use of feedback devices may improve CPR performance and survival to hospital discharge.
•         Monitoring of CPR quality: Improved data supports the use of arterial blood pressure and end-tidal CO₂ monitoring (at least 10 mm Hg but > 20 mm Hg is ideal) to monitor the quality of CPR and improve the likelihood of ROSC.
•         Sequential defibrillation: There is no evidence to support the use of applying two nearly simultaneous shocks for shockable rhythms in cardiac arrest.
•         IV access over IO access: In cardiac arrest, IV access may be attempted first during cardiac arrest since the IV route has been found to have better clinical outcomes than IO. If an IV cannot be established, providers should consider IO access.
•         Support during recovery: This new guideline adds a recovery component to the IHCA and OHCA chains of survival. This recommendation includes rehabilitation assessment and treatment before hospital discharge for cardiac arrest survivors and their families. This would include cardiopulmonary, neurologic, return to work, post-traumatic stress, and assessment and treatment of fatigue.
•         Lay-rescuer debriefings: Although debriefings for providers has been a recommendation, AHA and ILCOR now recommend debriefings for lay-rescuers, EMS personnel, and hospital providers following a cardiac arrest.
•         Cardiac arrest during pregnancy: There is a new algorithm for the in-hospital pregnant patient in cardiac arrest. In the pregnant patient with cardiac arrest, airway and oxygenation management must be prioritized. Fetal monitoring should not be initiated. After ROSC, targeted temperature management should be initiated with continuous fetal monitoring for bradycardia.