Part 5: Acute Coronary Syndromes 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Since 2000, the International Liaison Committee on Resuscitation (ILCOR) has published the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) every 5 years based on review of cardiopulmonary resuscitation (CPR) science. Seven task forces with representatives from the 7 member resuscitation organizations create the CoSTR that enables regional resuscitation organizations to create their individual guidelines. The different guidelines are based on the scientific evidence and incorporate or adjust for regional considerations. Coronary heart disease remains among the leading causes of mortality globally. There is considerable research focus worldwide on improving outcomes in patients with acute coronary syndromes (ACS). Undoubtedly, this has led to improved health and dramatically improved morbidity and mortality in much of the world. Indeed, timely and appropriate care of ACS can reduce and prevent cardiac arrest. Some of the recommended interventions for ACS, however, are considered resource intensive and/or require significant infrastructure, such as well-trained emergency medical services personnel to administer fibrinolysis, and cardiac catheterization laboratories that require capital and experienced staff. These regional disparities present challenges to regional and national health authorities as guidelines evolve and become more complex. The American College of Cardiology with the American Heart Association, European Society of Cardiology, and other organizations have developed guidelines for treatment and management of patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI ACS. These guidelines primarily focus on the hospital setting, and, for many years, the prehospital and emergency department (ED) management of patients was based on extrapolation of in-hospital evidence. There is now increasing interest and evidence on the prehospital decisions and management of ACS. The time-sensitive nature of ACS forces us to scrutinize not only the time goals to deliver the interventions but also the proper sequencing of them. For …