Guidelines for Cardiopulmonary Resuscitation. Advanced life support. Revised recommendations of the Resuscitation Council (UK)

The first guidelines for advanced life support promoted by the Resuscitation Council of the United Kingdom were published in 1984. The council adopted a policy of revising and updating them every five years so that policies were kept in line with current research. The new recommendations, together with those for basic life support, are now available. The advanced guidelines are summarised in a chart that shows algorithms for treating different modes of cardiac arrest, together with brief advice on the general conduct of resuscitation. This article draws attention to the major modifications in the algorithms. Since 1984 cooperation has increased greatly with many other European groups that have an interest in cardiopulmonary resuscitation. In particular, we have liaised closely with colleagues from Nordic countries. The recommendations for 1989-and the chart-are substantially the same for the United Kingdom, Sweden, Denmark, Norway, and Finland. We expect that the 1994 recommendations will represent a consensus from a larger group of European countries. The use of the precordial thump has been reintroduced but only for witnessed or monitored arrests, in line with published evidence of its efficacy for pulseless ventricular tachycardia or ventricular fibrillation of very recent onset. The risk of exacerbating a ventricular arrhythmia is recognised, but the likelihood of harm is small when the arrest has been witnessed. Moreover, a proarrhythmic effect is possible with all successful interventions, and the manoeuvre takes little time to execute.