ARC Guideline Updates

OVERVIEW

This page summarises recent key updates regarding basic and advanced life support made by the Australian Resuscitation Council (ARC).

• ARC and the New Zealand Resuscitation Council are partner members of the Australian and New Zealand Committee on Resuscitation (ANZCOR).

BASIC LIFE SUPPORT (2021)

• Basic principles remain the same with the same ratio of compressions to ventilations (30:2) and depth of compression (>5cm in adults, ~5cm in children, 4cm in infants), with a compression rate of 100-120/min
• Ventilation should be performed whenever the rescuer is willing and able
• In the presence of active community transmission of COVID-19 and mask-wearing restrictions, assess breathing by looking and focusing on compression-only CPR
• The wording around danger to the rescuer has changed
• Use of bag valve mask ventilation has been added to the breathing guideline
• Emphasis on the fact that most sudden cardiac arrests occur in the presence of family/friends/work colleagues, hence mouth-to-mouth ventilation should be encouraged if the rescuer is willing and able

NEWBORN ADVANCED LIFE SUPPORT (2021)

• For preterm infants born at <34 weeks’ gestational age who do NOT require resuscitation after birth, defer cord clamping for at least 30 seconds
• For term/late preterm infants born at >34 weeks’ gestational age who do NOT require immediate resuscitation after birth, defer cord clamping for ≥ 60 seconds
• Recommends against intact cord milking for infants <28+0 weeks gestational age
• Recommends against routine direct laryngoscopy with/without suctioning for infants exposed to meconium-stained amniotic fluid
• Intraosseous (IO) lines can be used as alternative access, especially if umbilical or venous access is not available
• For preterm infants born at <35 weeks’ gestation, commence resuscitation using room air or blended air and oxygen up to an inspired fraction of oxygen (FiO2) of 0.3 (30%) rather than FiO2s of 0.6 to 1.0 (60-100%)
• If ongoing newborn cardiopulmonary resuscitation (CPR) (and exclusion of reversible causes) after birth, a reasonable time frame to consider discontinuing resuscitative efforts is around 20 minutes after birth

ADVANCED LIFE SUPPORT (2018)

• A/B:
  • Administer 100% oxygen when available
  • Consider airway adjuncts, attempts to secure the airway should not interrupt CPR for >5 seconds
  • Waveform capnography should be used to confirm airway / monitor adequacy of CPR
• C/D:
  • Good quality CPR and reduced time to defibrillation are the highest priorities
  • Minimise interruptions of chest compressions (depth 5cm, rate 100-120/min) during any ALS intervention
  • if cardiac arrest + shockable rhythm (VF/VT) – single shock instead of stacked shocks
  • if witnessed arrest in a cardiothoracic patient after surgery – up to 3 stacked shocks may be given for the first attempt (refer to Resuscitation in Special Circumstances Guideline 11.10 — last updated November 2011)
  • if monophasic defibrillator use 360J and if biphasic defibrillator use 200J; if unsure of type of defibrillator – use 200J
  • after each defibrillation/rhythm check, 2 minutes of CPR prior to checking pulse
  • Adrenaline should be administered every second loop (~every 4 mins)
• ANZCOR recommends family members of adults, children, and infants undergoing resuscitation be given the option to be present during resuscitation – ideally with an assigned support person.

References and Links

• Australian Resuscitation Council Website: https://resus.org.au/the-arc-guidelines/

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