I can't recall if the list has been updated on the new resus guidelines. If
so, apologies for the repeat. If not, these are the definitive changes which
are in the new ALS manual (available to all ALS Instructors free of charge on
application to RC(UK))

The updates have been the result of a series of meetings in Dallas where
international experts came together and appraised the current evidence base.
if its any consolation, we in Europe had very few changes to our guidelines as
compared with the Americans who hadn't updated their guidelines since 1992 and
were hence still operating on separate algorithms for VF, asystole and PEA.

Basic Life Support
- No pulse checks required for lay persons
- The ratio of compressions to ventilations is now 15:2 irrespective of the
number of rescuers
- New algorithm for Health Professionals including AED

Advanced Life Support

Drugs
- Amiodarone 300mg IV to be considered in cardiac arrest due to pulselss VT or
VF after the third shock.
- No "high dose" epinephrine any more
- No bretyllium any more
- Atropine 3mg for PEA < 60 bpm
- Amiodarone preferable to lidocaine for peri-arrest tachyarrhythmias

Algorithm
- Amiodarone is now include in the universal cardiac arrest algorithm as a
consideration (see above)
- there is a new peri-arrest algorithm for atrial fibrillation
- narrow complex tachcardia with no pulse with no palpable pulse should now be
cardioverted (previously recoomended that it was treated as PEA with
epinephrine for some bizarre reason!)

Ventilations
- Once intubated, chest compressions should continue uninterrupted at 100 per
min. Ventilations should be given at 12 breaths per minute at the same time
without stopping compressions (NB only when patient intubated with protected
airway). Practically, i have found this much easier in A&E as once i have
checked the tube position, i attach the patients to the ventilator and hence
do not need a person to ventilate thus freeing them up to do something else!

Changes to ALS Manual
There are two new chapters - 'Acute Coronary Syndromes' and 'Audit & Outcome'.
The manual is less bulky, spiral bound and will also be available on CD-ROM in
the neart future.

Changes to the ALS Course
MINIMAL! With the new guidelines and manual, it was decided to limit the
changes to the course programme. The only changes are as follows:
- Risks lecture is now omitted and the important bits included in BLS lecture
- Causes and Prevention lecture will be extended slightly to include Acute
Coronary Syndromes (i.e. we now actually mention MI in Causes of Cardiac
Arrest!!!!)
- There are now compulsory standardised testing scenarios which have been
successfully piloted. For those of you who are instructors and are coming to
the Instructor day in Edinburgh in March, i will be talking about these.
- Slides have been updated and will be available on CD-ROM as PowerPoint
presentations.


In essence, the changes to the guidelines are minimal and are evidence based
(albeit some of the evidence is tentative and based upon small case series).
We are going to be looking at the ALS Course and the 1 Day (ILS) course over
the next 18 months. There have been several valid suggestions such as omitting
the BLS lecture. It has been decided that we are not going to be rushing in to
making any more major changes to the course imminently as people need to get
used to the new manual and guidelines first.

Andy

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