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1 resuscitation 95 (2015) 1 80 Contents lists available at ScienceDirectResuscitationjou rn al hom ep age : w resuscitation Council Guidelines for resuscitation 2015 Section 1. Executive summaryKoenraad G. Monsieursa,b, , Jerry P. Nolanc,d, Leo L. Bossaerte, Robert Greiff,g,Ian K. Maconochieh, Nikolaos I. Nikolaoui, Gavin D. Perkinsj,p, Jasmeet Soark,Anatolij Truhl rl,m, Jonathan Wyllien, David A. Zidemano,on behalf of the ERC Guidelines 2015 Writing Group1aEmergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumbFaculty of Medicine and Health Sciences, University of Ghent, Ghent, BelgiumcAnaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UKdSchool of Clinical Sciences, University of Bristol, Bristol, UKeUniversity of Antwerp, Antwerp, BelgiumfDepartment of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, SwitzerlandgUniversity of Bern, Bern, SwitzerlandhPaediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UKiCardiology Department, Konstantopouleio General Hospital, Athens, GreecejWarwick Medical School.

2 University of Warwick, Coventry, UKkAnaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UKlEmergency Medical Services of the Hradec Kr lov Region, Hradec Kr lov , Czech RepublicmDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kr lov , Hradec Kr lov , Czech RepublicnDepartment of Neonatology, The James Cook University Hospital, Middlesbrough, UKoImperial College Healthcare NHS Trust, London, UKpHeart of England NHS Foundation Trust, Birmingham, UKIntroductionThis executive summary provides the essential treatment algo-rithms for the resuscitation of children and adults and highlightsthe main guideline changes since 2010. Detailed guidance is pro-vided in each of the ten sections, which are published as individualpapers within this issue of resuscitation .

3 The sections of the ERCG uidelines 2015 are:1. Executive summary2. Adult basic life support and automated external defibrillation13. Adult advanced life support24. Cardiac arrest in special circumstances35. Post- resuscitation care46. Paediatric life support57. resuscitation and support of transition of babies at birth68. Initial management of acute coronary syndromes79. First aid810. Principles of education in resuscitation911. The ethics of resuscitation and end-of-life decisions10 Corresponding address: ( Monsieurs).1 See Appendix 1 for the ERC 2015 Guidelines Writing ERC Guidelines 2015 that follow do not define the only waythat resuscitation can be delivered; they merely represent a widelyaccepted view of how resuscitation should be undertaken bothsafely and effectively. The publication of new and revised treat-ment recommendations does not imply that current clinical care iseither unsafe or of the changes since the 2010 GuidelinesAdult basic life support and automated external defibrillation The ERC Guidelines 2015 highlight the critical importance ofthe interactions between the emergency medical dispatcher, thebystander who provides CPR and the timely deployment of anAED.

4 An effective, co-ordinated community response that drawsthese elements together is key to improving survival from out-of-hospital cardiac arrest (Fig. ). The emergency medical dispatcher plays an important role inthe early diagnosis of cardiac arrest, the provision of dispatcher-assisted CPR (also known as telephone CPR), and the location anddispatch of an AED. The bystander who is trained and able should assess the collapsedvictim rapidly to determine if the victim is unresponsive and notbreathing normally and then immediately alert the 2015 European resuscitation Council. Published by Elsevier Ireland Ltd. All rights Monsieurs et al. / resuscitation 95 (2015) 1 80 COMMUNITY RESPONSESAVES LIVES112 Fig. The interactions between the emergency medical dispatcher, the bystanderwho provides CPR and the timely use of an automated external defibrillator are thekey ingredients for improving survival from out of hospital cardiac arrest.

5 The victim who is unresponsive and not breathing normally isin cardiac arrest and requires CPR. Bystanders and emergencymedical dispatchers should be suspicious of cardiac arrest inany patient presenting with seizures and should carefully assesswhether the victim is breathing normally. CPR providers should perform chest compressions for all victimsin cardiac arrest. CPR providers trained and able to perform rescuebreaths should combine chest compressions and rescue confidence in the equivalence between chest compression-only and standard CPR is not sufficient to change current practice. High-quality CPR remains essential to improving outcomes. Theguidelines on compression depth and rate have not changed. CPRproviders should ensure chest compressions of adequate depth(at least 5 cm but no more than 6 cm) with a rate of 100 120 com-pressions min 1.

6 After each compression allow the chest to recoilcompletely and minimise interruptions in compressions. Whenproviding rescue breaths/ventilations spend approximately 1 sinflating the chest with sufficient volume to ensure the chest risesvisibly. The ratio of chest compressions to ventilations remains30:2. Do not interrupt chest compressions for more than 10 s toprovide ventilations. Defibrillation within 3 5 min of collapse can produce survivalrates as high as 50 70%. Early defibrillation can be achievedthrough CPR providers using public access and on-site AEDs. Pub-lic access AED programmes should be actively implemented inpublic places that have a high density of citizens. The adult CPR sequence can be used safely in children who areunresponsive and not breathing normally. Chest compressiondepths in children should be at least one third of the depth ofthe chest (for infants that is 4 cm, for children 5 cm).

7 A foreign body causing severe airway obstruction is a medicalemergency and requires prompt treatment with back blows and,if that fails to relieve the obstruction, abdominal thrusts. If thevictim becomes unresponsive CPR should be started immediatelywhilst help is advanced life supportThe ERC 2015 ALS Guidelines emphasise improved care andimplementation of the guidelines in order to improve patientfocused key changes since 2010 are: Continued emphasis on the use of rapid response systems for careof the deteriorating patient and prevention of in-hospital cardiacarrest. Continued emphasis on minimally interrupted high-quality chestcompressions throughout any ALS intervention: chest compres-sions are paused briefly only to enable specific interventions. Thisincludes minimising interruptions in chest compressions for lessthan 5 s to attempt defibrillation.

8 Keeping the focus on the use of self-adhesive pads for defibrilla-tion and a defibrillation strategy to minimise the preshock pause,although we recognise that defibrillator paddles are used in somesettings. There is a new section on monitoring during ALS with anincreased emphasis on the use of waveform capnography to con-firm and continually monitor tracheal tube placement, quality ofCPR and to provide an early indication of return of spontaneouscirculation (ROSC). There are a variety of approaches to airway management duringCPR and a stepwise approach based on patient factors and theskills of the rescuer is recommended. The recommendations for drug therapy during CPR have notchanged, but there is greater equipoise concerning the role ofdrugs in improving outcomes from cardiac arrest.

9 The routine use of mechanical chest compression devices isnot recommended, but they are a reasonable alternative insituations where sustained high-quality manual chest compres-sions are impractical or compromise provider safety. Peri-arrest ultrasound may have a role in identifying reversiblecauses of cardiac arrest. Extracorporeal life support techniques may have a role as a rescuetherapy in selected patients where standard ALS measures are arrest in special circumstancesSpecial causesThis section has been structured to cover the potentiallyreversible causes of cardiac arrest that must be identified orexcluded during any resuscitation . They are divided into two groupsof four 4Hs and 4Ts: hypoxia; hypo-/hyperkalaemia and otherelectrolyte disorders; hypo-/hyperthermia; hypovolaemia; tensionpneumothorax; tamponade (cardiac); thrombosis (coronary andpulmonary); toxins (poisoning).

10 Survival after an asphyxia-induced cardiac arrest is rare and sur-vivors usually have severe neurological impairment. During CPR,early effective ventilation of the lungs with supplementary oxy-gen is essential. A high degree of clinical suspicion and aggressive treatment canprevent cardiac arrest from electrolyte abnormalities. The newalgorithm provides clinical guidance to emergency treatment oflife-threatening hyperkalaemia. Hypothermic patients without signs of cardiac instability canbe rewarmed externally using minimally invasive with signs of cardiac instability should be transferreddirectly to a centre capable of extracorporeal life support (ECLS). Early recognition and immediate treatment with intramuscularadrenaline remains the mainstay of emergency treatment foranaphylaxis.