2015 AHA ACLS Guideline Updates

• C – A – B = Compressions, Airway, Breathing.
• Do NOT delay first 30 chest compressions. Chest compressions must be deep (2-2.4 inches) and fast (100-120 per minute) with complete recoil (do not lean on chest).
• Minimize CPR interruptions with a goal chest compression fraction as high as possible, aiming for at least 60%.
• Vasopressin removed from the ACLS 2015 update. 
• Advanced Airway Updates: deliver 1 breath every 6 seconds (10/minute) when using an advanced airway during CPR efforts.
• Administer epinephrine as soon as possible for non-shockable rhythm.
• Return of spontaneous circulation (ROSC):
  • Consider cooling to between 32 to 36 degrees for >24 hours.
  • Consider correcting hypotension of SBP <90 or MAP <65.
• Extracorporeal CPR with extracorporeal oxygenation and circulation may be considered for reversible cardiac arrest.
• Failure to achieve ETCO2 >10 mmHg by waveform capnography after 20 minutes of CPR may suggest poor chance of ROSC or survival.

COVID-19

• Reduce Provider Exposure. Adequate PPE is priority.
  • Limit personnel in the room and make sure you are properly gowned.
• Start CPR. 
  • Give oxygen to limit aerosolization.
  • Connect monitors as with standard practice.
• Early Intubation
  • Intubate patients early with a cuffed tube. 
  • Minimize closed-circuit disconnection.
  • Choose an intubator with the highest likelihood of first pass success. 
  • Consider video laryngoscopy. 
  • Connect to ventilator with filter (i.e. HEPA filter) when possible.
  • If intubation is delayed, consider a supraglottic airway. 
• Consider the appropriateness and timing of resuscitation. These patients are very ill from the underlying lung disease, or associated complications, without a reversible etiology. In clinical practice, these resuscitation efforts may be shorter than non-COVID efforts.