The 2005 European Guidelines for cardiopulmonary resuscitation: major changes and rationale

During the 2005 International Consensus Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science, a rigorous evidence-based evaluation process was conducted. The consensus reached during that Conference constituted the basis of the current CPR guidelines of the European Resuscitation Council (ERC), published in December 2005. Those guidelines included many important changes, made on the basis of emerging evidence. For example, the compression-ventilation ratio for CPR in non-intubated patients was increased from 15:2 to 30:2 and a strong recommendation to minimize interruptions in chest compression was issued in order to maximise organ perfusion. Energy levels for monophasic defibrillation were increased and specific energy levels for biphasic defibrillation have been recommended, in order to maximise the efficacy of the first shock. New timing of defibrillation shocks is now advised: the three-stacked shock sequence has been replaced by high-energy single shocks followed by two-minute cycles of CPR, in order to reduce CPR interruptions. Timing for administration of drugs has been adapted to the new shock sequence and the advanced life support (ALS) universal algorithm has been modified. Some controversial topics are still a matter of investigation and debate, including the use of therapeutic hypothermia in non-shockable cardiac arrests, the efficacy of a period of CPR before defibrillation in long-lasting cardiac arrests, and the chest-compression-only CPR for first responders of out-of-hospital cardiac arrests.