Preporuke 2021 - Novine u protokolu naprednih mera podrške životu
Sažetak
Preporuke za naprednu životnu podršku iz 2021. godine, koje je doneo Evropski resuscitacioni savet, u najvećoj meri se ne razlikuju značajno od ekvivalentnih smernica objavljenih šest godina ranije. Međutim, neke važne tačke su još više naglašene, a neki protokoli su dobili nove dodatke i pretrpeli izvesne strukturne promene.
Prema novim smernicama, još se više ističe činjenica da pacijenti sa srčanim zastojem u bolničkim i vanbolničkim uslovima mogu imati rane simptome i znake i da se mnogi od ovih zastoja srca mogu sprečiti blagovremenim tretmanom postojećih patoloških promena. Kompresije grudnog koša visokog kvaliteta sa minimalnim prekidima, rana primena defibrilacije i lečenje reverzibilnih uzroka ostali su visoko prioritetni koraci u procesu reanimacije. Nove smernice takođe preporučuju da, ako je potrebno primeniti napredne tehnike održavanja prohodnosti disajnih puteva, iste sprovode osobe sa visokom stopom uspešnosti endotrahealne intubacije.
Što se tiče korišćenja dijagnostičkih postupaka, lekova i posebnih metoda kardiopulmonalne reanimacije, najnovije smernice su takođe dale nove predloge. Prema ovim smernicama, kada se koristi adrenalin, treba ga primeniti što je pre moguće kada inicijalni ritam nakon zastoja srca nije šokabilan, a nakon tri pokušaja defibrilacije u slučaju šokabilnog ritma. Smernice prepoznaju sve veću ulogu tzv. point-of-care ehosonografije tokom perioda sprovođenja reanimacionih procedura u cilju postavljanja dijagnoze uzroka zastoja, ali naglašavaju da je za primenu ove metode potreban kvalifikovan operater, kao i potrebu da se minimalizuju prekidi tokom primena kompresija grudnog koša. Pored toga, preporuke iz 2015. godine sugerisale su upotrebu ove ehosonografske metode u dijagnozi nekoliko različitih stanja, potencijalnih uzroka srčanog zastoja. Međutim, preporuke iz 2021. godine ograničavaju indikacije primene ove metode u dijagnozi samo kardiogenih uzroka, poput tamponade srca ili pneumotoraksa.
Preporuke takođe odražavaju sve veće dokaze o vantelesnoj kardiopulmonalnoj reanimaciji kao spasonosnom tretmanu za pacijente sa srčanim zastojem kada konvencionalne metode napredne životne podrške ne daju zadovoljavajuće rezultate ili u cilju olakšavanja izvođenja određenih intervencija.
Pored toga, najnovije preporuke su napravile značajne promene u redosledu koraka koji se koriste u algoritmu za primenu reanimacionih postupaka u bolničkim uslovima, kao i promene u nekoliko vrlo važnih koraka lečenja tahikardije i tahiaritmija.
Reference
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