Q. Why is there an increase to 30 minutes of ALS in cardiac arrest (from 20 minutes) for general adult cardiac arrest (no special circumstances)?
A. The updated JRCALC guideline on adult resuscitation has several areas of focus:
1. Better guidance on decision-making around starting ALS.
2. Better guidance on decisions related to stopping resuscitation
3. Re-iteration of the conditions where ALS should be continued for prolonged periods (special circumstances).
4. Guidance related to the period of ALS for general cardiac arrest situations.
The guideline has extended the period of ALS from 20 minutes (in the previous guidelines) to 30 minutes because there is evidence of additional survivors with good neurological outcomes in this group.
We are aware that there are numerous possibilities in terms of changes in the rhythms seen during a cardiac arrest and that clinical professional judgement remains the main factor in decision-making related to all aspects of cardiac arrest management, including the appropriate period of attempted resuscitation.
The key message is that if resuscitation is attempted, a minimum period of 30 minutes is likely to optimise chances of neurologically intact survival, irrespective of the initial rhythms.