2022 Resus Updates

High-quality CPR with minimal interruptions still drives cardiac arrest outcomes, and the 2022 resuscitation consensus updates several long-debated practices. Post-arrest care now centers on normothermia rather than routine cooling, and prehospital strategy increasingly favors staying on scene over transporting during active CPR.

2022 Cardiac Arrest Updates

• On-scene resuscitation priority: CPR during transport is consistently worse than CPR on scene, so EMS should generally favor a stay-and-play approach for roughly 15 to 20 minutes before moving the patient.
• Normothermia after ROSC: Targeted temperature management has shifted away from routine cooling; fever prevention and maintaining about 37.5°C now anchor post-arrest neurologic care, a practice change we unpack in the episode.
• POCUS without pauses: Point-of-care ultrasound can help identify reversible causes of arrest, but only in experienced hands and only if it does not interrupt chest compressions.
• Access route equivalence: Intraosseous access is considered equivalent to IV access for adults and children during resuscitation, making early vascular access more practical when peripheral IVs are delayed.
• Medication recommendation changes: Epinephrine remains recommended in cardiac arrest, while routine vasopressin, corticosteroids, and bicarbonate are not supported for standard arrest care.
• Cath lab selection: Post-arrest coronary angiography is clearly recommended for STEMI, while non-ST-elevation arrest sits in a more selective early-versus-delayed zone. We get into that decision tension in the chapter.

Pediatric and Neonatal Resuscitation Pearls

• AED use in children: Defibrillation is recommended for cardiac arrest in children older than 1 year, reinforcing that shockable rhythms are not just an adult problem.
• Pediatric deterioration monitoring: Pediatric Early Warning Scores give hospitals a structured way to detect in-hospital decompensation before arrest, especially when subtle changes precede sudden decline.
• Refractory pediatric bradycardia: Epinephrine is recommended when pediatric bradycardia persists despite respiratory support, with atropine and pacing also entering the discussion for selected conduction problems.
• Extracorporeal CPR consideration: ECPR is a consideration for refractory pediatric cardiac arrest in the right setting, though the operational thresholds and candidate selection are where the real nuance lives. We walk through that in the podcast.
• Neonatal normothermia focus: Neonatal resuscitation also emphasizes maintaining normothermia rather than routine cooling, reflecting the broader move away from hypothermia as default post-arrest care.
• Amniotic fluid suctioning: Routine suctioning for clear amniotic fluid is not needed in neonates, a small but important reminder that less intervention is often better.

References:

1. Wyckoff MH, et al. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022;146(25):e483-e557. PMID: 36325905