The fundamentals of cardiac resuscitation include the immediate provision of high-quality
cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate).
These mainstays of therapy set the groundwork for other possible interventions such
as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and
post-cardiac arrest care, including targeted temperature management, cardiorespiratory
support, and percutaneous coronary intervention. Since 2015, an increased number of
studies have been published evaluating some of these interventions, requiring a reassessment
of their use and impact on survival from cardiac arrest. This 2019 focused update
to the American Heart Association advanced cardiovascular life support guidelines
summarizes the most recent published evidence for and recommendations on the use of
advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during
cardiac arrest. It includes revised recommendations for all 3 areas, including the
choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask
ventilation, supraglottic airway, or endotracheal intubation), the training and retraining
required, the administration of standard-dose epinephrine, and the decisions involved
in the application of extracorporeal cardiopulmonary resuscitation and its potential
impact on cardiac arrest survival.