The novel ACR approach to OHCA management deviates from traditional ACLS, which has been considered "standard of care" for decades, but the fundamentals are the same. This approach requires careful implementation, rigorous initial and ongoing training, and continuous quality review. The individual components in the bundle of care are supported in the literature, but a large randomized controlled trial evaluating the bundle "as a whole" has not been completed. Any agency or organization interested in changing how they manage OHCA must do so under the supervision of their physician medical director. A robust list of relevant studies can be found in the references section.
Recently, an Urban Fire Forum Position Statement pertaining to elevation of the head during cardiac arrest was published. This prompted a strong response from the National Association of EMS Physicians. While I can appreciate the passion and excitement of the Urban Fire Chiefs, I must agree these practices should not be considered "standard of care" ... yet. Even though the standard of care has resulted in very low survival rates for the past 40 years, we must proceed with caution when implementing any new science or technology. While some ACR agencies are seeing drastic improvements in ROSC and OHCA survival with favorable neurological outcomes, all EMS agencies may not be ready for this change. To realize these results, a strong effort is required from an entire community, which is why ACR promotes community engagement, T-CPR, investments in bystander CPR training, modifying on-scene medical care based on the latest evidence, and rigorous CQI programs. This type of change can take years to fully implement, but if it can result in even one more life saved, I believe it's worth our time...
Dustin Holland, MD, MPH, FACEP
