What's on the web for family physicians – Cardiopulmonary resuscitation and Advanced Primary Care Life Support

Alfred KY Tang 鄧權恩，Peter KY Lee 李家潤

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines external chest compressions, often with artificial ventilation, to manually maintain blood-flow up into the brain and maintain intact brain function, until further measures are taken to restore spontaneous blood circulation and breathing, in a person who is in cardiac arrest. It is indicated in those who are unresponsive, with no breathing or abnormal breathing, for example, agonal respirations.

Most doctors at some point in their professional life have undergone training for, or involved with CPR. It would be ideal if all doctors maintain their knowledge and skills with CPR. This can now be achieved by information on Internet and participating in training courses designed for doctors.

There are robust organisations in different parts of the world setting standards, conducting research, and providing training for CPR. The more active ones include:

International Liaison Committee on Resuscitation (ILCOR)
http://www.ilcor.org/home/

ILCOR was formed in 1992 to provide a liaison forum amongst principal resuscitation organisations worldwide and a common platform was created for discussion and coordination of all aspects of cardiopulmonary and cerebral resuscitation. It is involved in scientific research in areas of resuscitation, dissemination of resuscitation guidelines for training and education, and statements on specific issues related to resuscitation reflecting international consensus.

At present, ILCOR comprises representatives of American Heart Association (AHA), European Resuscitation Council (ERC), Heart and Stroke Foundation of Canada (HSFC), Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Councils of Southern Africa (RCSA), Inter American Heart Foundation (IAHF), and Resuscitation Council of Asia (RCA).

Available at the ILCOR website are documents of Consensus 2015 and its publications. There are also links to other associations that provide educational information regarding CPR and resuscitation.

American Heart Association
http://cpr.heart.org/AHAECC/CPRAndECC/UCM_473161_CPR-and-ECC.jsp

The website of the AHA CPR and Emergency Cardiac Care (ECC) harbors the 2015 AHA Guidelines for CPR and Emergency cardiovascular care, which is published as a web-based integrated guidelines at https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/. At the same time, one can find information on International AHA CPR courses, online courses of OnlineAHA.org or eLearning.heart.org. Learning materials including an eLearning site, course cards and eBooks are also available at the website.

European Resuscitation Council (ERC)
https://www.erc.edu/

The ERC was founded in 1989 and has provided the standard for resuscitation guidelines and training in Europe and beyond. It comprises of 33 National Resuscitation Councils. CPR guidelines published by ERC can be found at https://cprguidelines.eu/. One can choose to download only the ‘Summary of Changes’, which is a small book with the most important changes and algorithms. The CoSTR 2015, which summaries scientific evidence supporting all aspects of resuscitation.

Australian Resuscitation Council (ARC)
https://resus.org.au/

The ARC is a voluntary coordinating body which represents all major groups involved in the teaching and practice of resuscitation in Australasia. The ARC is sponsored by the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists. The ARC produces guidelines to meet its objectives in fostering uniformity and simplicity in resuscitation techniques and terminology. Guidelines published by the ARC can be found at https://resus.org.au/guidelines/

Resuscitation Council of Hong Kong (RCHK)
http://www.rchk.org.hk/about_us.aspx

The RCHK was established in May 2012, providing a ‘local Hong Kong’ aspect to providing guidelines and a standard for resuscitation. RCHK is also a member affiliated with the RCA, while RCA is a member of the ILCOR.

RCHK has 14 founding associations or colleges. It members covers the major providers of resuscitation knowledge and providers of resuscitation training in Hong Kong. Currently, RCHK is in the process of developing standards for CPR and matters related to resuscitation in Hong Kong.

Changes in Resuscitation Requirements
http://www.gptq.qld.edu.au/Training-Programs/Current-AGPT-Registrar/Advanced-LifeSupport-Emergency-Course-Requirement.aspx

The Royal Australian College of General Practitioners (RACGP) now requires all its Registrars that have joined the Training program after January 2012 to meet the RACGP 2005 standards for ALS training.

RACGP’s definition of Advanced Life Support (ALS) and early management of trauma is outlined in this document
https://www.racgp.org.au/education/fellowship/fellowship-of-the-racgp/policies/guidance-documents/cardiopulmonary-resuscitation-and-advanced-lifesupport-guidance-document/

The website outlines the components that a training standard for ALS should include:

Basic CPR:

• Assessment of DR CAB(D)
• Mouth to mouth /mouth to mask ventilation
• External chest compressions

Advanced CPR:

• Management of airway using bag-valve mask
• Inserted airways; examples given include Oropharyngeal/nasopharyngeal airway
• Knowledge of use of suction/ MacGill’s forceps to clear airway if available
• Defibrillation

Advanced management of trauma:

• Identification of potential neck injury in a victim
• Stabilisation of the neck with a stiff collar

The Hong Kong College of Family Physicians (HKCFP): Advanced Primary Care Life Support (APCLS)
http://www.hkcfp.org.hk/upload/FP_Links/FPLinks_201603.pdf

An announcement of APCLS can be found on page 9 of the Family Physician Link March 2016 issue. APCLS is the HKCFP’s course that meets the requirements laid down by RACGP. This course is now a requirement for all HKCFP Family Medicine (FM) trainees and Fellows sitting for the Conjoint or Exit examinations of the College as from 2017. Fellows requiring reciprocal recognition with RACGP should also acquire this certification during their current CME Triennium.

The Board of Education, CPR Subcommittee has upgraded the previous Basic Life Support (BLS) course taught to meet the requirements found in the RACGP’s definition of Advanced Life Support (ALS), effective starting 2017. HKCFP have already upgraded around 30 HKCFP BLS instructors to APCLS certified, through 2 instructor training courses in 2016, in collaboration with RCHK, to provide adequate trainers for the APCLS course in 2017 onwards.

The College’s course includes important elements of basic CPR from the latest 2015 guidelines from AHA, together with an airways and neck injury component . CPR now includes early use of an Automated External Defibrillator (AED) while performing CPR. The use of airways adjuncts, as well as assessment and application of an external cervical collar for initial stabilisation of cervical spine injury, making up the 3 components of the new course.

The APCLS course content has been endorsed by both HKCFP and RCHK. Passing the course will imply candidates meeting with the necessary requirements to meet the RACGP’s standard of ALS training.

APCLS will be promulgated to all College members, and priority will be given to candidates who apply to sit for Conjoint HKCFP/RACGP Fellowship Examination and those members who require reciprocal recognition of Quality Assurance Certificate with RACGP.

With increasing momentum and the support of RCHK, it is hoped that the course will be promoted to all Community doctors or health professionals outside of the College.