The English manual for adult intensive care was revised by the European Intensive Care Council in 1997 and the revised version was approved in 1998.

In 1999-2000 in Dallas, the American Association of Cardiology, with the participation of international scientific societies, held three conferences to assess recommendations for intensive care based on evidence from evidence-based medicine. The new guide, released after the adoption of an international consensus, was compiled taking into account the evidence and kept the simplicity of previous editions.

Experts from the American Cardiology Association, the European Critical Care Council, the Canadian Heart and Stroke Foundation, the Australian Critical Care Council, the South African, Latin American and Japanese Critical Care Councils attended the Dallas conferences. All existing resuscitation methods were considered taking into account the quality of the evidence in favor of each method. The European Intensive Care Council adopted most of the recommendations of the international consensus, the revised final version of which was published in the form of three documents. The English Intensive Care Council has adopted the revised manual and is recommended as instruction for teaching intensive care and resuscitation courses.

According to the recommendations of the new manual, in order to confirm the fact of a cardiac arrest, it is not necessary for people without medical training to determine the presence of a pulse on the carotid artery. According to several studies, the determination of the pulse on the carotid artery by non-professionals takes time and is often unreliable: the error in determination of the pulse by non-professionals is 50%. The changes to the guidelines are an example of the use of evidence in critical care. Health workers should determine if there is a pulse on the carotid artery to confirm cardiac arrest. The ratio of chest compressions to artificial respiration according to the revised guidelines is 15: 2, regardless of whether one or two people perform cardiopulmonary resuscitation. This ratio provides more chest compressions compared to a 5: 1 ratio. The number of compressions for indirect heart massage has remained the same, 100 in 1 minute.

After tracheal intubation, indirect cardiac massage should be continued at a frequency of 100 per 1 minute (unless otherwise indicated by defibrillation or pulse). Artificial respiration should be performed at a frequency of 12 in 1 minute. A break with indirect heart massage causes a significant drop in pressure in the coronary vessels. With the resumption of massage, the restoration of the initial value of the pressure in the coronary vessels occurs with a delay. Therefore, continuous cardiac massage without pause for artificial respiration helps to maintain an initial pressure in the vessels of the heart at a high number. In addition, only conducting an indirect cardiac massage without artificial ventilation during cardiopulmonary resuscitation can be used as an option during a consultation by telephone. The data indicate that most rescuers without medical training rarely have mouth-to-mouth resuscitation, which leads to the failure to implement basic resuscitation measures.

The new manual offers the possibility of using a two-phase electric shock discharge. During defibrillation, repeated two-phase electroshock discharges with a force of less than 200 J are also or more effective than single-phase discharges of increasing resistance (200 J, 200 J, 360 J).

The changes also affected recommendations for the conduct of drug therapy during intensive care measures. Bolus administration of 300 mg of amiodarone is indicated for ventricular fibrillation or if the pulse-free ventricular tachycardia does not stop after three discharges (200 D, 200 D, 360 D). Atropine at a dose of 3 mg is indicated for electrical activity (electromechanical dissociation) with absence of pulse and ventricular rhythm less than 60 in 1 minute and with asystole.

According to international recommendations, 40 units of vasopressin can replace adrenaline in case of ventricular fibrillation or ventricular tachycardia without pulse remaining after three categories of electric shock. The European Council for Critical Care and the English Council for Critical Care recommend evidence of 1 mg of adrenaline every 3 minutes during CPR before obtaining evidence. According to a recent study on cardiac arrest in hospitals, the use of vasopressin has no advantage over adrenaline for patient survival. The use of “high” doses of adrenaline (5 mg) and bretilium is not recommended.

The universal and affordable algorithm for resuscitation measures has remained unchanged. Resuscitation algorithms for cardiac arrest have been revised by the European Intensive Care Council and action algorithms for atrial fibrillation have been added. Due to insufficient data on the use of isoprenaline, low doses of adrenaline are recommended as an alternative treatment for symptomatic bradycardia resistant to atropine. Amiodarone is the drug of choice for the treatment of tachycardia with enlargement of the complexes, lidocaine remains an alternative drug. For the management of patients with tachycardia without enlargement of the complexes, a synchronized discharge is recommended if the heart rate exceeds 250 beats / minute and the patient has no pulse.

The management of patients with atrial fibrillation remained difficult. Several classes of high, medium and low risk patients have been identified. The choice of resuscitation measures depends on the duration of atrial fibrillation. Thus, when compiling new recommendations, the evidence was more taken into account. The purpose of the review of previous publications is to increase their effectiveness in improving results in patients who have suffered cardiac arrest.