October 20, 2020 Circulation. 2020;142(suppl 2):S366–S468. DOI: 10.1161/CIR.0000000000000916 S366 Key Words: AHA Scientifc Statements ◼ apnea ◼ cardiopulmonary resuscitation ◼ defbrillators ◼ delivery of health care ◼ electric countershock ◼ heart arrest ◼ life support care Ashish R. Panchal, MD, PhD, Chair Jason A. Bartos, MD, PhD José G. Cabañas, MD, MPH Michael W. Donnino, MD Ian R. Drennan, ACP, PhD(C) Karen G. Hirsch, MD Peter J. Kudenchuk, MD Michael C. Kurz, MD, MS Eric J. Lavonas, MD, MS Peter T. Morley, MBBS Brian J. O’Neil, MD Mary Ann Peberdy, MD Jon C. Rittenberger, MD, MS Amber J. Rodriguez, PhD Kelly N. Sawyer, MD, MS Katherine M. Berg, MD, Vice Chair On behalf of the Adult Basic and Advanced Life Support Writing Group © 2020 American Heart Association, Inc. Part 3: Adult Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation https://www.ahajournals.org/journal/circ TOP 10 TAKE-HOME MESSAGES FOR ADULT CARDIOVASCULAR LIFE SUPPORT 1. On recognition of a cardiac arrest event, a layperson should simultaneously and promptly activate the emergency response system and initiate cardiopul- monary resuscitation (CPR). 2. Performance of high-quality CPR includes adequate compression depth and rate while minimizing pauses in compressions, 3. Early defbrillation with concurrent high-quality CPR is critical to survival when sudden cardiac arrest is caused by ventricular fbrillation or pulseless ventricular tachycardia. 4. Administration of epinephrine with concurrent high-quality CPR improves survival, particularly in patients with nonshockable rhythms. 5. Recognition that all cardiac arrest events are not identical is critical for opti- mal patient outcome, and specialized management is necessary for many conditions (eg, electrolyte abnormalities, pregnancy, after cardiac surgery). 6. The opioid epidemic has resulted in an increase in opioid-associated out-of- hospital cardiac arrest, with the mainstay of care remaining the activation of the emergency response systems and performance of high-quality CPR. 7. Post–cardiac arrest care is a critical component of the Chain of Survival and demands a comprehensive, structured, multidisciplinary system that requires consistent implementation for optimal patient outcomes. 8. Prompt initiation of targeted temperature management is necessary for all patients who do not follow commands after return of spontaneous circula- tion to ensure optimal functional and neurological outcome. 9. Accurate neurological prognostication in brain-injured cardiac arrest survivors is critically important to ensure that patients with signifcant potential for recovery are not destined for certain poor outcomes due to care withdrawal. 10. Recovery expectations and survivorship plans that address treatment, surveil- lance, and rehabilitation need to be provided to cardiac arrest survivors and their caregivers at hospital discharge to optimize transitions of care to home and to the outpatient setting. PREAMBLE In 2015, approximately 350 000 adults in the United States experienced non- traumatic out-of-hospital cardiac arrest (OHCA) attended by emergency medical services (EMS) personnel. 1 Approximately 10.4% of patients with OHCA survive their initial hospitalization, and 8.2% survive with good functional status. The key drivers of successful resuscitation from OHCA are lay rescuer cardiopulmonary Downloaded from http://ahajournals.org by on September 5, 2021