Resuscitation Council (UK)

Quality standards for cardiopulmonary resuscitation practice and training

Acute care - equipment and drug lists

 

1. Introduction and scope

Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly to a level of proficiency appropriate to each individual’s expected role.

As part of the quality standards for cardiopulmonary resuscitation practice and training this document provides lists of the minimum equipment and drugs required for cardiopulmonary resuscitation. These lists are categorised according to the clinical setting.

This document is referred to by the standards documents pertaining to specific clinical settings. Links to these documents are provided below:

     Acute care
     Primary care
     Primary dental care
     Mental health inpatient care
     Community hospitals care


The core standards for the provision of cardiopulmonary resuscitation across all healthcare settings are described in the document:

Introduction and overview to quality standards for cardiopulmonary practice and training

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2. General points

  1. All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest. The standard defibrillator sign should be used in order to reduce delay in locating a defibrillator in an emergency    www.resus.org.uk/defibrillators/standard-sign-for-aeds/
  2. All settings must have a means of calling for help (e.g. landline telephone [internal or external], mobile telephone with reliable signal, or alarm bell).
  3. Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended.
  4. It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help.

    a. For example, in secondary or tertiary care specific locations may need special provisions (e.g. for failed intubation, tracheostomy care, cardiac arrest in pregnancy etc).
    b. Some settings need a wide range of equipment immediately available (e.g. resuscitation room in emergency department). Suggested options include having basic equipment (and possibly drugs) available immediately (on a resuscitation trolley), and further equipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.
    c. Staff should be trained to use the available equipment according to their expected roles.
  5. Depending on the organisation, this risk assessment must be overseen by a Resuscitation Committee or a designated resuscitation lead. Expert advice should also be sought locally from those commonly involved in resuscitation (e.g. resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, prehospital care physicians).
  6. Resuscitation equipment should be single-patient-use and latex-free, whenever possible and appropriate. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed.
  7. Personal protective equipment (e.g. gloves, aprons, eye protection) and sharps boxes must be available, based on a local risk assessment and local polices.
  8. A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest. The frequency of checks should be determined locally.
  9. It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency.
  10. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.
  11. Further equipment and drugs may be needed to manage other types of emergencies that are likely to be encountered in a particular setting; this may include:
    • monitoring equipment (e.g. blood pressure, pulse oximetry, 3-lead electrocardiogram [ECG], temperature, waveform capnography)
    • 12-lead ECG recorder
    • difficult airway equipment (e.g. scalpel and bougie for cricothyroidotomy)
    • near-patient tests (e.g. blood glucose, blood gas analysis).
  12. A formal procurement process that includes trialing of equipment before purchase is recommended. Trialing of resuscitation equipment can take place in actual care settings or in simulated clinical scenarios.
  13. The precise availability of equipment and drugs should be determined locally. The equipment lists include a suggestion on the immediacy with which equipment and drugs should be available:

    a. Immediate - available for use within the first minutes of cardiorespiratory arrest (i.e. at the start of resuscitation).
    b. Accessible - available for prompt use when the need is determined by resuscitation team.
  14. These lists are not exhaustive. Local experts should be consulted to ensure that the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation.

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Acute hospital care - Adult       


Acute hospital care - ADULT

AIRWAY AND BREATHING
 Item Suggested availability Comments
Pocket mask with oxygen port  Immediate  According to local policy 
Oxygen mask with reservoir  Immediate   
Self-inflating bag with reservoir  Immediate   
Clear face masks, sizes 3, 4, 5  Immediate
 
Oropharyngeal airways, sizes 2, 3, 4  Immediate   
Nasopharyngeal airways, sizes 6, 7 (and lubrication)  Immediate    
Portable suction (battery or manual) with Yankauer sucker and soft suction catheters
Immediate    Airway suction equipment. NPSA Signal. Reference number 1309. February 2011
Supraglottic airway device with syringes, lubrication and ties/tapes/scissors as appropriate  Immediate/Accessible  Choice of device (e.g. laryngeal mask airway, i-gel®, laryngeal tube) and size will depend on local policy and staff training
Oxygen cylinder (with key where necessary)  Immediate   
Oxygen tubing  Immediate    
Magill forceps  Immediate     
Stethoscope  Immediate      
Tracheal tubes, cuffed, sizes 6, 7, 8  Immediate/Accessible   This will depend on local policy and staff training. For example, there is not consenus on the role of a ‘stylet’. 
Tracheal tube introducer (stylet)  Immediate/Accessible   This will depend on local policy and staff training. For example, there is not consenus on the role of a ‘stylet’. 
Laryngoscope handles (x 2) and blades (size 3 and 4)

Spare batteries for laryngoscope and spare bulbs (if applicable) 
Immediate/Accessible   This will depend on local policy and staff training. For example, there is not consenus on the role of a ‘stylet’. 
Syringes, lubrication and ties/tapes/scissors for tracheal tube  Immediate/Accessible  This will depend on local policy and staff training. For example, there is not consenus on the role of a ‘stylet’. 
Waveform capnograph - with appropriate tubing and connector  Immediate/Accessible   For use with supraglottic airways or tracheal tube. NAP4 - 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011. 

Standards of monitoring - addendum regarding the use of capnography outside the operating theatre. Association of Anaesthetist of Great Britain and Ireland, 2011. AAGBI Safety Statement

EBA Recommendation for the use of Capnography. European Board of Anaesthesiology, 2011. EBA_UEMS

 


 

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Acute hospital care - ADULT

CIRCULATION

Item     Suggested availability     Comments     
Defibrillator
Manual and/or automated external defibrillator
Pacing function if needed 
Immediate  Type of defibrillator, and locations determined by a local risk assessment. Available to enable shock within 3 minutes of collapse.Pacing function is recommended for cardiac units, cardiac catheter laboratories, emergency departments, intensive care units and operating theatres. It may also be appropriate for other settings, and this should be determined locally
Adhesive defibrillator pads  Immediate
Spare set of pads also recommended. Pads should be suitable for external pacing if needed.
Razor  Immediate  
ECG electrodes  Immediate   
Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol wipes, tourniquets and cannula dressings  Immediate/Accessible   
Adhesive tape  Immediate/Accessible   
Intravenous infusion set  Immediate/Accessible    
0.9% sodium chloride (1000 ml)  Immediate/Accessible   Amount depends on availability of further supplies 
Selection of needles and syringes  Immediate/Accessible   
Intra-osseous access device  Accessible   
Central venous access - Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine / alcohol)  Accessible   Placed with ultrasound guidance, where possible 
Ultrasound / echocardiography  Accessible
To identify and treat reversible causes of cardiorespiratory arrest 

 


 

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Acute hospital care - ADULT

OTHER ITEMS

Item Suggested availability Comments
Clock/timer  Accessible   
Gloves, aprons, eye protection  Immediate  Further personal protective equipment may be required according to local policy 
Nasogastric tube  Accessible    
Sharps container and clinical waste bag  Immediate 
Sharps container must be immediately available wherever sharps used 
Large scissors  Accessible    
2% chlorhexidine / alcohol wipes  Accessible    
Blood sample tubes  Accessible     
IV extension set  Accessible   
Types of connectors, ports, and caps to be determined locally 
Pressure bags for infusion  Accessible  
 
Blood gas syringe  Accessible    
Blood glucose analyser with appropriate strips  Immediate/Accessible    According to local policy 
Drug labels  Accessible  Guidance on colour coding for syringe labels 
Manual handling equipment  Accessible  According to setting. 
See Guidance for safer handling during resuscitation in healthcare settings

Cardiorespiratory arrest record forms for patient records, audit forms and DNACPR forms  Accessible   
Access to algorithms, emergency drug doses  Accessible   


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Acute hospital care - ADULT

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !

Item Suggested availability Comments
Adrenaline 1mg (= 10 ml 1:10,000) as a prefilled syringe x 3  Immediate  Number of syringes depends on access to further syringes. 1mg needed for each 4-5 min of CPR 
Amiodarone 300mg as a prefilled syringe x 1  Accessible  First dose required after 3 defibrillation attempts 


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Acute hospital care - ADULT

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !

 Item Suggested availability Comments
Adenosine 6 mg x 5  Accessible   
Atropine - 1mg x 3  Accessible   
Adrenaline 1mg (= 10 ml 1:10,000) prefilled syringe  Accessible   Further syringes should be accessible for prolonged resuscitation attempts 
Amiodarone 300mg x 1  Accessible  If decision is made to give further doses of amiodarone 
Calcium chloride 10 ml 10% x 1  Accessible
Calcium gluconate can be used as an alternative. Note: 
10 ml 10% Calcium chloride = 
6.8 mmol Ca2+
10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Chlorphenamine 10 mg x 2  Accessible  Second-line treatment for anaphylaxis, can also be given intramuscularly 
Hydrocortisone 100 mg x 2  Accessible Second-line treatment for anaphylaxis, can also be given intramuscularly  
Glucose for intravenous use  Immediate/Accessible  Volume and concentration according to local policy 
20% lipid emulsion 500 ml  Accessible  For use in areas where large doses of local anaesthetic are used for regional blocks, according to Association of Anaesthetists Guidelines. 
Lidocaine 100 mg x 1  Accessible   Inclusion to be determined locally 
Magnesium sulphate (2 g = 8 mmol) x 1  Accessible   
Midazolam 5 mg in 5 ml x 1  Accessible   NPSA Alert 
Naloxone 400 microgram x 5  Accessible     
Potassium chloride  Accessible  Formulation to be determined locally.

Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002. 
Sodium bicarbonate 8.4% or 1.26%  Accessible
Volume and concentration according to local policy 


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Acute hospital care - ADULT

OTHER DRUGS

 Item Suggested availability Comments
Adrenaline 1mg (1 ml 1:1000)  Immediate  First-line treatment for anaphylaxis - 0.5 mg intramuscular injection in adults.
 
Aspirin 300 mg and other antithrombotic agents  Accessible  For acute coronary syndrome according to local policy 
Furosemide 50 mg IV x 2  Accessible   
Flumazenil 0.5 mg IV x 2  Accessible   
Glucagon 1 mg IV x 1
Accessible    
GTN spray  Accessible   
Ipratropium bromide 500 microgram nebules x 2 (and nebuliser device)  Accessible    
Salbutamol 5mg nebules x 2 (and nebuliser device) and IV preparation for infusion  Accessible   
0.9% sodium chloride or Hartmann’s solution 1000 ml x 2 cooled to 4°C  Accessible  For induction of therapeutic hypothermia as part of post-cardiorerspiratory arrest care 


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NOTES: Acute Hospital Care - ADULT

  1. Portable monitoring and other equipment for patient transfer should be readily available.
  2. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.

Supporting information

  1. Association of Anaesthetists of Great Britain and Ireland (AAGBI) Safety Guideline - Interhospital Transfer. 2009. http://www.aagbi.org
  2. Intensive Care Society. Guidelines for the transport of the critically ill adult (3rd Edition 2011). http://www.ics.ac.uk
  3. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus https://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf


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Acute hospital care - PAEDIATRIC

AIRWAY AND BREATHING

Item Suggested availability Comments
Pocket mask with oxygen port - paediatric and adult  Immediate  According to local policy 
Oxygen mask with reservoir - paediatric and adult  Immediate    
Self-inflating bag with reservoir - paediatric and adult  Immediate    
Clear face masks, size 00, 0, 1, 2, 3, 4, 5  Immediate    
Oropharyngeal airways, sizes 00, 0, 1, 2, 3, 4  Immediate    
Nasopharyngeal airways, sizes 4.0, 4.5, 5.0, 5.5, 6.0, 7.0 (and lubrication)  Immediate   Uncuffed tracheal tubes of appropriate length may be used as an alternative according to local policy 
Portable suction (battery or manual) with Yankauer sucker (paediatric and adult) and soft suction catheters, sizes 5, 6, 8, 10, 12, 14  Immediate   
Oxygen cylinder (with key if necessary)  Immediate    
Oxygen tubing  Immediate    
Magill forceps (adult and paediatric sizes)  Immediate    
Stethoscope  Immediate    
Supraglottic airway device with syringes, lubrication and ties/tapes/scissors as appropriate  Accessible  Choice of device and size will depend on local policy and staff training 
Tracheal tubes, uncuffed sizes 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6  Accessible  Cuffed paediatric tubes according to local policy 
Tracheal tubes, cuffed sizes 6, 7, 8,  Accessible   
Croup tube (uncuffed, longer than standard tracheal tube), sizes 2, 2.5, 3, 3.5  Accessible  Alternative devices may be substituted according to local policy (e.g. Cole's® tubes) 
Tracheal tube introducer (stylet) small and medium  Accessible   
Intubating bougie - 5 Ch & 10 Ch  Accessible   
Laryngoscope handles (x 2) and blades (sizes -straight 0, 1, curved 2, 3, 4)
Spare batteries for laryngoscope and spare bulbs (if applicable) 
Accessible   
Syringes, lubrication and ties/tapes (e.g. Elastoplast® / Hypofix® /ribbon gauze/tape) and scissors  Accessible    
Waveform capnograph - with appropriate tubing and connector (battery-operated)  Accessible  NAP4 - 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011 


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Acute hospital care - PAEDIATRIC

CIRCULATION

 Item Suggested availability Comments
Defibrillator
- Manual and/or automated external defibrillator (AED) 
Immediate  Type of defibrillator and locations decided by a local risk assessment. AEDs are not intended for use in infants (less than 12 months old) and this should be considered at risk assessment.

Availability of pacing function according to local policy
Adhesive defibrillator pads - paediatric and adult sizes  Immediate  Spare set of pads also recommended. Pads should be suitable for external pacing if needed
ECG electrodes (paediatric & adult sizes)  Accessible   
Intravenous cannulae (sizes 14, 16, 18, 20, 22, 24G) and 2% chlorhexidine / alcohol wipes, tourniquets and dressings  Immediate   
Adhesive tape  Immediate   
Intravenous infusion sets (with and without incorporated burette)  Accessible   
IV extension set with 3-way taps and bungs  Accessible    
0.9% sodium chloride¹  Accessible    Amount depends on access to further fluids 
10% Dextrose¹  Accessible  
Selection of needles and syringes  Immediate   
Intra-osseous access device with needles suitable for neonates, children and adults  Immediate   
Colloid solution for IV infusion¹  Accessible  According to local policy 
Central venous access - Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine / alcohol)  Accessible   Sizes and type according to local policy. Placed with ultrasound guidance, where possible 
Ultrasound / echocardiography  Accessible   To identify and treat reversible causes of cardiorespiratory arrest 


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Acute hospital care - PAEDIATRIC

OTHER ITEMS

Item Suggested availability Comments
Clock / timer  Accessible   
Gloves, aprons, eye protection  Immediate   
Urinary catheter, sizes 6 - 14  Accessible   
Nasogastric tube, sizes 8 - 14  Accessible   
Sharps container and clinical waste bag  Immediate  Sharps container must be immediately available wherever sharps are used 
Large scissors  Accessible 
 
2% chlorhexidine / alcohol wipes  Accessible     
Blood sample tubes  Accessible     
Pressure bags for infusion   Accessible    
Blood gas syringe  Accessible     
Blood glucose monitor with appropriate strips  Immediate/Accessible   
 
Drug labels  Accessible    Guidance on syringe labels 
Manual handling equipment  Accessible     According to setting. 
See Guidance for safer handling during resuscitation in healthcare settings
Cardiorespiratory arrest record form for patient records and audit forms. DNACPR forms appropriate for children.  Accessible   
Access to algorithms, emergency drug doses, paediatric drug dose calculators (e.g. Broselow tape)  Immediate  According to local policy 


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Acute hospital care - PAEDIATRIC

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !

 Item Suggested availability Comments
Adrenaline 1mg (= 10 ml 1:10,000) prefilled syringe(s)¹  Immediate  Number of syringes depends on ease of access to further syringes if needed 
Amiodarone 300mg prefilled syringe(s)¹  Accessible   


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Acute hospital care - PAEDIATRIC

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !

 Item Suggested availability Comments
Adenosine 6 mg¹  Accessible   
Atropine 1mg¹  Accessible   ALERT: Atropine is available in various concentrations 
Adrenaline 1mg (= 10 ml 1:10,000)  Accessible   
Amiodarone 300mg¹  Accessible   
Calcium chloride 10 ml 10%¹ Accessible  Calcium gluconate may be used as an alternative. Note:
10 ml 10% Calcium chloride = 6.8 mmol Ca2+
10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Chlorphenamine 10 mg¹  Accessible  Second-line treatment for anaphylaxis, can also give intramuscular 
Diazepam and/or Lorazepam  Accessible   For treatment of status epilepticus. Agent, dose and route of administration according to local policy 
Hydrocortisone 100 mg¹  Accessible Second-line treatment for anaphylaxis, can also be given intramuscularly
Glucose¹ Accessible  Concentration according to local policy 
20% Lipid emulsion¹  Accessible   For local anaesthetic toxicity 
Lidocaine 100 mg¹  Accessible   
Magnesium sulfate (2 g = 8 mmol)¹  Accessible   
Midazolam 5 mg in 5 ml¹  Accessible 
NPSA Alert 
Morphine¹  Accessible   According to local policy 
Naloxone 400 microgram¹  Accessible    
Potassium chloride¹  Accessible   Potassium chloride concentrate solutions. Patient safety alert.  The National Patient Safety Agency. July 2002.
Sodium bicarbonate 8.4% or 1.26%¹  Accessible   Concentration and preparation according to local policy


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Acute hospital care - PAEDIATRIC

OTHER EMERGENCY DRUGS

 Item Suggested availability Comments
Adrenaline 1mg (1 ml 1:1000)¹  Immediate  First-line treatment for anaphylaxis.
Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs 
Furosemide 50 mg IV¹  Accessible  
Flumazenil 0.5 mg IV¹  Accessible   
Glucagon 1 mg IV¹  Accessible   
Ipratropium bromide 500 microgram nebules (and nebuliser device)¹  Accessible   
Salbutamol 5mg nebules (and nebuliser device)¹  Accessible  
Salbutamol 1mg/ml for IV infusion¹  Accessible   


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NOTES - Acute Hospital Care - PAEDIATRIC

  1. The volume and/or quantities of the listed fluids and drugs stored and their location should be determined by local policy. This should ensure that there is sufficient availability to manage a paediatric resuscitation according to Resuscitation Council (UK) resuscitation guidelines without undue delay.
  2. Portable monitoring and other equipment for patient transfer should be readily available.
  3. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies.
  4. All interventions (e.g. drug therapy, practical procedures, discussions with other staff or relatives) should be documented with date and time and signed by an identifiable member of staff.

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November 2013, updated May 2017

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