Intermediate life support for the adult

Intermediate life support (ILS) refers to a range of skills that are used to treat adult patients during cardiopulmonary arrest until experienced assistance arrives (Resuscitation Council UK, 2016). Although these skills are predominantly used in the acute hospital environment, they may also be used in other clinical settings, depending on the availability of equipment such as defibrillators. ILS includes effective basic life support (BLS), which was discussed in a previous article (Barker, 2019). This article will focus on the ILS skills of early recognition of deterioration, airway management and defibrillation.

Up to 80% of patients suffering cardiac arrest display evidence of deterioration in the hours before arrest; once a cardiac arrest occurs, even in the hospital environment, fewer than 20% of patients will survive until discharge (Resuscitation Council UK, 2016). Early recognition of deterioration and a call for help therefore form the first link of the Chain of Survival (Nolan et al, 2006). The Resuscitation Council UK (2016) advocates the use of a scoring system to aid the responder in identifying the deteriorating patient. The currently used system in the UK is the National Early Warning Score 2 (NEWS2) instituted by the Royal College of Physicians (2017). This provides a score based on 5 numeric observations but, in addition to the previous version, includes the patient's level of consciousness using the ACVPU scale (alert, confused, voice, pain, unresponsive) (Table 1). NEWS2 and other early warning systems (EWS), also empower the patient's assessor to seek appropriate senior support when deterioration is identified. A study by Spearpoint et al (2009) found no significant change in the number of emergency alert calls made by hospital staff following inclusion of such a system of recognition in ILS training. However, this study recognised that the proportion of pre-arrest calls increased from 15% to 45%; a reduction in the numbers of in-hospital cardiac arrests was observed, as was a reduction in the number of unsuccessful resuscitation attempts.