Energy levels in biphasic waveform defibrillator is becoming more definite in the very near future – it seems that higher energy (200J- 300J - 360J) is associated with better outcome if more than one shock required
New evidence has shown that for certain cases of cardiac arrest patients who collapsed in the out of hospital setting, paramedics can terminate the resuscitation effort (even at BLS level only) because the survival rate is very very low.
www.999.gov.my 991 – Civil Defense Dept; 994 – Fire and Rescue By January 2008, all calls to 991 and 994 will be re-routed back to the 999 emergency call center
Prank Calls In 2006, 98.9% of all emergency calls received turned out to be prank calls Section 233, Communications and Multimedia Act 1998 - the penalty for misuse RM50 000 fine, and/or one year's jail The STAR, 25 th October 2007
“ This finding (SOS-KANTO’s) is an important piece of evidence that should lead to a prompt interim revision of the guidelines for out-of-hospital cardiac arrest. Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival.”
“ We should, for now, to follow the newer guidelines [guidelines 2005] of assisted ventilations and chest compression [meaning ratio 30:2 ] for respiratory arrest (such as in drowning and drug overdose), but the guidelines should promptly be changed to chest-compression alone for witnessed unexpected sudden collapse…”
(Ewy 2007, in an editorial comment in Lancet)
Ultimately our aim is to get more public member to perform bystander CPR!!! Not just knowing.. but willing
“ The optimal energy for first-shock biphasic waveform defibrillation … has not been determined”
“ Multiple .. studies have failed to identify an optimal biphasic energy level for first or subsequent shocks. Therefore, it is not possible to make a definitive recommendations for the selected energy for first or subsequent biphasic defibrillation attempts.”
Introduction: BIPHASIC Trial (Stiell et al. 2007)
“ In an editorial published more than 20 years ago, Cummins and Eisenberg suggested that prediction rules for the termination of resuscitation efforts should remain advisory and that they should be tempered by the clinical picture, taking into account the very small possibility of successful resuscitation when the prediction rules suggest termination”
(Morrison et al. 2006)
Can Our Paramedics Be Reliably Depended Upon To Terminate Resuscitation and sending the patient to mortuary? … or even to start resuscitation?
What Would The Future Be In The Area Of Pre-hospital Resuscitation ? Within the Malaysian context?
Looking At Things From Different Angles Improving ambulance response time Upgrading paramedics status Educating the public regarding CPR through campaign in mass media Purchasing new equipments – airway gadgets, CPR devices, etc Organize more BLS course A single universal access number Simplify the technique of effective CPR Placing more AEDs in public
Cummins RO, Ornato JP, Thies WH et al. Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991; 83 (5):1832-47.
Stiell IG, Walker RG, Nesbitt LP et al. BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 2007; 115 (12):1511-7.
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112 (24 Suppl):IV1-203.