Professor Stephen Bernard is an Intensive Care Physician at The Alfred Hospital and Medical Advisor to Ambulance Victoria. His research interests include the use of therapeutic hypothermia for the treatment of neurological injury after resuscitation from out-of hospital cardiac arrest. Here he provides a presentation on recent advances in the management of refractory cardiac arrest in the out of hospital setting.

1. Refractory Cardiac Arrest
Stephen Bernard
MD FACEM FCICM FCCM ASM

8. The Victorian setting: Refractory Arrest
– 12 month period (2012)
– Age < 65 years
– VF as initial cardiac rhythm
• 222 patients
• 149 (67%) ROSC
• (Survival of these = 55%)
• 68 no ROSC
• 5/68 transported with CPR (Autopulse)
• 63 declared deceased at scene

9. The Victorian setting: Refractory Arrest
– 12 month period (2012)
– Age < 65 years
– VF as initial cardiac rhythm
• 222 patients
• 149 (67%) ROSC
• (Survival of these = 55%)
• 68 no ROSC
• 5/68 transported with CPR (Autopulse)
• 63 declared deceased at scene

10. Refractory Arrest
– No ambulance transport
due to:
• Risk of unrestrained
CPR
• “Futility”

11. The CHEER Trial
– Pilot observational trial
– Refractory cardiac arrest
– No ROSC at 30 minutes
• CPR mechanical to The Alfred ED
• Hypothermia with IV cold saline
• ECMO
• Emergency
• Reperfusion

12. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR,
hypothermia, ECMO and early reperfusion (the CHEER Trial) Resuscitation 2015; 86:88-94

14. HERALD SUN 2/9/16 THE MAN DOCTORS BROUGHT
BACK TO LIFE AFTER BEING DEAD FOR 73 MINUTES
A MELBOURNE man has been brought back to life after spending a
staggering 73 minutes clinically dead. Robert Kinderman has praised his
survival as a miracle, while his stunned doctors at The Alfred hospital say
his remarkable case redefines what is possible for cardiac arrest patients
around the world.

16. What
about
me? 
What
about
me? 

17. Non-ECPR treatments for refractory cardiac arrest
Mechanical CPR to cardiac catheterisation laboratory?
New anti-arrhythmics? Wagner H, et al. Cardiac arrest in
the catheterisation laboratory: a
5-year experience of using
mechanical chest compressions
to facilitate PCI during prolonged
resuscitation efforts.
Resuscitation 2010; 81:383-7 3.
Driver BE, et al. Use of esmolol
after failure of standard
cardiopulmonary resuscitation to
treat patients with refractory
ventricular fibrillation.
Resuscitation 2014; 85:1337-41

19. Refractory Arrest:
“CHEER2” Clinical Practice
Guideline
Commenced 8/10/15
29 LUCAS2™ CPR
machines for transport to
metro ED for ECMO or
Cath lab

22. Refractory Arrest in Rural:
Autopulse™ in rural Victoria
for “extra pair of hands”
14 Units available
Issues about fitting in car
?Transport to ED
?Transport by HEMS

23. The RINSE trial:

24. The RINSE trial:

25. The RINSE trial:

26. Thank you!
s.bernard@Alfred.org.au
@AmbVicMedic