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Bernard - Refractory Cardiac Arrest

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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.

Published in: Health & Medicine

Bernard - Refractory Cardiac Arrest

  1. 1. Refractory Cardiac Arrest Stephen Bernard MD FACEM FCICM FCCM ASM
  2. 2. 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
  3. 3. 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
  4. 4. Refractory Arrest – No ambulance transport due to: • Risk of unrestrained CPR • “Futility”
  5. 5. 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
  6. 6. 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
  7. 7. 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.
  8. 8. What about me?  What about me? 
  9. 9. 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
  10. 10. Refractory Arrest: “CHEER2” Clinical Practice Guideline Commenced 8/10/15 29 LUCAS2™ CPR machines for transport to metro ED for ECMO or Cath lab
  11. 11. 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
  12. 12. The RINSE trial:
  13. 13. The RINSE trial:
  14. 14. The RINSE trial:
  15. 15. Thank you! s.bernard@Alfred.org.au @AmbVicMedic

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