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New trends in cardiac arrest management

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Lecture covering the paradigm shift in SCA management

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New trends in cardiac arrest management

  1. 1. New Trends In Cardiac Arrest Management The On-Scene Approach Luke Winkelman, Paramedic EMS-I ACLS Instructor
  2. 2. Cardiac Arrest Management Look how far we’ve come! https://www.youtube.com/watch?v=zygvMRZHkOg
  3. 3. Cardiac Arrest Management CPR-The research
  4. 4. Cardiac Arrest Management CPR-The research
  5. 5. Cardiac Arrest Management CPR-The research AHA Committee on research • Physicians & scientists from all over the world • 3.4 Billion spent on collecting data and using it to improve CPR guidelines.
  6. 6. Cardiac Arrest Management • Sudden cardiac arrest (SCA) is a leading cause of death among U.S. adults. • SCA survival is directly correlated to the time a patient waits before receiving treatment. What has the research found?
  7. 7. Cardiac Arrest Management No ROSC ROSC 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 100-110 110-120 >120 Chest compression rate (min-1 ) Mean rate, ROSC group 90 ± 17 * Mean rate, no ROSC group 79 ± 18 * 210 180 150 120 90 60 30 0 Numberof30secsegments Abella et al, 2005 p=0.003
  8. 8. Cardiac Arrest Management What has the research found? • We were doing compressions only 52% of the time! • When we WERE doing compressions I. 28% of the time they were too slow! II. 40% of the compressions weren’t deep enough! •ALSO, 60% of the time we were ventilating too fast!
  9. 9. Cardiac Arrest Management Christenson et al. Circulation 2009
  10. 10. Cardiac Arrest Management 0 20 40 60 80 100 ≤10.3 (n=10) 10.5-13.9 (n=11) 14.4-30.4 (n=11) ≥33.2 (n=10) Pre-shock pause, seconds Shocksuccess,percent 90% 10% 55% 64% p=0.003 Shock success by pre-shock pauses Edelson et al, 2006
  11. 11. Cardiac Arrest Management Aufderheide et al,Circ 2004 mean ventilation rate: 30 ± 3.2 first group: 37 ± 4 after retraining: 22 ± 3 16 seconds v v v v v v v v v v
  12. 12. Cardiac Arrest Management How can we know if we can do better?
  13. 13. Cardiac Arrest Management It can be done!
  14. 14. Cardiac Arrest Management What can we do better?
  15. 15. Cardiac Arrest Management What can we do better? • Code management is most effective when a rescue team works together to provide patient care. • Coordination of code management resuscitation efforts improve outcomes for cardiac arrest patients. • The resuscitation team is comprised of the following roles: – Team Leader – Chest compressor(s) – Airway manager – AED operator
  16. 16. Cardiac Arrest Management Pit-Crew approach
  17. 17. Cardiac Arrest Management BLS Pit-Crew tasks • Compressions • AED • Airway management • Call for advanced care The Team leader will assign the roles
  18. 18. Cardiac Arrest Management Team Leader • Should be most experienced team member • Assesses patient and determines need for CPR • Begins chest compressions until AED is applied • Alternates compressions/airway until more members arrive • Monitors the team’s progress as other members arrive
  19. 19. Cardiac Arrest Management 2 person team Member 1 • Team Leader • Assigns roles • Assesses patient • Begins Compressions • Manages Airway after first AED analysis Member 2 • Applies AED • Analyzes/shocks • Compressions after AED analyzes • Alternates Compressions/ Airway with Member 1 every 2 minutes
  20. 20. Cardiac Arrest Management
  21. 21. Cardiac Arrest Management 3 person team Member #1 • Team Leader • Assigns roles • Assesses patient • Begins Compressions • Holds mask seal after first AED analysis Member #2 • Applies AED • Analyzes/shocks • Compressions after AED analyzes • Alternates Compressions/ Airway with Member 3 every 2 minutes Member 3 • Assembles BVM, connects O2, inserts adjunct • Delivers ventilations while Member #1 holds seal • Alternates compressions with Member #2
  22. 22. Cardiac Arrest Management Airway Options During CPR • Airway insertion must not interrupt compressions ! – Naso/oropharyngeal Airway + BVM/ oxygen – King LT + BVM/oxygen
  23. 23. Cardiac Arrest Management On Scene management http://www.ncbi.nlm.nih.gov/pubmed/22834854 http://www.ems1.com/columnists/kenny-navarro/articles/1432503-Prove-it-Transporting-patients-in-cardiac-arrest-improves-outcome/
  24. 24. Cardiac Arrest Management http://portland.wcsh6.com/news/news/1701 00-new-ems-protocol-1-year-later-more- cardiac-arrest-patients-saved
  25. 25. Cardiac Arrest Management What does this mean for us? • BLS crews without ALS support perform 3 rounds of CPR & AED analysis, then transport • BLS crews with ALS tiered support and no significant delay manage arrest on scene until ALS arrival • ALS crews manage cardiac arrest for ~30 minutes and contact medical direction for orders to transport or terminate efforts
  26. 26. Cardiac Arrest Management
  27. 27. Cardiac Arrest Management
  28. 28. Cardiac Arrest Management We have ROSC!!!!! • Monitor airway, may still not be breathing • Obtain vitals • Obtain 12-Lead & transmit to destination • Load patient with care • Monitor continuously for loss of pulse • Transport to cardiac care facility
  29. 29. Cardiac Arrest Management To freeze or not to freeze… • Protocols direct induced hypothermia if transporting to a facility that can maintain • Trinity Regional in Fort Dodge does not have capability to maintain hypothermia • Hypothermia may not be all that great http://pulmccm.org/2013/randomized-controlled-trials/hypothermia-help-hospital-cardiac-arrest-nejm/
  30. 30. Cardiac Arrest Management Questions?

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