This is the slide deck for the lecture portion of the hands-on class for the 2022 High-Performance CPR update.

1. ACCESS – BT – 2022 01 HP CPR Update

3. What will we do today?
•Quick Lecture overview of
topics
•HP CPR w/ AED or X series and
Q CPR mannequin
•HP CPR W/ Lucas
•Firefighter CPR

4. Infection
Control
Station
Station 1:
High performance
CPR with Zoll X
Series or
Zoll AED 3BLS
Station 2:
High performance
CPR Lucas
Station 3:
FF CPR transition
into HP CPR
Class Exit
(Roster
check,
etc)
Classroom
and
Lecture
Admin
(Roster
etc)

5. • RATE
• 100-120
• 110 ideal
• DEPTH
• 2”
• RELEASE/RECOIL
• Complete
• UNINTERRUPTED
• 3 second goal
• 80% compression fraction
• DECREASED VENTILATION
• 6-10/min
Remember the 5 pillars of HP CPR….

6. The importance of maintaining compression fraction:

9. Use of Feedback

10. Zoll Dashboard Display
Rate
indicator
Perfusion
performance
indicator
Depth indicator
Release
ETCO2
CPR Quality

11. Rate indicator
Depth indicator
CPR Timer

12. Personal Feedback may DOUBLE CPR
effectiveness. (John Hopkins Study)

14. Remember:
Call “200” to
swap on 220
Helps the team
get ready for
the switch

15. Hovering

16. Pre-Charging (ALS)

17. Ventilation control 6-10 times a minute.

18. 2-step Lucas
Placement
Don’t Rush to the
Lucas

19. “Out-of-hospital cardiac arrest outcomes with “pit
crew” resuscitation and scripted initiation of
mechanical CPR”
• 444 patients in the A-TCEMS system. ½ received manual, ½ received
LUCAS.
• “Conclusions: In this EMS system with a standardized, "pit crew" approach
to OHCA that prioritized initial high-quality initial resuscitative efforts and
scripted the sequence for initiating mechanical CPR, use of mechanical CPR
was associated with decreased ROSC and decreased survival to discharge.”
• “In the propensity matched analysis (n = 176 manual CPR; 176 mechanical
CPR), both ROSC (38.6% vs. 28.4%; difference: 10.2%; CI: 0.4% to 20.0%)
and survival to discharge (13.6% vs. 6.8%; difference: 6.8%; CI: 0.5% to
13.3%) remained significantly higher for patients receiving manual CPR.”

20. Firefighter CPR

22. Steps of FF CPR
• Evacuation
• Extrication Part 1
• Extrication Part 2
• EMS Integration
• Transition to HP CPR
• Integration of Lucas
• Transport Considerations

23. Evacuation
• “Mayday” initiated
• The downed firefighter is
removed by most appropriate
means available to a “Safe
zone” for further care.
• Victim is removed from
structure.

24. Extrication Part 1
• Focuses on the removal of gear from the
upper half of the downed FF.
• Rescuer 1 cradles FF SCBA between legs,
removed helmet, mask, and loosens
SCBA. Secures “wristlets”
• Rescuer 2 Opens turnouts and provides
continuous compressions
• Rescuer 3 removes gloves and hands
arms to rescuer 1, then moves to feet
and grabs legs.
• ALL RESCUERS On “Rescuer 1’s”
command, slide victim downward out of
coat, removing the victim from the upper
protective gear

25. Extrication Part 2
• Focuses on the removal of lower gear from the upper half
of the downed FF.
• Rescuer 1: Discard gear and move into the “airway
position” and perform as described in High Performance
CPR.
• Rescuer 2: Reposition and continue chest compressions.
Compressions should be alternated between rescuers
every two minutes as described in High Performance CPR.
• Rescuer 3: Removing boots and undoing suspenders from
pants. Rescuer 3 will then grab inner lining of pants and
raise legs
• ALL RESCUERS: Rescuer 3 will grab bottom of pants and on
Rescuer 1s count. Rescuer 1 and 2 will slide victim up and
onto a backboard, removing the pants and boots in the
process.

26. Why do we want them
completely disrobed
(If Possible)
• Heat dissipation
• Off Gassing
• Access to the patient
• IO
• Lucas Placement
• Part of the crime scene
investigation
• Arson?
• Homicide
• OSHA

27. EMS Integration

28. Transition to HP CPR
• Rescuer at the head manages
airway until relived.
• Rescuers at side become
“Compressor 1” and “Compressor
2” performing compressions and
ventilation until released.
• NOTE: The initial Rescuers should
be relieved as soon as practical

29. Integration of Lucas
• Still two step process.
• Step 1: Back plate
• Perform 2 minutes of
CPR
• Step 2: Attach Lucas
• High Quality CPR > Lucas
• ETCO2
• ROSC
• Neuro Outcomes
• Timing?

30. Transport Considerations
• Resist the urge to “scoop and run”
• Things that should be done on
scene:
• Communicate!
• Place pads with CPR feedback and
assess EKG. Shock as needed.
• Optimize compressions with CPR
Feedback. The focus is still on HP
CPR!
• Other priorities:
• Bag and establish an advanced airway
• Establish Vascular Access.
• Apply a Lucas
• Get organized!
• IDLH related care:
• Bag and advanced airway
• Cyanokit
• Trauma Specific Care:
• TQ?
• Pelvic Binder?
• Decompression?

31. Why work them on scene? (Part 1)
• MOST Fireground deaths are
related to cardiac causes.(NFPA
2020 stats)
• 46% of all FF LOD deaths
• 80% of fireground deaths were
cardiac in nature
• Coronary heart disease (CHD)
• Left Ventricular Hypertrophy
• Most likely cause DURING fire
suppression Duties and other
physical exertion
• Trauma was second leading
cause
• Blunt trauma: 29%
• Burns: 8%
• Heat: 2%
• Asphyxia and smoke: 4%
Fahy, R., & Petrillo, J. T. (2021, October). Firefighter fatalities in the United States | NFPA. https://www.nfpa.org/News-
and-Research/Data-research-and-tools/Emergency-Responders/Firefighter-fatalities-in-the-United-States
NFPA statistics—Firefighter deaths by cause and nature of injury. (2020, July). National Fire Protection Association.
https://www.nfpa.org/News-and-Research/Data-research-and-tools/Emergency-Responders/Firefighter-fatalities-in-the-
United-States/Firefighter-deaths-by-cause-and-nature-of-injury
Smith, D. L., Haller, J. M., Korre, M., Sampani, K., Porto, L. G. G., Fehling, P. C., Christophi, C. A., & Kales, S. N. (2019). The
Relation of Emergency Duties to Cardiac Death Among US Firefighters. The American Journal of Cardiology, 123(5), 736–
741. https://doi.org/10.1016/j.amjcard.2018.11.049

32. Why work them on scene? (Part 2)
• On-the-scene CPR provides better
survival than “scoop and run”
resuscitation.
• 43,969 patients from 10 major
metropolitan areas.
• Survival to hospital discharge was
3.8% for patients who underwent
intra-arrest transport and 12.6% for
those who received on-scene
resuscitation.
• Favorable neurological outcome
occurred in 2.9% of patients who
underwent intra-arrest transport vs
7.1% who received on-scene
resuscitation
• “Among patients experiencing out-
of-hospital cardiac arrest, intra-
arrest transport to hospital
compared with continued on-scene
resuscitation was associated with
lower probability of survival to
hospital discharge.”

33. Why work
them on
scene? (Part 3)
•When should we work
them on scene?
•When should we
transport?

34. Key Point: EMS should bring up a scoop or backboard
in addition to other gear when the stage for rehab
and rescue.
• What should EMS have
ready at rehab?
• Scoop?
• ALS Bag?
• Code Bag?
• Trauma Bag?
• Zoll?
• O2?
• Rad 57?
• Turnouts and Helmets
• What Else?

35. Questions?