b-card Symposium - Cardiac Arrest in the Field in the USA 2017
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1) The document summarizes a presentation on cardiac arrest treatment in the field given by Dr. Nicolas Peschanski on March 7, 2017. 2) It discusses principles for emergency medical services (EMS) treatment of cardiac arrest including immediate recognition, early CPR, rapid defibrillation, effective advanced cardiovascular life support (ACLS), and integrated post-resuscitation care. 3) New strategies discussed include telephone CPR instructions, public access defibrillation using social media, pit crew/high-performance CPR, and re-evaluating pulse checks and epinephrine administration.
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b-card Symposium - Cardiac Arrest in the Field in the USA 2017
- 1. b-card symposium Cardiac Arrest in the Field Today U A Goes Beyond ACLS Tuesday March 7th 2017 Nicolas PESCHANSKI, MD, PhD
- 2. Acknowledgments Salim R. Rezaie, MD @srrezaie Tom R. Bouthillet, EMT @tbouthillet
- 3. Cardiac Arrest in the Field USA
- 5. Principles for EMS in the Field Immediate Recognition & EMS Activation (911) Early CPR w/ Emphasis on Chest Compressions Rapid Defib’ Effective ACLS Integrated Post-Resus Care
- 6. Cardiac Arrest Process of Care Call Processing Collapse (Time Zero) Reaction Time Pit Crew / High Performance CPR Public Access Defibrillation (Social Media Citizen Responders) 9-1-1 Call Dispatch En Route (Wheels-Up) At Patient (CPR) First Shock Arrival Curbside (Wheels Down) Second Shock Third Shock Fourth Shock Sweet Spot Telephone CPR (T-CPR) Dispatcher Instructions ROSC
- 7. “It isn’t complicated but it’s not easy.”
- 9. Is the patient conscious? Isthepatientbreathingnormally? Begin CPR instructions! No! No! 9-1-1 DISPATCH
- 10. ON SCENE BLS 3% to 78% Al-Khatib SM et al. Circulation CVQO 2016
- 15. C P R EMS ACLS
- 16. 2015 AHA CPR RATE 100 – 120/min DEPTH: 2in - 2.4in RECOIL Allow Full Recoil INTERRUPTIONS Minimize Pauses RULES Guideline Update
- 17. CPR: Man or Machine? vs EMS ACLS+ Gates S et al. Resuscitation 2015
- 18. Cunningham LM et al. AJEM 2012 PAUSE = Decreased Perfusion P E R F U S I O N P R E S S U R E TIME No Pause… Should Be Your Cause!
- 19. EMS ACLS* 0% 10% 20% 30% 40% 50% 60% Survival to Discharge HQ-CPR Davis DP et al. Resuscitation 2015
- 23. >5sec 43% >10sec 4% Ochoa FJ et al. Resuscitation 1998 Pulse Check EMS ACLS Problem with Manual
- 24. Is the Pulse Check Dead?EMS ACLS
- 25. Trans Thoracic Echo No Cardiac Activity on TTE ROSC = 2.4% Cardiac Activity on TTE ROSC = 51.6% Blyth L et al. Acad Emerg Med 2012 EMS ACLS+
- 27. EMS ACLS
- 28. IV Epinephrine 1mg q3 – 5min MAYBE Reasonable Class I (Strong) Benefit>>>Risk Class IIa (Moderate) Benefit>>Risk Class IIb (Weak) Benefit≥Risk Class III (No Benefit) Benefit=Risk Class III (Harm) Risk>Benefit 1mg q3 – 5min MAYBE Reasonable EMS ACLS
- 29. Evidence for Epi OHCA EMS ACLS+ ROSC ≠ Neuro Intact Survival ↑ ROSC No ↑ Survival ↑ Mortality
- 30. IV Access in the Field EMS ACLS
- 31. IO vs PIV Higher Success Rate Faster Access Achieved EMS ACLS+
- 32. Cardiac Arrest Ventilation Fouche PF et al. Prehosp Emerg Care 2014 > >
- 33. BVM Vent is Difficult! EMS ACLS Guyette FX et al. Prehosp Emerg Care 2007
- 34. EMS ACLS+ Is There Still Room for ETI? Sunde GA et al. Scan J Trauma Resus Emerg Med 2015
- 35. EMS ACLS+ Maybe… YES Benoit JL et al. Resuscitation 2015
- 37. b-card symposium Thank You for Your Attention Q & A Tuesday March 7th 2017 Nicolas PESCHANSKI, MD, PhD