How ILCOR need to improve the cardiac arrest process of care with emphasis on Oxygenation

1. b-card symposium
ILCOR 2015 & CPR-Ventilation
Continuous 02 Insufflation in Cardiac Arrest
Tuesday
March 7th
2017
Nicolas PESCHANSKI, MD, PhD

2. Acknowledgments
Salim R. Rezaie, MD
@srrezaie
Justin L. Benoit, MD
@justinleebenoit

3. ILCOR Cardiac Arrest Ventilation
Callaway CW et al. Circulation 2015

4. Chain-Of-Survival
Soar J et al. Resuscitation 2015

5. Missing Link
or
Weak Link?
ILCOR
2015
CPR-Ventilation
Ewy GA et al. JACC 2009

6. Chain-Of-SurvivalILCOR
2015

7. ILCOR
2015
Give
O2
Callaway CW et al. Circulation 2015

8. ILCOR
2015 Advanced Airway
10”
Deakin CD et al. Resuscitation 2010

9. EtCO2
ILCOR
2015
Ahrens T et al. Am J Crit Care 2001
20’

10. Negative Factors
Rhythm <100/min
Interruptions
Depth <2’
Hyperventilation
ILCOR
2015
Travers AH et al. Circulation 2010

11. Real
Life
Hyper
Ventilation
Aufderheide TP et al. Circulation 2004

12. Do we
hyperventilate?
Real
Life
P
r
e
s
s
u
r
e
O’Neill JF et al. Resuscitation 2007
Bag-Valve-Mask
Inflation Rate
A
i
r
w
a
y
M
e
a
n

13. ➘
Perfusion
Pressure
ILCOR
2015
➘
Coronary
Perfusion
➚Vent’
Berg RA et al. Circulation 2010
➚Chest Comp’
Interruptions

14. ILCOR
2015
“Everything should be made
as simple as possible,
but not simpler”
Hands-Only
CPR
Rea TD et al. NEJM 2010
Bobrow BJ et al. JAMA 2010

15. Real
Life

16. Passive Oxygen Delivery
Bobrow BJ et al. Annals Emerg Med 2009

17. Passive Oxygen Delivery
Saissy JM et al. Anesthesiology 2000

18. Passive Oxygen Delivery
Recommendations Grade IIb LOE C
Boussignac©
Cardiac
Arrest Tube

19. Continuous O2 INSUFFLATION
Bertrand C et al. Intens Care Med 2006
Concept
Cardiac
Arrest
Tube

20. Steen S et al. Resuscitation 2004
Results
Animal
Study
CIO vs. PPV
➚ROSC

21. Steen S et al. Resuscitation 2004
Animal
Study
➚Coronary Perfusion
CIO vs. PPV

22. Real
Life
M
I
C
U
No➚
Vent’

23. ILCOR
2015
First Responders / EMT
No CIO!

24. ILCOR
2020
Is There
A
Next
Step?

25. Maybe…
ILCOR
2020

26. Virtualvalve
15 L/min
Same Concept

27. Same Concept

28. Lab Tests

29. Negative Pressure

30. Cadavers’ Study
Segal N et al. Resuscitation 2015
CPR-Induced
Gastric Air➘
COI
Effects

31. New
Recommendations
In Cardiac Arrest
Oxygenation?

32. Bag-Valve-Mask
Can Be Bad
for CPR-Ventilation

33. Advanced-Airway
Can Be Bad
for CPR-Ventilation

34. CPR-Ventilation
Is Compulsory!

35. CPR-Ventilation
=
CPR-Designed Devices!

36. b-card symposium
Thank You for Your Attention
Q & A
Tuesday
March 7th
2017
Nicolas PESCHANSKI, MD, PhD