EMS Role in Improving Outcomes from Sudden Cardiac Arrest
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This presentation is designed to facilitate open discussion regarding the EMS role in saving lives from sudden cardiac death. Additionally it discusses the Guidelines for CPR an ECC process. Through a better understanding of the science behind treatment recommendations it is possible that EMS professionals will not only perform better, but may play a more active role in improving the system of care for these patients.
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EMS Role in Improving Outcomes from Sudden Cardiac Arrest
- 1. David B. Hiltz, NREMT-P AHA National ECC Program RESUSCITATION UPDATE
- 2. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
- 4. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 5. THE STORY OF BOB
- 6. ISSUE: SUB-OPTIMAL SURVIVAL RATES Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 7. OUR JOB: SAFETY NET
- 8. REAL PEOPLE BEHIND THE STATS
- 9. ISSUE: RECOGNITION AND ACTION!
- 10. THE "FIX" GROUP DISCUSSION
- 11. ISSUE: HEART ATTACK GRILLS Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 12. THE "FIX" GROUP DISCUSSION
- 13. ISSUE: UNSATISFACTORY RATES OF BYSTANDER CPR
- 14. THE "FIX" GROUP DISCUSSION
- 15. DID YOU KNOW?
- 18. ISSUE: INCONSISTENT EMD Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 19. THE "FIX" GROUP DISCUSSION
- 20. ISSUE: QUALITY OF CPR
- 21. THE "FIX" GROUP DISCUSSION
- 22. DID YOU KNOW?
- 23. ISSUE: UNDERUTILIZATION OF LEA Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
- 24. THE "FIX" GROUP DISCUSSION THE "FIX"
- 25. ISSUE: ALL ALS SYSTEMS? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 26. THE "FIX" GROUP DISCUSSION
- 27. ISSUE: INCIDENT COMMAND DURING CARDIAC ARREST Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 28. THE "FIX" GROUP DISCUSSION
- 29. ISSUE: DISTRACTIONS! Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 30. THE "FIX" GROUP DISCUSSION
- 31. ISSUE: REPROGRAMMING? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 32. AIRWAYS ON VACATION? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
- 33. THE "FIX" GROUP DISCUSSION
- 34. ISSUE: TRANSPORT? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 35. THE "FIX" GROUP DISCUSSION
- 36. ISSUE: BRRR! IT’S COOL TO BE COOL Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 37. THE "FIX" GROUP DISCUSSION
- 38. ISSUE: CARDIAC ARREST CENTERS
- 39. THE "FIX" GROUP DISCUSSION
- 40. ISSUE: TAKE TO CATH LAB? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 41. THE "FIX" GROUP DISCUSSION
- 45. DID YOU KNOW?
- 51. TIME FOR AN UPGRADE? Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 52. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers. IMPEDANCE THRESHOLD
- 53. COACHING AND FEEDBACK Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 54. PISTON CPR DEVICE Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 55. LOAD DISTRIBUTING BAND Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 56. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 57. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 59. CPR
- 60. GOOD CPR
- 61. EVEN BETTER CPR
- 62. AND EARLY SHOCK GOOD CPR
- 63. CPR, EARLY SHOCK , SMART ACLS HYPOTHERMIA
- 64. CPR, EARLY SHOCK , SMART ACLS, HYPOTHERMIA AND CARDIAC ARREST CENTER
- 65. EVERTHING DONE VERY WELL
- 66. LUCKY!
- 67. LUCKIER!
- 68. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 71. http://www.youtube.com/watch?v=NcwK1QVxfXU Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 73. HANDS ONLY CPR?
- 74. HANDS ONLY CPR?
- 75. Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
- 79. WE WON’T ASK!
- 80. EVALUATE CONFIRM ACKNOWLEDGE RECOMMEND GUIDELINES 2010
- 82. URBAN LEGEND
- 83. NO SACRED COWS
- 84. THERE SURE ARE A LOT OF QUESTIONS
- 87. REVISION SEQUENCE Determine class of recommendation Assess quality of evidence Gather relevant evidence Define, refine question/hypothesis
- 91. WARNING!
- 92. Due to the ongoing nature of the evidence evaluation process, it is not possible to predict what changes, if any, may occur to current resuscitation guidelines. As draft evidence evaluation worksheets are made available for public review and comment I’d encourage anyone interested in a particular topic to actively participate in this public portion of the process.
- 97. LIFE is the ULTIMATE Goal
- 98. D
Editor's Notes
- Humor break. Alternative airways waiting for the news!
- The impedance threshold device (ITD) is a valve that limits air entry into the lungs during chest recoil between chest compressions. It is designed to reduce intrathoracic pressure and enhance venous return to the heart. In initial studies the ITD was used with a cuffed endotracheal tube during bagtube ventilation and ACD-CPR.42–44 The ITD and ACD device are thought to act synergistically to enhance venous return during active decompression. In recent reports the ITD has been used during conventional CPR45,46 with an endotracheal tube or face mask. Studies suggest that when the ITD is used with a face mask, it may create the same negative intratracheal pressure as use of the ITD with an endotracheal tube if rescuers can maintain a tight face mask seal.43,45,46 In 2 randomized studies (LOE 1)44,47 of 610 adults in cardiac arrest in the out-of-hospital setting, use of ACD-CPR plus the ITD was associated with improved ROSC and 24-hour survival rates when compared with use of standard CPR alone. A randomized study of 230 adults documented increased admission to the intensive care unit and 24-hour survival (LOE 2)45 when an ITD was used during standard CPR in patients in cardiac arrest (pulseless electrical activity only) in the out-of-hospital setting. The addition of the ITD was associated with improved hemodynamics during standard CPR in 1 clinical study (LOE 2).46 Although increased long-term survival rates have not been documented, when the ITD is used by trained personnel as an adjunct to CPR in intubated adult cardiac arrest patients, it can improve hemodynamic parameters and ROSC (Class IIa).
- ECC guidelines are the most viewed/downloaded guidelines that the AHA publishes. They are considered the standard of care. Evidence evaluation Confirm the safety and effectiveness Acknowledge that other approaches may not be optimal Recommend new treatments that have undergone evidence evaluation
- Reinforce that Guidelines are not created by a small group of people in a dimly lit smoke filled room but rather…(go to next slide)
- The evidence evaluation process results is a judgment of the quality of available science and, ultimately, the strength of a recommendation for clinical care. Experts who participated in the guidelines revision first developed a question and hypothesis (eg: “What is the appropriate dose of epinephrine for endotracheal administration? Hypothesis – the dose should be 10 times greater than the intravenous dose.”), then used an evidence-based template to research the questions. At least 2 international experts independently completed an evidence review of each topic. Experts then presented the quality and level of evidence and whether the evidence supported or refuted the hypotheses or proposed revision questions (usually presented in a “pro and con” format at the Evidence Evaluation Conferences). After considering the evidence, ILCOR members came to a consensus and published recommendations..
- The highest level, one, represents a randomized controlled trial with positive results. Note that there are very few RCTs that definitively support a specific resuscitation recommendation. Much evidence is classified as level 5, case series, and, in the case of pediatric patients, some evidence is extrapolated from the adult experience (level 7).
- The “questions” and the publications for answering.
- Good slide to explain that comments made during the presentation should not be misconstrued as indicators of what a new guideline is going to be. Listeners would “have better chances with the fortune teller at the carnival” in determining what will ultimately be released in Nov./Dec.
- Let’s leave status quo!