The document discusses new trends in cardiac arrest management based on research findings. It finds that survival is directly related to how quickly a patient receives treatment. Research showed that chest compressions were only being performed 52% of the time, and when they were being done, 28% were too slow and 40% were not deep enough. It also found ventilations were being done too quickly 60% of the time. The document recommends a "pit crew" approach where rescuers are assigned specific roles like compressions, airway management, and operating the AED to improve coordination during resuscitation efforts. Managing cardiac arrest on scene for 30 minutes before transporting is also discussed as improving outcomes based on studies.

1. New Trends In Cardiac Arrest
Management
The On-Scene Approach
Luke Winkelman, Paramedic EMS-I
ACLS Instructor

2. Cardiac Arrest Management
Look how far we’ve come!
https://www.youtube.com/watch?v=zygvMRZHkOg

3. Cardiac Arrest Management
CPR-The research

4. Cardiac Arrest Management
CPR-The research

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. 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. 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. 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. Cardiac Arrest Management
Christenson et al. Circulation 2009

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. 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. Cardiac Arrest Management
How can we know if we can do better?

13. Cardiac Arrest Management
It can be done!

14. Cardiac Arrest Management
What can we do better?

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. Cardiac Arrest Management
Pit-Crew approach

17. Cardiac Arrest Management
BLS Pit-Crew tasks
• Compressions
• AED
• Airway management
• Call for advanced care
The Team leader will assign the roles

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. 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. Cardiac Arrest Management

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. Cardiac Arrest Management
Airway Options During CPR
• Airway insertion
must not interrupt
compressions !
– Naso/oropharyngeal
Airway + BVM/
oxygen
– King LT +
BVM/oxygen

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. Cardiac Arrest Management
http://portland.wcsh6.com/news/news/1701
00-new-ems-protocol-1-year-later-more-
cardiac-arrest-patients-saved

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. Cardiac Arrest Management

27. Cardiac Arrest Management

29. 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

30. 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/

31. Cardiac Arrest Management
Questions?