The document discusses the integration of technology in resuscitation practices, emphasizing the importance of continuous chest compressions and real-time feedback for performance improvement. It highlights the significance of compression depth and associated monitoring metrics, as well as the role of hypothermia in post-arrest management. Overall, the document presents evidence-based approaches to enhance survival rates and outcomes in cardiac arrest scenarios.

1. Daniel Davis, MD
UCSD Emergency Medicine
Integrating Technology
into Resuscitation

2. Technology
Opportunities
• Change treatment algorithms
• Real-time feedback
• Performance improvement
• Research
• Training

3. CQI
ADVANCED RESUSCITATION TRAINING
Training Technology
Best
Practices Scientific
Evidence

4. Arrest Resuscitation

6. The Primary Directive
Chest compressions should be performed
from the moment of arrest until return of
spontaneous circulation is assured.

7. Kern (2002) Circulation
Prime the Pump!

8. Christenson (2009) Circulation
Stay on the chest!
1
2.13 2.26
2.88
3.3
0
1
2
3
4
5
0-20 21-40 41-60 61-80 81-100
Chest Compression Fraction
AdjustedOR
* Adjusted for: age, gender, bystander CPR,
public location, response time, compression rate

9. Codus Interruptus
• Initiating compressions
• Rhythm analysis
• Shock sequence
• Pulse check
• Intubation
• Vascular access

10. Rhythm Analysis

11. Shock Sequence

12. Stiell et al (2008) AHA Scientific Sessions
Deeper Compressions

13. Aufderheide (2005) Resuscitation
Good Recoil

14. Compression Associations
• Depth  ROSC
• Depth  survival
• Rise in depth  ROSC, survival
• Compression depth/patient wt  PetCO2
• Depth/rate  inversely proportional

15. Perfusion Checks
0
20
40
60
80
100
120
140
0 10 20 30 40 50
Time
HeartRate(BPM)&PetCO2(mmHg)
Electrical
(HR)
Mechanical
(PetCO2)

16. PetCO2 Monitoring

17. PetCO2 Associations
• Initial PetCO2  arrest etiology
• Initial PetCO2  ROSC
• CPR depth/patient weight  PetCO2
• Pre-shock PetCO2  ROSC for VF
• Rise in PetCO2  ROSC

19. CPR Feedback

25. VF arrest in CCU

26. Initial rhythm

27. Defibrillation
EtCO2 6
Sinus rhythm
No pulse
EtCO2 16

28. EtCO2 25
Pause compressions
A-line 70/30
Pulse palpated

29. Post-Resuscitation

30. Hyperventilation: Three Flavors

31. Cerebral Perfusion During Shock
0
5
10
15
20
25
30
35
40
45
RR6 RR12 ETCO2
P = .004 v 12
P = .004 v 12
mL/100 gm/min

32. Capnometry

33. Intubated Patient
Confirm ET placement using
continuous capnography
SBP <90 mmHg SBP 90 mmHg
SBP  90 mmHg
SpO2 <90%
SBP <90 mmHg
Decrease ventilation rate
EtCO2 >45 mmHg
EtCO2 <35 mmHg
•Increase FiO2
•Check circuit
•Suction ET tube
Lung-Protective Ventilation Mode
• Volume Control (TV = 6 cc/kg)
• Ppeak = 40 cm H2O
• Ventilation rate = 12/min
• PEEP = 5 cm H2O (2 cm H2O for TBI)
Decrease FiO2 to
50%
Resuscitation Ventilation Mode
• Pressure Control (Ppeak = 40 cm H2O)
or Volume Control (TV = 12 cc/kg)
• Ventilation rate = 6/min
• No PEEP
SpO2 >97% SpO2 >97%
SpO2 <90%
Increase ventilation rate •Increase FiO2
•Check circuit
•Suction ET tube
•Increase PEEP
•Increase I time
Decrease FiO2 to
50%

36. Hypothermia After Cardiac Arrest Study Group (2002) NEJM
Evidence for Hypothermia

37. Evidence for Hypothermia?

38. Hypothermia After Cardiac Arrest Study Group (2002) NEJM
Hypothermia vs. Normothermia?

39. When should we cool?

40. no cooling
33oC
0 10 20 30 40 50 60
% survival
36%
53%
no cooling
33oC
26%
49%
36oC
33oC
52%
50%
Post-Arrest Hypothermia
HACA
Bernard
TTM

41. Temperature Management

42. Outcomes

43. 0
5
10
15
20
25
30
35
40
45
50
2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
Arrest Survival
Survival-to-Discharge(%)
Current U.S. Benchmark

44. Ventura/Santa Barbara EMS
0
5
10
15
20
25
30
35
40
45
50
All Treated Witnessed VF
Pre-ART
Post-ART
GoodNeurologicalOutcome(%)

45. Air Medical Arrests