Dr. Domagoj Damjanović gave a presentation on February 8th, 2023 about optimizing the use of resuscitation ultrasound. The presentation discussed updating teaching content based on recent findings, focusing on minimizing hands-off times during cardiac arrest, and integrating ultrasound training with simulation and emphasis on the workflow process. The goal is to seamlessly integrate ultrasound into advanced life support protocols to improve patient care and outcomes.

1. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Stop complaining and train!
About the news in resuscitation ultrasound
Credits: www.zadar.travel/hr/atrakcije/atrakcije/morske-orgulje

2. Support for ultrasound education (machines lent)
Butterfly, GE, Philips, Sonosite, multimed
Instructor in ultrasound courses
I N S T I T U T I O N A L
P E R S O N A L
Dr. Domagoj Damjanović
COI
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

3. Further reading
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

4. Google Maps
Dr. Domagoj Damjanović in Zermatt | February 8th, 2023
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

5. www.croatia.org/crown/articles/9359/1/nikola-baiae-author-of-the-zadar-sea-organ.html
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

6. www.croatia.org/crown/articles/9359/1/nikola-baiae-author-of-the-zadar-sea-organ.html
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

7. • A window in the breast
• Ultrasound and the ALS-algorithm
• A way out – training, and process optimization!
• Simulation
Learning points
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

8. Insights in CPR
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
systemic perfusion
electricalactivity

9. systemic perfusion
electricalactivity
mechanicalactivity
Insights in CPR
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

10. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

11. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

12. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

13. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

14. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
I like to look
inside the body
Credits retractor: www.teleflexsurgicalcatalog.com

15. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits retractor: www.teleflexsurgicalcatalog.com

16. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

17. Insights
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

18. Insights
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

19. • Mechanical myocardial activity
• Reversible causes
• RV dilation
• Pericardial effusion
Resuscitation ultrasound
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

20. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

21. • Other than echo
– Pulse checks
– Lung
– Aorta
– DVT
Resuscitation ultrasound
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

22. • Other than echo
– Procedural guidance
• Vascular access
• Airway management
• other
Resuscitation ultrasound
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

23. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

24. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Best of Kleinanzeigen on Facebook, 21.2.2019
True value

25. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Best of Kleinanzeigen on Facebook, 21.2.2019
True value
“Siemens
resuscitation device”

26. Ultrasound in cardiolpulmonary resuscitation
GAME CHANGER
Dr. Domagoj Damjanović | Zermatt | February 10th, 2022

27. UPS
Image credits pain scale: brgfx on Freepik; graph made with visme
Dimensionless
Ultrasound
Enthusiasm
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

28. Image credits pain scale: brgfx on Freepik; graph made with visme
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Dimensionless
Ultrasound
Enthusiasm
UPS – Ultrasound Pain Scale

29. Dimensionless
Ultrasound
Enthusiasm
Image credits pain scale: brgfx on Freepik; graph made with visme
FEEL ILCOR Y
Hands-Off
x3
TEE
Prognosis
Hs & Ts
ILCOR N
CASA
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
UPS – Ultrasound Pain Scale

30. Dimensionless
Ultrasound
Enthusiasm
Image credits pain scale: brgfx on Freepik; graph made with visme
1
2
3
4
5
6 8
9
7
Breitkreutz 10
ILCOR 15
Huis in’t Veld 17
Reed 17
Clattenburg 18
Clattenburg 18’
Teran 19
Reynolds 20
Reynolds 22
1
2
3
4
5
6
7
8
9
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
UPS – Ultrasound Pain Scale

31. Pauses
>10 seconds
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

32. • RV dilates in almost all codes – time dependent
• Prognostic value of standstill – time dependent
(and low)
• Area of compression may not always be where
guidelines say
Resuscitation ultrasound news
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Reynolds 2020, 2022; Wyckoff 2022, Teran 2019

33. Ultrasound
ALS guidelines
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

34. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Treatment recommendations:

35. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Treatment recommendations:

36. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Treatment recommendations:

37. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Treatment recommendations:

38. Ultrasound in cardiolpulmonary resuscitation
PREVENTING
FURTHER DAMAGE
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

39. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

40. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

41. P
A
N
T
S
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Excourse:

42. Excourse:
Paramedic/physician
Acute
New
Toy
Syndrome
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

43. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

44. Credits: www.skillstat.com/tools/ecg-simulator/#/-home
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

45. Distraction potential
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
???

46. ???
Distraction potential
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

47. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

48. WHAT IS
YOUR ANSWER?
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: Ben Faist, Pixabay, modified DD

49. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: Ben Faist, Pixabay, modified DD

50. TRAIN
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

51. Making worlds meet
ALS
PoCUS
Credits: stockpic, Pixabay
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

52. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: Lars Nissen, Pixabay
ALS
ULTRASOUND

53. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: Lars Nissen, Pixabay
ULTRASOUND
ALS

54. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: qimono, Pixabay
ALS ULTRASOUND

55. ULTRASOUND
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: qimono, Pixabay
qCPR
Defibrillation
Airway
IV access
Meds
mCPR
ALS

56. Improving resuscitation ultrasound use
Dr. Domagoj Damjanović in Zermatt | February 8th, 2023
Training
Single task Process

57. • Awareness and acknowledgement of “news”
• Update your teaching content
• Focus on hands-off-times
• RV-Dilation
• Standstill and prognosis
• Area of compression
• Adapt learning objectives
Basics
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

58. • Cardiac views
– Put the probe on and off
– Use 10 sec sequences
– Integrate clip recording & review
• Extracardiac views
Image acquisition and optimization
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

59. • Simulation training
• Protocols with process aspects
Integration
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

60. Breitkreutz 2007, 2009, 2010; Price 2010
[15 years] Course Participants, PHEM/ EMS
ALS-conformed ultrasound is feasible
Process-focused training program
FEEL
Dr. Domagoj Damjanović in Zermatt | February 8th, 2023

61. Contents on resuscitation ultrasound
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

62. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

63. • Assign roles (teamleader  u/s provider)
• Announce; have machine ready
• Place probe under ongoing chest compressions
• Count down (automatic timer)
• Record clip
• Resume chest compressions
• Review clip
Integration
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

64. The acronym of resuscitation ultrasound
RCC
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

65. The acronym of resuscitation ultrasound
RESUME
CHEST
COMPRESSIONS!
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

66. SIMULATE
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

67. Ultrasound training, CPR training
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

68. Ultrasound training, CPR training
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

69. Integration
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

70. Low-cost, high fidelity simulation
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Damjanovic 2017

71. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 sasksonic.com

72. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

73. Low-cost, high fidelity simulation
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Damjanovic 2017

74. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: Lars Nissen, Pixabay
ULTRASOUND
ALS

75. Simulation publication
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

76. TRAINING
WORKS
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

77. Olszynski, 2016
N= 25
N= 8
Trainees
EPs/ Instructors
• edus2 simulator more immersive
• better integration of ultrasound into scenarios
• No difference in MCQ
Simulation study
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

78. Real world study – CASA
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Clattenburg, 2018
N= 267 arrests Pre-/post-intervention design
• 4s shorter pauses in CCs
• 3s shorter when probe placed w ongoing CCs
• 3s shorter with ED ultrasound trained faculty
• (interruptions still >10 sec)

79. Ultrasound Pain Recovery
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Image credits pain scale: brgfx on Freepik; graph made with visme
X

80. Ultrasound Pain Recovery
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Image credits pain scale: brgfx on Freepik; graph made with visme
X
Ultrasound
• Training/ Sim
• TEE
• Pulse check
• Compression
area
• Extracardiac
Science
• Better data
• Study design
• Protocols
• Revise
guidelines
System
• SOPs
• Governance
• QI

81. • ALS into ultrasound training?
• Ultrasound into ALS training?
• ALS trainings with a focus on PoCUS? Or
routine integration into all trainings?
• Instructor qualification and scalability?
Questions to discuss
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

82. • The idea of a seamless integration of
PoCUS into ALS is not new,
but there is room für improvement
• Training and simulation are promising
targets of intervention
Summary
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

83. Summary
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023
Basics
Acquisition
Interpretation
Integration
• Update content; awareness
• qCPR, appropriate indications
• Put the probe on and off
• Use 10 sec sequences
• Integrate clip recording & review
• Simulation, drills
• Protocols with focus on the process
• RV-Dilation
• Standstill

84. Conclusion
• Ultrasound remains a window into the body.
• More than echocardiography.
• Optimize imaging – AND the process.
• Train. Simulate.
• Resume Chest Compressions!
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

85. Further reading
Dr. Domagoj Damjanović | Zermatt | February 8th, 2023

86. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023 Credits: www.zadar.travel/hr/atrakcije/atrakcije/morske-orgulje

87. Dr. Domagoj Damjanović | Zermatt | February 8th, 2023