This document appears to be a presentation on performing high-quality CPR. It emphasizes the importance of fast, hard, uninterrupted chest compressions and minimizing pauses in compressions. It discusses using end-tidal carbon dioxide monitoring to guide CPR efforts and resuscitation. The presentation encourages attendees to go beyond standard ACLS guidelines and focus on delivering early, high-quality CPR to improve survival from cardiac arrest.

2. The Most Provocative Talk of Your life
“How To Do Damn Good CPR”
will begin in….
2

3. How to do
Damn Good CPR
Going Beyond ACLS
J. Scott Wieters MD

4. Will work
for
Conflict Of
interest

5. `

6. picture of goal

13. Good CPR?

14. Fast CPR

15. Hard CPR

16. Uninterrupted
CPR

18. ETCO2

19. • Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of
uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/
j.ajem.2012.02.015. Epub 2012 May 23.

20. • Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of
uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/
j.ajem.2012.02.015. Epub 2012 May 23.

21. How much pause?
Edelson DP, Robertson-Dick BJ, Yuen T, et al. Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Resuscitation
2010;81:1521–6.

22. Why?
STOP!

29. Pulse check/rhythm analysis 6 sec
Charging “I’m clear you’re clear we’re all clear” 6 sec
Post shock pulse/rhythm analysis 6 sec
18 sec

30. 50% Less Survival
Vs.
Preshock
Pause

31. Preshock
Pause <3s
6X ROSC

32. Every 5s = 18% Mortality

33. Man or Machine
V
V

34. No Difference!

35. No Difference!

36. No Difference!
12 studies 6,538 pts all showed

37. Man or Machine
V
V
No Difference!

39. Defibrillation

40. I think you are
giving me a Black
Pearl?

41. “There were 13 injuries 1986-1990
Most injuries involved a mild shock or burn.

42. “There are no serious injuries inflicted by
defibrillation/cardioversion of a patient.“

43. Testing included four glove materials
Concerns that they leaked initially
Degraded with electricity

44. Took normal and post CPR nitrile gloves
Gloves break down after CPR and leak current.

45. Gloves tested under electrical current similar
to defibrillation.
Electrical leak and glove degradation even
after one shock.

46. Letter by Sullivan regarding article, "Hands-on defibrillation: an analysis of electrical current
flow through rescuers in direct contact with patients during biphasic external defibrillation".
[Circulation. 2008]

47. Can you feel the burn?

48. 2012 Resuscitation

50. Dr. Larry Mellic UGA

51. Concerns that they leaked

52. Took normal and post CPR nitrile gloves
Gloves break down And leak Current.

53. Dangerous levels
of Energy

55. Access

56. Aren’t IOs just for
unconscious people?

59. DBP <30
ETCO2 <20
More EPI?

66. Hyperventilation?

67. PEA Asystole

68. Reversible Causes of PEA
– Hypovolemia
– Hypoxia
– Hydrogen ions
(acidosis)
– Hyper/hypokalemia
– Hypothermia
– Tablets (drug OD)
– Tamponade
– Tension ptx
– Thrombosis
(coronary)
– Thrombosis (PE)

69. Wide? PEA
Electrolytes/Toxins
Ca++ or Bicarb

70. Narrow? PEA
Obstruction/Shock
Diagnose/Treat

71. ROSC?

72. ET CO2 PICTURE
GOOD CPR

73. ETCO2

74. Pokorná et al.
Text
ETCO2

75. EtCO2 No ROSC

76. Arterial Line Anyone?

77. Hypothermia?

78. Cath Lab?

79. Future of Resuscitations?

80. Break
for
Questions?

81. • Go Beyond ACLS
• Early High Quality CPR
• ETCO2 as marker
• Stay on the chest 80% of the time
• Minimize the Perishock Pause
• Go out and do Damn Good CPR!

83. Twitter Email
@jscottwieters jswieters@sw.org