New trends in cardiac arrest management
31
New Trends In Cardiac Arrest Management The On-Scene Approach Luke Winkelman, Paramedic EMS-I ACLS Instructor
-
Upload
luke-winkelman -
Category
Science
-
view
106 -
download
1
Transcript of New trends in cardiac arrest management
New Trends In Cardiac Arrest Management
The On-Scene Approach
Luke Winkelman, Paramedic EMS-IACLS Instructor
Cardiac Arrest Management
Look how far we’ve come!
https://www.youtube.com/watch?v=zygvMRZHkOg
Cardiac Arrest Management
CPR-The research
Cardiac Arrest Management
CPR-The research
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.
Cardiac Arrest Management
• Sudden cardiac arrest (SCA) is a leading cause of death among U.S. adults.
• SCA survival is directly correlated to the t ime a patient waits before receiving treatment.
What has the research found?
Cardiac Arrest Management
No ROSCROSC
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
Num
be
r of 3
0 se
c s
eg
me
nts
Abella et al, 2005
p=0.003
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!
Cardiac Arrest Management
Christenson et al. Circulation 2009
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
Sh
ock
su
cces
s, p
erce
nt
90%
10%
55%64%
p=0.003
Shock success by pre-shock pauses
Edelson et al, 2006
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
Cardiac Arrest Management
How can we know if we can do better?
Cardiac Arrest Management
It can be done!
Cardiac Arrest Management
What can we do better?
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 fol lowing roles:
– Team Leader– Chest compressor(s)– Airway manager– AED operator
Cardiac Arrest Management
Pit-Crew approach
Cardiac Arrest Management
BLS Pit-Crew tasks
• Compressions• AED• Airway management• Call for advanced care
The Team leader wil l assign the roles
Cardiac Arrest Management
Team Leader
• Should be most experienced team member• Assesses patient and determines need for
CPR• Begins chest compressions unti l AED is
applied• Alternates compressions/airway unti l more
members arrive• Monitors the team’s progress as other
members arrive
Cardiac Arrest Management
2 person team
Member 1• Team Leader• Assigns roles• Assesses patient• Begins
Compressions• Manages Airway
after f irst AED analysis
Member 2• Applies AED• Analyzes/shocks• Compressions
after AED analyzes
• Alternates Compressions/ Airway with Member 1 every 2 minutes
Cardiac Arrest Management
Cardiac Arrest Management
3 person team
Member #1• Team Leader• Assigns roles• Assesses patient• Begins Compressions• Holds mask seal after
f irst 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 venti lat ions while Member #1 holds seal• Alternates compressions with Member #2
Cardiac Arrest Management
Airway Options During CPR
• Airway insertion must not interrupt compressions !– Naso/oropharyngeal
Airway + BVM/ oxygen
– King LT + BVM/oxygen
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/
Cardiac Arrest Management
http://portland.wcsh6.com/news/news/170100-new-ems-protocol-1-year-later-more-cardiac-arrest-patients-saved
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 signif icant delay manage arrest on scene unti l ALS arrival
• ALS crews manage cardiac arrest for ~30 minutes and contact medical direction for orders to transport or terminate efforts
Cardiac Arrest Management
Cardiac Arrest Management
Cardiac Arrest Management
We have ROSC!!!!!
• Monitor airway, may st i l l 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 facil i ty
Cardiac Arrest Management
To freeze or not to freeze…
• Protocols direct induced hypothermia if transporting to a facil i ty that can maintain
• Trinity Regional in Fort Dodge does not have capabil i ty to maintain hypothermia
• Hypothermia may not be all that great
http://pulmccm.org/2013/randomized-controlled-trials/hypothermia-help-hospital-cardiac-arrest-nejm/
Cardiac Arrest Management
Questions?
