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3/4/2019
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New Strategies in Resuscitation
Walt Lubbers, MD FAAEMUniversity of Cincinnati
No financial disclosures
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New Strategies in Resuscitation
Walt Lubbers, MD FAAEMUniversity of Cincinnati
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1.Fix your compressions
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100-120 cpm
2.0-2.4”
Idris et al, Circulation. 2012;125:3004-3012.
1241241601608080 140140
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Stiel et al. Circulation. 2014;130:1962-1970.
1.8”1.8”
2.4 in2.4 in2 in2 in
Push hard…kindaDon’t push that fast
Push CorrectlyDon’t Stop
Push HardPush Fast
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ARE YOU DOING THAT?
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RT
Compressions
IV/ MedsIV/
Meds
Lines
Airway
Leader
Other guySpectator
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60 Seconds
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Identify the need
Put the pieces together
Make a controlled stop
Fill in the gap
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HIGH
PERFORMANCE
CPR
RateDepth
ReleaseVentilations
Pauses
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Chest compressions:
a 2 person job
2. Your pulse check is too long
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21 SECONDS
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21 sec
11 sec
56 sec
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Forget about 2 minutes
Don’t stop until you are ready
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NOTIFICATION/ SAY “P ULSE CHECK”STOP CPR
STABILIZE COMPRESSOR
HANDS OFF PATIENT
LOOK AT MONITORANALYZE RHYTHM
COMMAND PULSE CHECK
RECOGNIZE RHYTHM
VERBALIZE RHYTHM
PULSE CHECK : FINGERS ON PATIENTMOVE FINGERS
FEEL PULSE
RECOGNIZE PULSEVERBALIZE PULSE
COMMAND SHOCK
DELIVER SHOCK
CHARGE DEFIBRILATORCLEAR PATIENT
PUSH BUTTON
SHOCK DELIVERED
FIRST COMPRESSOR MOVES
NEW COMPRESSOR MOVES INNEW COMPRESSOR HANDS ON
BEGIN COMPRESSIONS
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NOTIFICATION/ SAY “PULSE CHECK”STOP CPR
STABILIZE COMPRESSOR
HANDS OFF PATIENT
LOOK AT MONITOR
ANALYZE RHYTHM
COMMAND PULSE CHECK
RECOGNIZE RHYTHM
VERBALIZE RHYTHM
PULSE CHECK: FINGERS ON PATIENT
MOVE FINGERS
FEEL PULSE
RECOGNIZE PULSE
VERBALIZE PULSE
COMMAND SHOCK
DELIVER SHOCK
CHARGE DEFIBRILATOR
CLEAR PATIENT
PUSH BUTTON
SHOCK DELIVERED
FIRST COMPRESSOR MOVES
NEW COMPRESSOR MOVES IN
NEW COMPRESSOR HANDS ON
BEGIN COMPRESSIONS
Precharge defibrillator
Have next compressor ready
Be looking at the monitor
Never just stop
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3.You’re bagging to fast… or
maybe too slow
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Continuous Interrupted
ROSC 24.2 25.3
Survival 9.0 9.7
Neuro intact 7.0 7.7SAME!
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Continuous Interrupted
CCF 0.83 0.77
Pauses > 2 sec 3.8 7
Pre-shock pause 12 12
Post-shock pause 6 6
Intubated 48% 49%
SAME!
SAME!
SAME!
SAME!
REALLY LOW!
37 breaths/ minute
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Synchronous Asynchronous Compressions
What is your survival?
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What’s your Utstein survival?
MEASUREIMPROVEMEASURE
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4.Data drives your improvements
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Improve Family PresenceImprove ETCO2 use
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+ / -Resus
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1
0.9%
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RateDepthRecoil
VentilationCCF
Peri-shock interval
+ / -Resus
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Resus
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The
ERire
The ER
ADminisgard Mt
Cardior
Minis
CVICU
Among patients resuscitated from VF/pVT OHCA
with ST-segment elevation on their
postresuscitation ECG, the prevalence of coronary
artery disease has been shown to be 70% to 85%.
More than 90% of these patients have had
successful percutaneous coronary intervention.
Conversely, among patients resuscitated from VF/pVT
OHCA without ST-segment elevation on their
postresuscitation ECG, the prevalence of coronary
artery disease has been shown to be 25% to 50%. For
these patients, early access to the cardiac
catheterization laboratory is associated with a 10%
to 15% absolute higher functionally favorable
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5.A change in survival takes more
than a single department
DOUBLE YOUR UTSTEIN SURVIVAL
IN 5 YEARS
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