Changes in Cardiac Arrest Management

Pathophysiology of V-Fib Arrest

Defibrillation

No more stacked shocksTakes too longAll shocks maximum energy.EMS probably should not use AED’sBiphasic increases efficacy

Defibrillation

• Primary treatment for V-fib at 3 minutes and under

• Should be delayed until good CPR for 2 minutes if down time over 3 minutes

• Biphasic should be used• AED’s good in 3 minutes, bad after• One shock only with no pulse checks

after

Pulse Checks

Deadly!!Only check pulses when rhythm appears to have converted thru CPR on ECG or signs of lifeECC says check before shock delivered after 5 cycles of 30:2 CPR

Vascular Access

• Avoid ET drugs whenever possible• Peripheral IV’s OK• Central IV’s slightly better, but

compression interruption frequent with placement

• Interosseous recommended when peripheral IV’s not obtainable

Pharmacology

• No improvements evident based on science with drugs to improve outcome

• Epinephrine every 5 minutes• No added benefit to Vasopressin• Amiodarone and Lidocaine equal

effectiveness

What about intubation?

In first 6 minutes, not a priority (V-fib) ASAP in PEA and Asystole.Understand that positive pressure breaths decrease cardiac output.Some air exchange from CPR plus gasping.Once intubated, 1 second breaths,six per minute. NO MORE.

AirwayCombitube or ET equivalentRSA Mentality-view and see cords place ET, otherwise

immediate Combitube first try.

Recommendations

Bystander CRR program911 CRR phone instructionDefib in first 2-3 minutes

CRR before shocks otherwise

Recommendations

• AED’s in community, not on ambulance

• 200 uninterrupted compression• No airway first 3 rounds of CRR• Immediate vascular access- IO if

needed• Epinephrine 1mg as soon as possible

Recommendations

• When airway is placed, use non-visualized airway or RSA technique if intubating

• No pause to put in airway• Never a pause after defib to check

pulse or rhythm.

Testimony and Example

• A great example