New Concepts in CPRNew Concepts in CPR

Presented by Presented by Alyson WelchAlyson WelchEMS Educator EMS Educator

Gilbert Fire DepartmentGilbert Fire Department

ObjectivesObjectives Overview of new concepts in CPROverview of new concepts in CPR Discuss CC CPR including:Discuss CC CPR including:

Who, Why, and HowWho, Why, and How Watch demonstration of CC CPRWatch demonstration of CC CPR Overview case with CC CPROverview case with CC CPR Discuss CCRDiscuss CCR

Including Who, Why, and HowIncluding Who, Why, and How Watch demonstration of CCRWatch demonstration of CCR Overview of case with CC CPROverview of case with CC CPR ReviewReview

Three Types of CPR Three Types of CPR used in Arizonaused in Arizona

AHA CPR 2005 Guidelines (CPR)AHA CPR 2005 Guidelines (CPR) Continuous Chest Compresssion CPR (CC Continuous Chest Compresssion CPR (CC

CPR)CPR) Cardio Cerebral Resusitation (CCR)Cardio Cerebral Resusitation (CCR)

AbbreviationsAbbreviations

SCA - Sudden Cardiac ArrestSCA - Sudden Cardiac Arrest CPR – Cardio Pulmonary ResuscitationCPR – Cardio Pulmonary Resuscitation CC CPR – Chest Compression CPRCC CPR – Chest Compression CPR CCR – Cardio Cerebral ResuscitationCCR – Cardio Cerebral Resuscitation

Alternatives to Traditional CPRAlternatives to Traditional CPR

Why are alternatives acceptable?Why are alternatives acceptable? How are alternatives developed?How are alternatives developed? Were these piloted and where?Were these piloted and where?

Why are alternatives acceptable?Why are alternatives acceptable?

Oxygen Supply in the Body Oxygen Supply in the Body

Respiratory Arrest patients have depleted Respiratory Arrest patients have depleted oxygen stores in their blood.oxygen stores in their blood.

Sudden Cardiac Arrest patients have non Sudden Cardiac Arrest patients have non circulating oxygen supply in their blood.circulating oxygen supply in their blood.

How are alternatives developed?How are alternatives developed?

University of Arizona has been studying University of Arizona has been studying version of CPR and their outcomes on version of CPR and their outcomes on pigs.pigs.

Were these piloted and where?Were these piloted and where?

Tucson began a pilot study using a version Tucson began a pilot study using a version of CPR.of CPR.

Other cities in the state joined in after Other cities in the state joined in after being approached and reviewing the data.being approached and reviewing the data.

Mesa, Gilbert, and Apache Junction began Mesa, Gilbert, and Apache Junction began using this during the summer of 2005.using this during the summer of 2005.

Phases of CPRPhases of CPR

Possible therapeutic hypothermia or other new concepts

After about 10 to 15 min

Metabolic phase3

CPR before electrical therapy

About 5 min to 10 or 15 min after arrest

Circulatory (hemodynamic) phase

2

Electrical therapyFrom time of arrest to about the first 5 min after arrest

Electrical phase1

Important intervention

Time from VF arrestPhase NamePhase

CPRCPR

Cardio Pulmonary Resuscitation = heart, Cardio Pulmonary Resuscitation = heart, lung resuscitationlung resuscitation

During traditional CPR, patients are given During traditional CPR, patients are given both chest compressions and ventilations both chest compressions and ventilations during resuscitation attempts. during resuscitation attempts.

Continuous Chest Compresssion Continuous Chest Compresssion CPR (CC CPR)CPR (CC CPR)

This type of CPR is taught to lay people. (non This type of CPR is taught to lay people. (non health care providers)health care providers)

CC CPR emphasizes on hard, fast chest CC CPR emphasizes on hard, fast chest compressions, minimizing interruptions.compressions, minimizing interruptions.

During CC CPR, a patient receives chest During CC CPR, a patient receives chest compressions that circulates oxygenated compressions that circulates oxygenated blood.blood.

Early defibrillation when a device is available.Early defibrillation when a device is available.

CC CPR DemonstrationCC CPR Demonstration

http://www.azshare.gov/http://www.azshare.gov/

http://www.azshare.gov/SHAREvideos.htm# http://www.azshare.gov/SHAREvideos.htm#

CPR JackhammerCPR Jackhammer

Steve Steve BerryBerry

Survivor StorySurvivor Story

Cardio Cerebral Resuscitation (CCR)Cardio Cerebral Resuscitation (CCR)

This type of CPR is taught to healthcare This type of CPR is taught to healthcare providers, with approval from medical providers, with approval from medical direction. direction.

CCR emphasizes on hard, fast chest CCR emphasizes on hard, fast chest compressions, minimizing interruptions, compressions, minimizing interruptions, defibrillation, and administration of defibrillation, and administration of epinephrine and atropine..epinephrine and atropine..

During CCR, a patient receives chest During CCR, a patient receives chest compressions that circulates oxygenated compressions that circulates oxygenated blood, vital defibrillations, and medications.blood, vital defibrillations, and medications.

CCRCCR

CCR is used on patient who have a sudden cardiac CCR is used on patient who have a sudden cardiac arrestarrest

DO NOT USE ONDO NOT USE ON::Primary Respiratory ArrestPrimary Respiratory ArrestOverdose Arrest Overdose Arrest Traumatic ArrestTraumatic ArrestDrowningDrowningAny patient <8 years oldAny patient <8 years old

Why CCR?Why CCR?

Oxygenated heart is critical to defibrillationOxygenated heart is critical to defibrillation Sudden Cardiac Arrest patients have non Sudden Cardiac Arrest patients have non

circulating oxygen supply in their bloodcirculating oxygen supply in their blood The medications given help to increase a The medications given help to increase a

heart rateheart rate

ResultsResults

Since the pilot began, CCR has changed Since the pilot began, CCR has changed several times based on the patient several times based on the patient outcomes.outcomes.

Save rate was at <3% in the Town of Save rate was at <3% in the Town of Gilbert prior to using CCR.Gilbert prior to using CCR.

Current save rate is at 33% in the Town of Current save rate is at 33% in the Town of Gilbert using CCR. Gilbert using CCR.

CCR DemonstrationCCR Demonstration

Please welcome Gilbert Fire Department Please welcome Gilbert Fire Department L253 A shift. L253 A shift.

Captain ParamedicCaptain Paramedic Frank PliteFrank Plite

EngineerEngineer Dave TavaresDave TavaresFirefighter Paramedic Firefighter Paramedic Jodi SpargoJodi SpargoFirefighterFirefighter Chris MillsChris Mills

Return of spontaneous pulsesReturn of spontaneous pulsesduring cardiocerebral resusitation (CCR)during cardiocerebral resusitation (CCR)

If patient has an organized rhythm with a pulse during the analysis If patient has an organized rhythm with a pulse during the analysis phase, then proceed with the following:phase, then proceed with the following:

1. Support patient ventilation with BVM at 8/min (strictly avoid 1. Support patient ventilation with BVM at 8/min (strictly avoid hyperventilation)hyperventilation)2. Administer 250 ml of intravenous fluid2. Administer 250 ml of intravenous fluid3. Administer Lidocaine bolus at 1 to 1.5 mg/kg IV and hang a drip.3. Administer Lidocaine bolus at 1 to 1.5 mg/kg IV and hang a drip.4. Perform 12-lead ECG to check for STEMI (ST elevation MI) and 4. Perform 12-lead ECG to check for STEMI (ST elevation MI) and

pre-notify EDpre-notify ED

If patient goes into cardiac arrest again, perform chest If patient goes into cardiac arrest again, perform chest compressions at a rate of 100/per minute. Ventilate the patient at 8 compressions at a rate of 100/per minute. Ventilate the patient at 8 breaths per minute. Follow ACLS protocols.breaths per minute. Follow ACLS protocols.