Slides ROSC Lecture 2 Part 3

7/27/2019 Slides ROSC Lecture 2 Part 3

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Study of resuscitation event review:

All residents and students rotating through

resuscitation team roles

Debrief teams on their events

Weekly 30-45 min resuscitationdebriefing/teaching sessions

Can also use CPR data for DEBREIFING


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0%

10%

20%

30%

40%

50%

60%

Baseline Feedback Feedback +

40%45%

59%

P=0.04

Edelson et al, 2008

Training effect co nfirm ed by Dine et al, 2008

CPR is much more important that medications


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CPR is much more important that medications

Intravenous drug administration during out-of-hospital cardiac arrest

Olasveengen et al, JAMA 2009

Randomized trial of epinephrine versus no epinephrineFor EMS treated cardiac arrest NO SURVIVAL BENEFIT!
http://www.google.com/imgres?imgurl=http://www.goodmoney.com/norflag.gif&imgrefurl=http://www.goodmoney.com/norway.htm&h=288&w=475&sz=4&tbnid=MXESPrIWofUxrM:&tbnh=78&tbnw=129&prev=/images?q=norway+flag&hl=en&usg=__N13G4IS7k1SvgCqXnFjG_7iVgUc=&sa=X&ei=0m5hTIKQFoOClAfG2-H9CQ&ved=0CCkQ9QEwAw


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Manual CPR support devices

Mechanical CPR devices

Zoll AED, R series

Philips MRx

Autopulse

LUCAS

Different methods to ensure CPR quality


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Hallstrom et al, 2006 (ASPIRE)

Out-of-hospital, multicenter randomized trialSites in US, Canada

ROSC 92/373 (24.7%) 104/394 (26.4%)

D/C 37/373 (9.9%) 23/394 (5.8%)

Manual Autopulse

Major studies of the Zoll Autopulse device


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EMS leaders in Arizona recognized the

Importance of high quality CPR

Tripled survival to hospital discharge (3.8% 9.1%)

Minimally interrupted cardiac resuscitation by emergency medical

Services for out-of-hospital cardiac arrest

Bobrow et al, 2008

What can professional rescues do to improve CPR?

Interventions:

1. Delay intubation

2. 200 compressions before first shock3. Minimize pre and post shock pauses


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The million dollar (and million lives.) question:

What is the CPR quality like in YOUR

community EMS agency?

If your loved one collapsed right now, and you called 911would theEMS providers give resuscitation care following the Arizona protocol?


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1.Cardiac arrest is not hopeless!

2.CPR quality has big impact

3.Minimize ventilations

4.Maximize chest compression rate and depth

5.For professional responders: consider CPRfeedback tools and code debriefing

6. For the lay public: learn CPR!

Summarykey learning points


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Upcoming Coursera lectures in this program

Lecture 2: Rethinking CPR: quality of care andnew ideas about training

Lecture 3: Finding the AEDsthe role of social

media

Lecture 4: Therapeutic hypothermia and post-resuscitation care

Lecture 5: Frontiers in resuscitation: reperfusion

medicine and cardiac bypass

Lecture 6: Survivorship and end-of-life issuesafter cardiac arrest

Documents

Slides ROSC Lecture 2 Part 3