Changes in Cardiac Arrest Management

Pathophysiology of V- Fib Arrest

Defibrillation No more stacked shocks Takes too long All shocks maximum energy. EMS probably should not use AED’s Biphasic 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 life ECC 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.

Airway Combitube or ET equivalent RSA Mentality-view and see cords place ET, otherwise immediate Combitube first try.

Recommendations Bystander CRR program 911 CRR phone instruction Defib 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