high performance-high density- pit crew- team cpr
DESCRIPTION
Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)TRANSCRIPT
HIGH PERFORMANCE CPR:A BEGINNERS GUIDE TO
IMPLEMENTATION
DISCLAIMER
INTRODUCTORY REMARKS
QUESTION FOR AUDIENCE:HOW MANY OF YOU PRACTICE CPR
(OUTSIDE OF YOUR AHA CLASS)
?
BEGINNERS PERMIT
DON’T THROW OUT THE BABY WITH THE BATH WATER!
YOUR STANDARDIZEDTRAINING IS IMPORTANT!
TOO MANY PEOPLE ARE GOING HERETOO EARLY!
SURVIVAL is the
BENCHMARK for
EMS PERFORMANCE
A QUICK REVIEWOF RELATED SCIENCE
SystoleDiastole
DUTY CYCLE
DELAYS AND INTERRUPTIONS KILL!
DEATH BY HYPERVENTILATION
A COMMON EXPERIENCE IN CARDIAC ARREST
TRANSITION TIME-NO FLOW-DEFIBRILLATION
WATCH YOUR TRANSITION
FROM MANUAL TO
MECHANICAL CPR IF THESE DEVICES ARE
USED
•Perceived performance does not always match observed performance.
•Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance.
•Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations.
•The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest compressions/minute).
THE PAINFUL TRUTH
COMPRESSIONS……..C
VENTILATIONS………..C
DATA COLLECTION…..D
SURVIVAL……....……….D
HAVING QUALITY TIME ON THE CHESTIS ESSENTIAL
TUNNEL VISION AND ALTERATIONS
IN SITUATIONAL AWARENESS DURING RESUSCITATION
Eastern Airlines 401 crashed into the Everglades in
December of 1972 as a result of the flight crew's failure
to recognize a deactivation of the autopilot during their
attempt to troubleshoot a malfunction of the landing
gear position indicator system (an indicator light).
Fatigue and poor crew resource management (CRM)
contributed to the accident.
EA 401 gradually lost altitude while the flight crew was
preoccupied and eventually crashed.
The effect of this crash on the airline industry continues
today and has resulted in the development of Crew
Resource Management (CRM). CRM is a technique that
requires air crews to divide the work in the cockpit
amongst available crew ensuring that someone
continues focusing on flying the plane while
troubleshooting continues.
“Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)”
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
EACH PERSON HAS AN ASSIGNED ROLE
AND PRACTICES AGAIN AND AGAIN!
Compress
> 2 inches
Minimize interruptions
Full recoil
Rate between 100 and 120/min
Improved survival
Switch compressors every 2 min. Hover hands
Prioritize compressions
C-A-B
Rapid rhythm analysis
Minimize pauses
Administer drugs
Intubation IV placement
EMT CPR Foundation
Paramedic Advanced Life
Support
BLS Continuous BLS 30:2
Compression/ventilation ratio 10:1 30:2
Stop for ventilations no yes
Rhythm assessment every 2 minutes every 2 minutes*
Compressions prior to rhythm assessment
2 minutes or 200 compressions variable*
•EMTs own CPR•Minimize interruptions in CPR at all times•Ensure proper depth of compressions (>2 inches)•Ensure full chest recoil/decompression•Ensure proper chest compression rate (100-120/min)•Rotate compressors every 2 minutes •Hover hands over chest during shock administration and be ready to compress as soon as patient is cleared•Intubate or place advanced airway with ongoing CPR•Place IV or IO with ongoing CPR•Coordination and teamwork between EMTs and paramedics
10 PRINCIPLES
•C-A-B•Minimize interruptions in compressions•Compress at least 100/min•Allow complete chest wall recoil/decompression between compressions•Rhythm assessment every 2 minutes•Rotate compressors every 2 minutes•Hover over patient with hands ready during defibrillation so compressions can start immediately after the shock (or analysis) has occurred
ALWAYS TRUE!
HOVERING
BREAK TIME!
1
2
3
4
5
6
PIT CREW LEADERAIRWAY LEADERDEFIB-IV/IO-MEDSCPR CHIEFCPR DEPUTY CHIEF
*VARIABLE PLAYER
PRE-ASSIGNED ROLES
1
3
24
56
BOSS
ACCESSMEDS
MONITOR
CPR 1
CPR 2
AIRWAYVENTILATION
AIRWAYASSISTANT
RESUSCITATIONPIT CREW MODEL
FEEDBACK?
PRACTICELIKEYOUPLAY
HP CPRPREVIEW
30:2
CONTINUOUS
THIS IS WHERE IT IS AT
CONTEXTUALIZETRAINING
CONTEXTUALIZE:THIS?
MEASURINGTIME
VIDEO TAPEPRACTICE
USEINSTRUMENTED
MANIKINS
FREQUENCY OF
PRACTICE
FREEING UP TIMEFOR PRACTICE
WITHELEARNING
ANDMICROSIMULATION
NON-PUNITIVE QI
Shock 1 Delivered Medics on scene: no break in CPR
Analysis 2: no shock advised
Compressions
Ventilations
DID YOU KNOW?
Culture of ExcellenceIterative Process
EMDCitizen CPREarly Shock
HP CPRHypothermia
READ!READ!READ!
AND READ AGAIN!
Are you interested in high quality resuscitation related news, discussion topics
and other associated interests?
HEARTSafe Community andAmerican Heart Association- Public Safety
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