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New Strategies in Resuscitation

Walt Lubbers, MD FAAEMUniversity of Cincinnati

No financial disclosures

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New Strategies in Resuscitation

Walt Lubbers, MD FAAEMUniversity of Cincinnati

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1.Fix your compressions

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100-120 cpm

2.0-2.4”

Idris et al, Circulation. 2012;125:3004-3012.

1241241601608080 140140

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Stiel et al. Circulation. 2014;130:1962-1970.

1.8”1.8”

2.4 in2.4 in2 in2 in

Push hard…kindaDon’t push that fast

Push CorrectlyDon’t Stop

Push HardPush Fast

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ARE YOU DOING THAT?

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RT

Compressions

IV/ MedsIV/

Meds

Lines

Airway

Leader

Other guySpectator

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60 Seconds

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Identify the need

Put the pieces together

Make a controlled stop

Fill in the gap

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HIGH

PERFORMANCE

CPR

RateDepth

ReleaseVentilations

Pauses

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Chest compressions:

a 2 person job

2. Your pulse check is too long

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21 SECONDS

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21 sec

11 sec

56 sec

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Forget about 2 minutes

Don’t stop until you are ready

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NOTIFICATION/ SAY “P ULSE CHECK”STOP CPR

STABILIZE COMPRESSOR

HANDS OFF PATIENT

LOOK AT MONITORANALYZE RHYTHM

COMMAND PULSE CHECK

RECOGNIZE RHYTHM

VERBALIZE RHYTHM

PULSE CHECK : FINGERS ON PATIENTMOVE FINGERS

FEEL PULSE

RECOGNIZE PULSEVERBALIZE PULSE

COMMAND SHOCK

DELIVER SHOCK

CHARGE DEFIBRILATORCLEAR PATIENT

PUSH BUTTON

SHOCK DELIVERED

FIRST COMPRESSOR MOVES

NEW COMPRESSOR MOVES INNEW COMPRESSOR HANDS ON

BEGIN COMPRESSIONS

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NOTIFICATION/ SAY “PULSE CHECK”STOP CPR

STABILIZE COMPRESSOR

HANDS OFF PATIENT

LOOK AT MONITOR

ANALYZE RHYTHM

COMMAND PULSE CHECK

RECOGNIZE RHYTHM

VERBALIZE RHYTHM

PULSE CHECK: FINGERS ON PATIENT

MOVE FINGERS

FEEL PULSE

RECOGNIZE PULSE

VERBALIZE PULSE

COMMAND SHOCK

DELIVER SHOCK

CHARGE DEFIBRILATOR

CLEAR PATIENT

PUSH BUTTON

SHOCK DELIVERED

FIRST COMPRESSOR MOVES

NEW COMPRESSOR MOVES IN

NEW COMPRESSOR HANDS ON

BEGIN COMPRESSIONS

Precharge defibrillator

Have next compressor ready

Be looking at the monitor

Never just stop

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3.You’re bagging to fast… or

maybe too slow

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Continuous Interrupted

ROSC 24.2 25.3

Survival 9.0 9.7

Neuro intact 7.0 7.7SAME!

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Continuous Interrupted

CCF 0.83 0.77

Pauses > 2 sec 3.8 7

Pre-shock pause 12 12

Post-shock pause 6 6

Intubated 48% 49%

SAME!

SAME!

SAME!

SAME!

REALLY LOW!

37 breaths/ minute

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Synchronous Asynchronous Compressions

What is your survival?

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What’s your Utstein survival?

MEASUREIMPROVEMEASURE

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4.Data drives your improvements

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Improve Family PresenceImprove ETCO2 use

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+ / -Resus

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1

0.9%

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RateDepthRecoil

VentilationCCF

Peri-shock interval

+ / -Resus

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Resus

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The

ERire

The ER

ADminisgard Mt

Cardior

Minis

CVICU

Among patients resuscitated from VF/pVT OHCA

with ST-segment elevation on their

postresuscitation ECG, the prevalence of coronary

artery disease has been shown to be 70% to 85%.

More than 90% of these patients have had

successful percutaneous coronary intervention.

Conversely, among patients resuscitated from VF/pVT

OHCA without ST-segment elevation on their

postresuscitation ECG, the prevalence of coronary

artery disease has been shown to be 25% to 50%. For

these patients, early access to the cardiac

catheterization laboratory is associated with a 10%

to 15% absolute higher functionally favorable

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5.A change in survival takes more

than a single department

DOUBLE YOUR UTSTEIN SURVIVAL

IN 5 YEARS

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