slides rosc lecture 4 part 5

7/28/2019 Slides ROSC Lecture 4 Part 5

1/15

Suspended Animation =

Emergency Preservation and

Recovery


2/15

Hypovolemic Cardiac Arrest

Trauma hypovolemia cardiac arrest

1984: Safar and Bellamy:

Suspended animation: rapid preservationof viability of the organism in temporarily

unresuscitable cardiac arrest

Immediate deep to profound hypothermia

Pharmacology

Surgical repair

1988: Tisherman dog model of EPR

Safer Center for Resuscitation Research. http://www.safar.pitt.edu/content/programs/safar/


3/15

CoolColdUltra Cold!

Normothermia: 37oC

Mild hypothermia: 34 36oC

Moderate hypothermia: 30

o

C

Profound hypothermia: 5 - 10oC

Ultraprofound hypothermia: < 5oC

Deep hypothermia: 20oC


4/15

Safar: Suspended Animation

Design 14 dogs exsanguinate > 5min, cardiac arrest

Flush of saline at 2C into the femoral artery

at 2 min of cardiac arrest until animal is 10C Randomized

No trauma

Trauma- laparotomy, splenic injury prior to

exsanguination; after cardiac arrest, underwentthoracotomy and splenectomy

Resuscitated after cardiac arrest no-flow of60 minutes with CPB and defibrillation


5/15

Results


6/15

REGIONALIZATION


7/15

Post-arrest care: problem #1

300,000 arrest patients each year in USA

50,000 arrests reach hospital with a pulse

5,000 hospitals in USA

10 arrests per year per hospital

SOME HOSPITALS LACK EXPERIENCE


8/15


No catheterization lab

No early hemodynamic management strategy

Cannot perform EEG/neurocritical care

Do not have 24/7 intensivist availability

SOME HOSPITALS dOnT PrOvIdE

ESSEnTIAL ASPEcTS Of bundLE Of cArE


9/15


Emergency Medical Services (EMS)designed to bring to nearest hospital

post-arrest care is complex,

? trauma bypass EMS model

EMS BRINGS to closest HOSPITALS


10/15

Possible solution: Regionalization?

Concept is not new; specialization in:

Stroke Centers

Trauma Centers

Burn Centers
http://images.google.com/imgres?imgurl=http://img.medscape.com/fullsize/migrated/editorial/clinupdates/2001/713/fig9.jpg&imgrefurl=http://cme.medscape.com/viewarticle/416589_2&usg=__vRbSWDkPe9_lourGVTyskJZSmL4=&h=272&w=400&sz=37&hl=en&start=4&tbnid=MGHgyxbqMzP0cM:&tbnh=84&tbnw=124&prev=/images?q=burn+patient&hl=en&rlz=1T4SMSN_enUS323US324http://images.google.com/imgres?imgurl=http://teleburst.files.wordpress.com/2009/07/cliveowensplash_450x450.jpg&imgrefurl=http://teleburst.wordpress.com/2009/07/15/&usg=__r5r-btF2bT1xYUsfh1FXkHibxNE=&h=450&w=450&sz=46&hl=en&start=13&tbnid=UvHCQKemsgSEEM:&tbnh=127&tbnw=127&prev=/images?q=gunshot+victim&hl=en&rlz=1T4SMSN_enUS323US324http://images.google.com/imgres?imgurl=http://www.getthecholesterolfacts.com/images/how-a-stroke-happens.gif&imgrefurl=http://www.getthecholesterolfacts.com/heart-attack-and-stroke.jsp&usg=__egqq7MPNL3eFyeA5oXicLajBjyg=&h=291&w=374&sz=26&hl=en&start=5&tbnid=qOb-Gw6ph3reLM:&tbnh=95&tbnw=122&prev=/images?q=brain+with+stroke&hl=en&rlz=1T4SMSN_enUS323US324http://images.google.com/imgres?imgurl=http://www.laxcast.com/images/Penn%20Logo3.jpg&imgrefurl=http://www.laxcast.com/laxcasts.php&h=575&w=504&sz=86&hl=en&start=2&tbnid=FQB_-U94MtoUWM:&tbnh=134&tbnw=117&prev=/images?q=Penn+logo&svnum=10&hl=en&lr=&rls=DKUS,DKUS:2006-32,DKUS:en


11/15

Initial experiences in the USA

Initial attempts at regionalization:

ArizonaMinneapolis

New York City

Philadelphia

Some also attempting cooling in the field
http://images.google.com/imgres?imgurl=http://www.laxcast.com/images/Penn%20Logo3.jpg&imgrefurl=http://www.laxcast.com/laxcasts.php&h=575&w=504&sz=86&hl=en&start=2&tbnid=FQB_-U94MtoUWM:&tbnh=134&tbnw=117&prev=/images?q=Penn+logo&svnum=10&hl=en&lr=&rls=DKUS,DKUS:2006-32,DKUS:en


12/15

ArizonaBureau of EMS met 12/2007

Established Cardiac Arrest Centercriteria

Voluntary hospital participation/no cost All acute care hospitals meeting criteria were invited

to participate

EMS bypass guideline (approved 5/2008)

Arizona experience
http://images.google.com/imgres?imgurl=http://www.photoatlas.com/photo/usa_monument_valley_arizona.jpg&imgrefurl=http://www.photoatlas.com/pics02/pictures_of_usa_07.html&usg=__GI7lOE06BpMaOaqeoX36nKKqnBQ=&h=419&w=640&sz=60&hl=en&start=14&um=1&tbnid=_TM19zf7O4LFvM:&tbnh=90&tbnw=137&prev=/images?q=arizona&hl=en&rlz=1T4SMSN_enUS323US324&sa=N&um=1http://images.google.com/imgres?imgurl=http://www.destination360.com/north-america/us/arizona/images/s/arizona-scottsdale.jpg&imgrefurl=http://www.destination360.com/north-america/us/arizona/scottsdale-arizona&usg=__1VvHb8yXBLwhrsTk7HOnae5c5Xg=&h=332&w=415&sz=44&hl=en&start=20&um=1&tbnid=nLwtCzVKndwYIM:&tbnh=100&tbnw=125&prev=/images?q=arizona&hl=en&rlz=1T4SMSN_enUS323US324&sa=N&um=1


13/15

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

All rhythms --Non-shockable --Witnessed VF

Initial EMS Rhythm

Survivalto

Disc

harge

Pre-

Post-

OR: 2.1 [1.3-3.4]

OR: 1.6 [0.5-4.8]

OR: 3.1 [1.3-7.6]

10.9%

20.5%

3.9% 6.0%

20.3%

39.5%

Arizona CACs save lives


14/15

The Penn experience

6 helicopters

100 mile flight radius

Most hospitals have

helipads
http://images.google.com/imgres?imgurl=http://www.laxcast.com/images/Penn%20Logo3.jpg&imgrefurl=http://www.laxcast.com/laxcasts.php&h=575&w=504&sz=86&hl=en&start=2&tbnid=FQB_-U94MtoUWM:&tbnh=134&tbnw=117&prev=/images?q=Penn+logo&svnum=10&hl=en&lr=&rls=DKUS,DKUS:2006-32,DKUS:en


15/15

slides rosc lecture 4 part 5

Documents