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In-hospital Cardiac Arrest-First and foremost Chest Compressions PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "In-hospital Cardiac Arrest: First and foremost, Chest Compressions", to know about In-hospital Cardiac Arrest and Chest Compressions.

Tags : Emergency Medical Services, EMS, In-hospital Cardiac Arrest, Chest Compressions

Published on : Aug 06, 2021 | Views : 1243 | Downloads : 6

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Slide 1-

In-hospital Cardiac Arrest: First and foremost, Chest Compressions Charles L Campbell MS MD Associate Professor of Medicine University of Kentucky College of Medicine
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No Disclosures
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Outline IHCA Hospitals Vary in Outcome Why What is recommended How should it be done Does it really matter
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IHCA is pretty common… ˜200,000 in the US Survival is 18-20% There is tremendous variability among hospitals Get with the Guidelines 135,896 20% with Ventricular fibrillation or Ventricular tachycardia 64% occur in an ICU Median Survival Varies 8.3% at the lowest Decile 31.4 at the highest JAHA. 2014;3:e000400
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JAHA. 2014;3:e000400
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JAHA. 2014;3:e000400
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JAHA. 2014;3:e000400
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What seems to work? Performing ACLS correctly is associated with an improvement in outcome MUSC study Compared guideline adherence for survivors vs. non-survivors 75 survivors 75 non-survivors Survivors older and with more cormorbidities Resuscitation. 2013;85:82-87
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Resuscitation. 2013;85:82-87
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Resuscitation. 2013;85:82-87
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Resuscitation. 2013;85:82-87
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Resuscitation. 2013;85:82-87
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Each 10% improvement in adherance results in a ˜30% increase in ROSC. Resuscitation. 2013;85:82-87
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What is Happening Weisfeldt and Becker Electrical Phase 4 min Defibrillation alone may be effective Circulator Phase Chest compressions are necessary Metabolic Phase Stone Heart JAMA.2002;288:3035-3038
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Time course of VF
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Circulation. 2005;111:1136-1140 and e294
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J Cardiovascular Magnetic Resonance. 2011;13:17 Hypothermia during VT/VF
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What is Recommended Defibrillation Chest Compressions Oxygenation Medications Procedures
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NEJM 2008;358:9-17
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Chest Compressions Place patient on a firm surface Backboard Deflation of air mattress Had in the middle of the chest 5 cm of depression Allow complete recoil Lifting the hand completely of the chest can improve recoil Circulation. 2010;122:S685-705
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How Fast Rate 100-120 cpm Deliver >80 per minute That means minimal interruption Duty Cycle Time between the start of one compression and the start of the next Target is 50% As much time relaxing as compressing Circulation. 2010;122:S685-705
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Circulation. 2005;428-434
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Circulation. 2005;428-434
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Circulation. 2005;428-434
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Circulation. 2012;125:3004-12 ROC consortium (9 sites) OHCA in which monitors/defib measured chest compression rates 3098 cases analyzed
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Circulation. 2012;125:3004-12
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Circulation. 2012;125:3004-12 Compression rate vs Compressions Delivered
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Circulation Qual Outcomes.2013;6:148-156
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Compression Depth
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Resuscitation. 2005;64:363-372
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Circulation Qual Outcomes.2013;6:148-156
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Recoil Matters…
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Resuscitation. 2006;71:341-351
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Resuscitation. 2006;71:341-351
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Resuscitation. 2006;64:353-362
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Circulation Qual Outcomes.2013;6:148-156
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Resuscitation, 2007;73:54-61
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Resuscitation, 2007;73:54-61
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Resuscitation, 2007;73:54-61
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Resuscitation. 2009;80:743-751
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Non-Shockable Rhythms
Slide 42-

Circulation. 2012;125:1787-94
Slide 43-

Circulation. 2012;125:1787-94
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Chest Compressions and Defibrillation
Slide 45-

Resuscitation. 2006;71:137-145
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Resuscitation. 2006;71:137-145
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Survival from OHCA improved after the implementation of a protocol that required 90 seconds of CPR prior to the delivery of a shock via an AED 24% to 30% Particularly in those in whom the intial response interval was > 4 min. JAMA. 1999;281:1182-1188
Slide 48-

Resuscitation. 2008;77:10-15
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Resuscitation. 2008;77:10-15
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Resuscitation. 2008;77:10-15
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Mechanical CPR?
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ppt slide no 53 content not found
Slide 54-

Conclusions Chest Compressions are the cornerstone of resuscitation Rate Depth Recoil Minimizing Interruptions Feedback is probably helpful In some cases chest compressions aid defibrillation Mechanical chest compressors have not been demonstrated to be helpful