Changes in Cardiac Arrest Management
Pathophysiology of V-Fib Arrest
Defibrillation
No more stacked shocksTakes too longAll shocks maximum energy.EMS probably should not use AED’sBiphasic 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 lifeECC 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.
AirwayCombitube or ET equivalentRSA Mentality-view and see cords place ET, otherwise
immediate Combitube first try.
Recommendations
Bystander CRR program911 CRR phone instructionDefib 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