Cardiac Arrest Rescusitation Attempts

What are people doing 5 years later? I have seen two groups of EMS/medics form out in the past few years. The first is establishing an IV and ETT and transporting as early as possible cardiac arrest patients while continuing CPR and ACLS.

The second is sitting on scene for an extended period of time, up to 45-60min to perform their resuscitation under the auspices that they are doing the same thing as in the ED. All ACLS is followed appropriately, CPR is great, etc.

Anyone seeing differences in outcomes to hospital discharge?

I was a strong proponent of the latter until a recent code I had that was witnessed and secondary to a LAD occlusion. One could argue that if we transported immediately we could have gone to the cath lab while performing CPR and opened the LAD and tried to see if that helped. the other argument is CPR during transport has poor quality. Thoughts?

Tags: ACLS, BCLS, CPR, arrest, cardiac, codes

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Permalink Reply by Rocco on November 7, 2009 at 9:53pm

Kevin, our protocol is now 20 minutes onscene without change of rhythm or return of pulse to terminate the efforts at scene and not transport.

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Permalink Reply by Kevin Collopy on November 7, 2009 at 10:12pm

So will you terminate with a patient still in persistent VT after 20min?

Rocco said:

Kevin, our protocol is now 20 minutes onscene without change of rhythm or return of pulse to terminate the efforts at scene and not transport.

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Permalink Reply by Rocco on November 7, 2009 at 10:15pm

No, should have said asystole

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Permalink Reply by Kevin Collopy on November 7, 2009 at 10:19pm

Thanks for clarifying. So what does your protcol, or physicans, recommend you do with persistent VT/VF after 20? 30? 40? min on scene.

Rocco said:

No, should have said asystole

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Permalink Reply by Kevin Collopy on November 7, 2009 at 10:19pm

For the record. I fully support and agree, and typically utilize 10-20min of asystole is terminal and we terminate those patients on scene.

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Permalink Reply by Rocco on November 7, 2009 at 10:23pm

Hopefully not onscene longer than 20 minutes. Transport and follow ACLS

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Permalink Reply by Kevin Collopy on November 7, 2009 at 10:26pm

i am simply playing devils advocate. Can't you perform better CPR and ACLS on scene rather than transporting? The debate here is how is this balanced with delivering likely MI patients to a cath lab that my correct the underlying problem

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Permalink Reply by Rocco on November 7, 2009 at 10:34pm

You might be able to with an autopulse. Have to consider responders getting tired while working the code and how much meds you have and what meds you carry.

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Permalink Reply by Kevin Collopy on November 7, 2009 at 10:41pm

right, its a careful balance.

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Permalink Reply by Rocco on November 7, 2009 at 10:53pm

For one I don't not like to decide transport or not. Leave that to someone paid more then I am to say STOP the efforts. How do you deal with the family at the scene if you terminate efforts and don't transport? Hard question to answer.

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Permalink Reply by Michael Fraley on November 8, 2009 at 5:36pm

It will be interesting to see if this idea of taking a pre-hospital CPR-in-progress patient to a cath lab catches on. It occurs with in-hospital codes regularly but could we ever do everything that needs to be done (including recognize the MI) and get them to the lab with excellent CPR in time?

As far as calling scene codes with persistent fine VF, it can be done. Dr. Eisenberg talks about it in his book Resuscitation. He cited a Swedish study that survival in long-term VF (>20 minutes) is virtually non-existent.

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Permalink Reply by Travis Constable on November 9, 2009 at 4:00pm

Intubate, shock if needed, continous chest compressions 100/min, acls protocol, early induced hypothermia for all cardiac arrest not just with rosc, and rapid transport.