CPR What Works, What Doesn t

Size: px
Start display at page:

Download "CPR What Works, What Doesn t"

Transcription

1 Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128: Cardiac arrest claims more lives per year than colorectal, breast and prostate cancer, influenza, pneumonia, MVCs, HIV, house fires and guns combined Current survival from out of hospital arrests range from 3%-16.3% (ROC and NHS data) Variable CPR quality greatly affects survival CPR What Works, What Doesn t Authoritative and comprehensive review What works and what doesn t 99 references Insightful recs for PEA and Post Resus care Effect of Intervention on Outcome Effect of Intervention on Outcome Intervention Effect on Outcomes Intervention Effect on Outcomes Compressions only CPR Single vs multiple stacked shocks Mechanical chest compressions Advanced airway placement Uncertain Impedance threshold device Intravenous line placement Active compression /decompression Delayed vs immediate CPR Epinephrine vs placebo High vs standard epinephrine dose, possible harm 1

2 Effect of Intervention on Outcome Intervention Amiodarone vs nifekalant Lidocaine vs placebo Amiodarone vs placebo Atropine vs placebo Aminophylline vs placebo Effect on Outcomes Possible benefit Uncertain Therapeutic Hypothermia New Engl J Med 2013, 369: (32º - 34º) Therapeutic Hypothermia significantly improves survival ( 26%) and neurologic outcome ( 40%) after VF/pVT cardiac arrest What temperature for Therapeutic Hypothermia? 939 patients in randomized trial 36 ICUs in Europe and Australia Evaluated: mortality & neuro outcome at 180d 80% VF/VT; 20% AS and PEA (12%/7%) Hypothermia vs Normal Temp Survival and Neuro Outcomes New Engl J Med 2013, 369: New Engl J Med 2013, 369: % Compared to TH No unwitnessed Asystole patients P = NS 24% intravascular; 76% surface cooled 28 hours of cooling Rewarmed at 0.5 /hour Survival Poor Neuro 36 Survival Poor Neuro 33 2

3 Therapeutic Hypothermia Take Homes The future of deep TH is unclear Preventing Hyperthermia appears crucial Future studies will determine optimal TH temp looks like the new Resuscitation 2015;96: There is no benefit to prehospital hypothermia regardless of cooling method, time to induce TH, continuation of TH in ED or initial arrest rhythm Maximizing In-Hospital Survival JAMA Cardiol 2016;1: JAMA Cardiol 2016;1: What strategies can maximize CPR survival 131 GWTG Resuscitation registry hospitals with 20 arrest Minimizing interruptions Frequent review of CPR cases High quality CPR training Data is from 1/ /2013 Median survival = 23.6% 5 Keys to Optimal CPR compressions/min Depress 2 inches Allow full recoil Minimize interruptions Ventilate Q 6 seconds (8-10 min) Resuscitation 2016;108:54-60 Is PCI indicated s/p VF/pVT arrests if no STEMI on 12-lead? Systematic review and meta-analysis 11 articles involving 2,885 pts. STEMI pts 13 x for transport to CCL Evaluated STEMI in CCL if no STEMI ECG 3

4 Resuscitation 2016;108:54-60 Immediate CCL s/p VF/pVT Arrest Resuscitation 2016;108: % of STEMI on ECG pts had an acute culprit lesion 32.2% of non-stemi ECG pts had an acute culprit lesion Improves survival by a factor of 3.7 (CI ) regardless of STEMI or no STEMI on ECG survival by 30% if no STEMI on ECG Effect of Intervention on Outcome Intervention Sodium bicarbonate vs placebo Magnesium sulfate vs placebo Calcium chloride vs placebo Out-of-hospital cooling Extracorporeal CPR vs conventional CPR Effect on Outcomes Uncertain Uncertain Possible benefit ECMO and ECLS Do they have a role in CPR? ECMO E-CPR Mechanical CPR Resuscitation 2015;86:88-94 ECLS Therapeutic Hypothermia Immediate post ECMO PCI 24 hours of TH Am J Respir Crit Care Med 2014;190:

5 Am J Respir Crit Care Med 2014;190: Uses of ECMO and ECLS Respiratory failure ARDS, H 1 N 1, SARS Bridge to heart transplant Bridge to lung transplant Cardiogenic shock ECLS s/p cardiac arrest Resuscitation 2015;86:88-94 Does ECMO improve post-arrest resuscitation outcomes The CHEER trial Refractory VF x 30 minutes No known underlying severe disease CPR within 10 minutes of arrest Mechanical CPR available ECMO Team with 2 MDs present 26 patients (11 OHCA, 15 IHCA) ECMO within 56 minutes; 2 days on 96% ROSC E-CPR Results Resuscitation 2015;86: % (14/26) survived to discharge with CPC score of 1 full neurologic recovery ECMO CPR Requires large team and planning Careful patient selection 76% complication rate May require transfer to OR 5

6 Resuscitation 2015;88: Can ECMO improve survival from hypothermic drowning patients? 11 year retrospective study ( ) 43 drowning patients, core temp < 30 C All directly admitted to ICU in asystolic arrest 20 patients received ECMO Resuscitation 2015;88: Results & Outcomes 4/20 ECMO patients survived 24 hours 2 discharged, 2 died in ICU 1 (5%) good cerebral performance (CPC 1) 1 severe cerebral disability (CPC 3) ECMO For Drowning Take Homes Rarely effective, but can work All survivors were warmer than 26 C and had a K less than 6 meq/l Drowning + hypothermia is likely worse than acute hypothermia alone This series is scene to immediate ELS at specialty hospital and hard to improve upon Resuscitation 2016;99:26-32 Korean national database of OHCA 36,547 pts, , 320 ECLS pts Propensity matched evaluation (1:1, 2:1, 3:1) Compared ECMO ECLS vs standard care 20% 15% 10% 5% 0% Survival ECMO vs Standard CPR Resuscitation 2016;99: % Std CPR ECLS Std CPR ECLS Survival to DC 18% P=NS 7% 9% Discharge with Good Neuro P=NS Resuscitation 2017;112:34-40 Has CPR survival improved over time with ECMO? Extracorporeal Life Support Organization 1,796 pts from 53 countries in ELSO Divided into 3 groups: ; ; Use of ECMO has increased 10 x Comorbidities while complications over time 6

7 ECPR from Resuscitation 2017;112:34-40 ECPR Survival Over Time Resuscitation 2017;112:34-40 Complications of ECLS After adjusting for severity, there has been no difference in ECMO survival over the past decade Average survival is 29% Major bleeding Infection Lower extremity ischemia Stroke and neurologic complications Lower extremity amputation ECMO Complications and Survival Resuscitation 2017;112:34-40 CVA rate of 7% GI bleeding requiring transfusion > 6% Cannula site bleeding requiring intervention > 20% Indicators for ECMO and ECLS survival: PE, myocarditis, transplant, s/p VF/VT survival: sepsis, ARF, hematologic dsx 7

8 ECPR ECPR Shockable arrest rhythm or known precipitant Reversible cause of arrest Witnessed arrest with CPR Duration of pulselessness < min or transient ROSC Absence of major life-limiting comorbidities No ECLS Survival Improvement with ECLS (CPC 1-2) Resuscitation 2016;103: Elderly or serious underlying diseases Irreversible neurologic insult Morbid obesity or arterial disease ECLS team not readily available Contraindications to LVAD, Heart Transplant Chen 2008 Shin 2011 Meekawa 2013 Sakamoto x (12.3 vs 28.8) 3.6 x (7.8 vs 28.2) 5.0 x (6.4 vs 32.1) 8.2 x (1.5 vs 12.3) ECLS clearly improves in-hospital arrest outcomes if begun within minutes of arrest ECLS of variable benefit for out of hospital arrests unless transported rapidly to the ED J Am Heart Assoc 2016;5:e Rapid ECLS for VF/pVT ECLS s/p 3 shocks + amio in 18 pts 911 to CCL 60 min + 6 min for ECMO No significant complications 50% good neuro outcomes 9/18 8

9 Resuscitation 2016;107:38-46 ED ECMO done infrequently Many centers do 3 cases / year Most programs do not have strict criteria Many did not exclude no CPR > 10 min J Am Heart Assoc 2016;5:e Many did not exclude trauma or comorbidities ECMO costs $42,000 - $537,000 depending on indication & duration In Conclusion The benefits and risks of ECPR remain uncertain ECPR improves survival and good neuro outcomes ECPR increases survival in coma and vegetative status Do not let it be a bridge to nowhere Resuscitation 2015;91:73-5 Think about ECMO in relatively healthy patients with acute reversible diseases like massive PE, refractory VF or shock due to acute AMI that can be cardiogenic with thrombectomy, PCI or bypass. Team needs to be ready to go in under an hour Need high-quality CPR while waiting 9

10 10

Code Talkers NONE. Disclosures Brady & Slovis. Lay Provider Care. Cardiac Arrest 2017 Resuscitation & Post-arrest Management

Code Talkers NONE. Disclosures Brady & Slovis. Lay Provider Care. Cardiac Arrest 2017 Resuscitation & Post-arrest Management X 10/27/2017 Code Talkers 2017 Cardiac Arrest 2017 Resuscitation & Post-arrest Management What makes sense - & doesn t - in cardiac arrest management William Brady, MD University of Virginia Corey Slovis,

More information

Most Important EMS Articles EAGLES 2017

Most Important EMS Articles EAGLES 2017 Most Important EMS Articles EAGLES 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Overview Best antiarrhythmic

More information

Most Important EMS Articles EAGLES 2017

Most Important EMS Articles EAGLES 2017 Most Important EMS Articles EAGLES 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Overview Best antiarrhythmic

More information

Cardiac Arrest January 2017 CPR /3/ Day to Survival Propensity Matched

Cardiac Arrest January 2017 CPR /3/ Day to Survival Propensity Matched Cardiac Arrest January 217 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN CPR 217 Used data based on protocol that

More information

Epinephrine Cardiovascular Emergencies Symposium 2018

Epinephrine Cardiovascular Emergencies Symposium 2018 Epinephrine Cardiovascular Emergencies Symposium 218 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN High Quality

More information

VanderbiltEM.com. Prehospital STEMIs. EMS Today 2018 Research That Should Be On Your Radar Screen 3/1/2018

VanderbiltEM.com. Prehospital STEMIs. EMS Today 2018 Research That Should Be On Your Radar Screen 3/1/2018 EMS Today 2018 Research That Should Be On Your Radar Screen Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN VanderbiltEM.com

More information

ECLS: A new frontier for refractory V.Fib and pulseless VT

ECLS: A new frontier for refractory V.Fib and pulseless VT ECLS: A new frontier for refractory V.Fib and pulseless VT Ernest L. Mazzaferri, Jr. MD, FACC September 15, 2017 Cardiovascular Emergencies: An exploration into the expansion of time-critical diagnosis

More information

5 Key EMS Articles for 2012

5 Key EMS Articles for 2012 5 Key EMS Articles for 2012 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN 5 Key Topics Cardiac Arrest Trauma

More information

Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines

Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines www.circ.ahajournals.org Elham Pishbin. M.D Assistant Professor of Emergency Medicine MUMS C H E S Advanced Life Support

More information

Emergency Cardiac Care Guidelines 2015

Emergency Cardiac Care Guidelines 2015 Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced

More information

Lesson learnt from big trials. Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ.

Lesson learnt from big trials. Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ. Lesson learnt from big trials Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ. Trend of cardiac arrest research 1400 1200 1000 800 600 400 200 0 2008 2009 2010 2011 2012 2013 2014 2015 2016

More information

Advanced Resuscitation - Adult

Advanced Resuscitation - Adult C02A Resuscitation 2017-03-23 17 years & older Office of the Medical Director Advanced Resuscitation - Adult Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia Algorithm

More information

Update on Sudden Cardiac Death and Resuscitation

Update on Sudden Cardiac Death and Resuscitation Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio

More information

E-CPR National Trends & Local Plans

E-CPR National Trends & Local Plans E-CPR National Trends & Local Plans Objectives What is E-CPR? Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Why would one do it? Evidence behind E-CPR?

More information

E-CPR National Trends & Local Plans

E-CPR National Trends & Local Plans E-CPR National Trends & Local Plans Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Objectives What is E-CPR? Why would one do it? Evidence behind E-CPR?

More information

Advanced Resuscitation - Child

Advanced Resuscitation - Child C02C Resuscitation 2017-03-23 1 up to 10 years Office of the Medical Director Advanced Resuscitation - Child Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia Algorithm

More information

The 2015 BLS & ACLS Guideline Updates What Does the Future Hold?

The 2015 BLS & ACLS Guideline Updates What Does the Future Hold? The 2015 BLS & ACLS Guideline Updates What Does the Future Hold? Greater Kansas City Chapter Of AACN 2016 Visions Critical Care Conference Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff

More information

Hypothermia: The Science and Recommendations (In-hospital and Out)

Hypothermia: The Science and Recommendations (In-hospital and Out) Hypothermia: The Science and Recommendations (In-hospital and Out) L. Kristin Newby, MD, MHS Professor of Medicine Duke University Medical Center Chair, Council on Clinical Cardiology, AHA President, Society

More information

Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016

Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016 Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In

More information

Update on Sudden Cardiac Death and Resuscitation

Update on Sudden Cardiac Death and Resuscitation Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio

More information

2015 AHA Guidelines: Pediatric Updates

2015 AHA Guidelines: Pediatric Updates 2015 AHA Guidelines: Pediatric Updates Advances in Pediatric Emergency Medicine December 9, 2016 Karen O Connell, MD, MEd Associate Professor of Pediatrics and Emergency Medicine Emergency Medicine and

More information

PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured.

PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. Question Should AMIODARONE vs LIDOCAINE be used for adults with shock refractory VF/pVT PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. OPTION: AMIODARONE plus standard

More information

Samphant Ponvilawan Bumrungrad International

Samphant Ponvilawan Bumrungrad International Samphant Ponvilawan Bumrungrad International Definitions Artificial circulation using VA ECMO as an alternative to ventilation and external cardiac massage Indications Out-of-Hospital Cardiac Arrest (OHCA)

More information

Advanced Resuscitation - Adolescent

Advanced Resuscitation - Adolescent C02B Resuscitation 2017-03-23 10 up to 17 years Office of the Medical Director Advanced Resuscitation - Adolescent Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia

More information

HIGH QUALITY CPR: IS IT TIME FOR MECHANICAL ASSISTANCE?

HIGH QUALITY CPR: IS IT TIME FOR MECHANICAL ASSISTANCE? HIGH QUALITY CPR: IS IT TIME FOR MECHANICAL ASSISTANCE? EMERGENCY NURSES ASSOCIATION - 2018 Nicole Kupchik MN, RN, CCNS, CCRN-K, PCCN-CMC Objectives Discuss issues with CPR performance in hospitals Describe

More information

Lessons Learned From Cardiac Resuscitation Research: What Matters at the Bedside?

Lessons Learned From Cardiac Resuscitation Research: What Matters at the Bedside? Lessons Learned From Cardiac Resuscitation Research: What Matters at the Bedside? JILL LEY, MS, RN, CNS, FAAN CLINICAL NURSE SPECIALIST SURGICAL SERVICES CALIFORNIA PACIFIC MEDICAL CENTER CLINICAL PROFESSOR,

More information

Refractory cardiac arrest

Refractory cardiac arrest Refractory cardiac arrest Claudio Sandroni Dept. of Anaesthesiology and Intensive Care Catholic University School of Medicine Rome Italy IRC Scientific Committee Conflicts of interest None Cardiac arrest:

More information

Outcomes with ECMO for In Hospital Cardiac Arrest

Outcomes with ECMO for In Hospital Cardiac Arrest Outcomes with ECMO for In Hospital Cardiac Arrest Subhasis Chatterjee, MD, FACS, FACC, FCCP. ECMO Program Director CHI Baylor St. Lukes Medical Center/ Texas Heart Institute Asst. Professor of Surgery,

More information

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,

More information

Enhancing 5 th Chain TTM after Cardiac Arrest

Enhancing 5 th Chain TTM after Cardiac Arrest Enhancing 5 th Chain TTM after Cardiac Arrest Seoul St. Mary s Hospital Department of Emergency Medicine Chun Song Youn Agenda Past Current Future First study, 1958 2002, Two landmark paper HACA Trial

More information

JUST SAY NO? THE LATEST LOOK AT ACLS MEDICATIONS BRIDGETTE SVANCAREK, MD

JUST SAY NO? THE LATEST LOOK AT ACLS MEDICATIONS BRIDGETTE SVANCAREK, MD JUST SAY NO? THE LATEST LOOK AT ACLS MEDICATIONS BRIDGETTE SVANCAREK, MD OBJECTIVES Review the progression of the American Heart Association s ACLS cardiac arrest medication guidelines Identify the latest

More information

New ACLS/Post Arrest Guidelines: For Everyone? Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael s Hospital, University of Toronto

New ACLS/Post Arrest Guidelines: For Everyone? Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael s Hospital, University of Toronto New ACLS/Post Arrest Guidelines: For Everyone? Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael s Hospital, University of Toronto COI Declaration Industry and ROC ALS Taskforce ILCOR Author

More information

THE FOLLOWING QUESTIONS RELATE TO THE RESUSCITATION COUNCIL (UK) RESUSCITATION GUIDELINES 2005

THE FOLLOWING QUESTIONS RELATE TO THE RESUSCITATION COUNCIL (UK) RESUSCITATION GUIDELINES 2005 THE FOLLOWING QUESTIONS RELATE TO THE RESUSCITATION COUNCIL (UK) RESUSCITATION GUIDELINES 2005 1. The guidelines suggest that in out-of-hospital cardiac arrests, attended but unwitnessed by health care

More information

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Margaret Oates, PharmD, BCPPS Pediatric Critical Care Specialist GSHP Summer Meeting July 16, 2016 Disclosures I have nothing to

More information

The ARREST Trial: Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation

The ARREST Trial: Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation The ARREST Trial: Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation Introduction The ARREST (Amiodarone in out-of-hospital Resuscitation of REfractory Sustained

More information

VanderbiltEM.com ACLS ACEP 2016 Cruising the Literature Cardiology Oxygen Use 10/14/2016. Use 100% O 2 during CPR

VanderbiltEM.com ACLS ACEP 2016 Cruising the Literature Cardiology Oxygen Use 10/14/2016. Use 100% O 2 during CPR ACEP 2016 Cruising the Literature Cardiology 2016 VanderbiltEM.com Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville,

More information

ADVANCED LIFE SUPPORT

ADVANCED LIFE SUPPORT ANSWERS IN ITALICS WITH REFERENCES 1. The guidelines suggest that in out-of-hospital cardiac arrests, attended but unwitnessed by health care professionals equipped with a manual defibrillator, the providers

More information

Extracorporeal Life Support (ECLS)

Extracorporeal Life Support (ECLS) Extracorporeal Life Support (ECLS) Moderatore: A. Spagna Discussant M. Rugna, A. Peris, G. Gerosa, M. Raimondi, P. Rosi ADRIANO PERIS- CURE INTENSIVE DEL TRAUMA E SUPPORTI EXTRACORPOREI AOUC- FIRENZE PLANNING

More information

GETTING TO THE HEART OF THE MATTER. Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS

GETTING TO THE HEART OF THE MATTER. Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS GETTING TO THE HEART OF THE MATTER Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS TAKE HOME POINTS CPR is the most important thing Train like we fight Measure

More information

Resuscitation Articles 2017

Resuscitation Articles 2017 Resuscitation Articles 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Annal Emerg Med 2017;Epub ahead of print

More information

ACLS/ACS Updates 2015

ACLS/ACS Updates 2015 ACLS/ACS Updates 2015 Advanced Cardiovascular Life Support by: Fareed Al Nozha, JBIM, ABIM, FKFSH&RC(Cardiology) Consultant Cardiologist Faculty, National CPR Committee, ACLS Program Head, SHA Dr Abdulhalim

More information

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee

More information

EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST

EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST Massimo MASSETTI Cardiac Surgery Department University of Sacred Heart, Gemelli Hospital Rome «No financial interest to declare» ESC CONGRESS 2012

More information

Hypothermia After Cardiac Arrest: Where Are We Now?

Hypothermia After Cardiac Arrest: Where Are We Now? Hypothermia After Cardiac Arrest: Where Are We Now? David A. Pearson, MD, MS Associate Professor Director of Cardiac Arrest Resuscitation Carolinas HealthCare System Disclosures I have no financial interest,

More information

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.

More information

TXA. Things Change. Tranexamic Acid TXA. Resuscitation 2017 TXA In The ED March 31, MAST Trousers. High Flow IV Fluids.

TXA. Things Change. Tranexamic Acid TXA. Resuscitation 2017 TXA In The ED March 31, MAST Trousers. High Flow IV Fluids. Resuscitation 2017 In The ED March 31, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN SECURE THE ABC S MAST

More information

IN HOSPITAL CARDIAC ARREST AND SEPSIS

IN HOSPITAL CARDIAC ARREST AND SEPSIS IN HOSPITAL CARDIAC ARREST AND SEPSIS MARGARET DISSELKAMP, MD OVERVIEW Background Epidemiology of in hospital cardiac arrest (IHCA) Use a case scenario to introduce new guidelines Review surviving sepsis

More information

Johnson County Emergency Medical Services Page 23

Johnson County Emergency Medical Services Page 23 Non-resuscitation Situations: Resuscitation should not be initiated in the following situations: Prolonged arrest as evidenced by lividity in dependent parts, rigor mortis, tissue decomposition, or generalized

More information

What works? What doesn t? What s new? Terry M. Foster, RN

What works? What doesn t? What s new? Terry M. Foster, RN What works? What doesn t? What s new? Terry M. Foster, RN 2016 Changes Updated every 5 years Last update was 2010 All recommendations have been heavily researched with studies involving large number of

More information

EXTRACORPOREAL LIFE SUPPORT FOR REFRACTORY IN-HOSPITAL AND OUT-OF-HOSPITAL CARDIAC ARREST: ARE THE OUTCOMES REALLY DIFFERENT? A 10-YEAR EXPERIENCE

EXTRACORPOREAL LIFE SUPPORT FOR REFRACTORY IN-HOSPITAL AND OUT-OF-HOSPITAL CARDIAC ARREST: ARE THE OUTCOMES REALLY DIFFERENT? A 10-YEAR EXPERIENCE EXTRACORPOREAL LIFE SUPPORT FOR REFRACTORY IN-HOSPITAL AND OUT-OF-HOSPITAL CARDIAC ARREST: ARE THE OUTCOMES REALLY DIFFERENT? A 10-YEAR EXPERIENCE Pozzi M 1, Armoiry X 2, Koffel C 3, Pavlakovic I 3, Lavigne

More information

Post-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena

Post-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Post-Resuscitation Care Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Conflict of interest Emcools Shareholder and founder, honoraria Zoll: honoraria Bard: honoraria, nephew works

More information

in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014

in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014 in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014 1. Capnography 2. Compressions 3. CPR Devices 4. Hypothermia 5. Access 6. Medications Outline Capnography & Termination Significantly Associated

More information

Prof Gavin Perkins Co-Chair ILCOR

Prof Gavin Perkins Co-Chair ILCOR Epidemiology of out of hospital cardiac arrest how to improve survival Prof Gavin Perkins Co-Chair ILCOR Chair, Community Resuscitation Committee, Resuscitation Council (UK) Conflict of interest Commercial

More information

Supplemental Digital Content 1. Simulation scenarios and critical action checklist for debriefing

Supplemental Digital Content 1. Simulation scenarios and critical action checklist for debriefing Supplemental Digital Content 1. Simulation scenarios and critical action checklist for debriefing Simulation Scenario #1 I. Title (ACS)-VF-Asystole-ROSC II. Target learner 6-7 medical students per team

More information

Sooner to the Ballooner: Going Straight to the Cath Lab with Refractory VF/VT

Sooner to the Ballooner: Going Straight to the Cath Lab with Refractory VF/VT Sooner to the Ballooner: Going Straight to the Cath Lab with Refractory VF/VT Marc Conterato, MD, FACEP Office of the Medical Director NMAS and the HC EMS Council/Minnesota Resuscitation Consortium DISCLOSURE

More information

Sudden Cardiac Arrest

Sudden Cardiac Arrest Sudden Cardiac Arrest Amit Sharma, MD, FACP, FACC Interventional Cardiologist Rockledge Regional Medical Center Assistant Professor of Medicine University of Central Florida Disclosures No relevant financial

More information

Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences

Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences Science Behind CPR Update from 2010 Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences FRAMING THE DISCUSSION NO ONE SURVIVES CARDIAC ARREST, EXCEPT ON TV Conflicts of

More information

Overview and Latest Research on Out of Hospital Cardiac Arrest

Overview and Latest Research on Out of Hospital Cardiac Arrest L MODULE 1 Overview and Latest Research on Out of Hospital Cardiac Arrest Jamie Jollis, MD Co PI RACE CARS 2 Out of Hospital Cardiac Arrest in U.S. 236 000 to 325 000 people in the United States each year

More information

Outcomes of Therapeutic Hypothermia in Cardiac Arrest. Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC

Outcomes of Therapeutic Hypothermia in Cardiac Arrest. Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC Outcomes of Therapeutic Hypothermia in Cardiac Arrest Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_427331.pdf

More information

Patient Case. Post cardiac arrest pathophysiology 10/19/2017. Disclosure. Objectives. Patient Case-TM

Patient Case. Post cardiac arrest pathophysiology 10/19/2017. Disclosure. Objectives. Patient Case-TM Disclosure TARGETED TEMPERATURE MANAGEMENT POST CARDIAC ARREST I have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect

More information

INDUCED HYPOTHERMIA. F. Ben Housel, M.D.

INDUCED HYPOTHERMIA. F. Ben Housel, M.D. INDUCED HYPOTHERMIA F. Ben Housel, M.D. Historical Use of Induced Hypothermia 1950 s - Moderate hypothermia (30-32º C) in open heart surgery to protect brain against global ischemia 1960-1980 s - Use of

More information

Out-of-Hospital Cardiac Arrest In North Carolina. Christopher Granger, M.D. Director, Duke CCU

Out-of-Hospital Cardiac Arrest In North Carolina. Christopher Granger, M.D. Director, Duke CCU Out-of-Hospital Cardiac Arrest In North Carolina Christopher Granger, M.D. Director, Duke CCU Disclosure Research contracts: AstraZeneca, Novartis, GSK, Sanofi-Aventis, BMS, The Medicines Company, Astellas,

More information

Improving Outcome from In-Hospital Cardiac Arrest

Improving Outcome from In-Hospital Cardiac Arrest Improving Outcome from In-Hospital Cardiac Arrest National Teaching Institute San Diego, CA Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff Nurse Objectives 1. Discuss the AHA in-hospital

More information

Manual Defibrillation. CPR AGE: 18 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: N/A

Manual Defibrillation. CPR AGE: 18 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: N/A ROC AMIODARONE, LIDOCAINE OR PLACEBO FOR OUT OF HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION OR TACHYCARDIA (ALPS) STUDY: MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE An Advanced Care Paramedic

More information

Victorian Ambulance Cardiac Arrest Registry (VACAR)

Victorian Ambulance Cardiac Arrest Registry (VACAR) Victorian Ambulance Cardiac Arrest Registry (VACAR) Dr Karen Smith (PhD) VACAR Chair Manager Research and Evaluation Ambulance Victoria Smith K, Bray J, Barnes V, Lodder M, Cameron P, Bernard S and Currell

More information

Kiehl EL, 1,2 Parker AM, 1 Matar RM, 2 Gottbrecht M, 1 Johansen MC, 1 Adams MP, 1 Griffiths LA, 2 Bidwell KL, 1 Menon V, 2 Enfield KB, 1 Gimple LW 1

Kiehl EL, 1,2 Parker AM, 1 Matar RM, 2 Gottbrecht M, 1 Johansen MC, 1 Adams MP, 1 Griffiths LA, 2 Bidwell KL, 1 Menon V, 2 Enfield KB, 1 Gimple LW 1 C-GRApH: A Validated Scoring System For The Early Risk Stratification Of Neurologic Outcomes After Out-of-hospital Cardiac Arrest Treated With Therapeutic Hypothermia Kiehl EL, 1,2 Parker AM, 1 Matar RM,

More information

Prehospital Resuscitation for the 21 st Century Simulation Case. VF/Asystole

Prehospital Resuscitation for the 21 st Century Simulation Case. VF/Asystole Prehospital Resuscitation for the 21 st Century Simulation Case VF/Asystole Case History 1 (hypovolemic cardiac arrest secondary to massive upper GI bleed) 56 year-old male patient who fainted in the presence

More information

Targeted temperature management after post-anoxic brain insult: where do we stand?

Targeted temperature management after post-anoxic brain insult: where do we stand? Targeted temperature management after post-anoxic brain insult: where do we stand? Alain Cariou Intensive Care Unit Cochin University Hospital Paris Descartes University INSERM U970 (France) COI Disclosure

More information

DECLARATION OF CONFLICT OF INTEREST. Research grants: Sanofi-Aventis

DECLARATION OF CONFLICT OF INTEREST. Research grants: Sanofi-Aventis DECLARATION OF CONFLICT OF INTEREST Research grants: Sanofi-Aventis Invasive management after cardiac arrest Nikolaos I Nikolaou FESC, FERC Athens, Greece Survival (%) Survival from Out of Hospital Cardiac

More information

Adult Extracorporeal Life Support (ECLS)

Adult Extracorporeal Life Support (ECLS) Adult Extracorporeal Life Support (ECLS) Steven Scott, M.D., F.A.C.S. Piedmont Heart Institute Cardiothoracic Surgery Disclosures None ECMO = ECLS A technique of life support that involves a continuous

More information

UK Paediatric Cardiac Arrest Registries

UK Paediatric Cardiac Arrest Registries UK Paediatric Cardiac Arrest Registries Dr Barney Scholefield University of Birmingham, Birmingham Children s Hospital, UK @BarneyUoB Overview UK Cardiac Arrest Registries Why create a registry? Challenges

More information

2016 Top Papers in Critical Care

2016 Top Papers in Critical Care 2016 Top Papers in Critical Care Briana Witherspoon DNP, APRN, ACNP-BC Assistant Director of Advanced Practice, Neuroscience Assistant in Division of Critical Care, Department of Anesthesiology Neuroscience

More information

Eagles 2007 Focused Quality in EMS The Five Required Actions

Eagles 2007 Focused Quality in EMS The Five Required Actions Eagles 2007 Focused Quality in EMS The Five Required Actions Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Prior

More information

The Pentagon Papers: The Five Most Important Publications of the Past Year EAGLES 2015

The Pentagon Papers: The Five Most Important Publications of the Past Year EAGLES 2015 The Pentagon Papers: The Five Most Important Publications of the Past Year EAGLES 2015 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International

More information

Lecture. ALS Algorithm

Lecture. ALS Algorithm Lecture ALS Algorithm 1 Learning outcomes The ALS algorithm Treatment of shockable and non-shockable rhythms Potentially reversible causes of cardiac arrest 2 Adult ALS Algorithm 3 To confirm cardiac arrest

More information

Developments in Cardiopulmonary Resuscitation Guidelines

Developments in Cardiopulmonary Resuscitation Guidelines Developments in Cardiopulmonary Resuscitation Guidelines Bernd W. Böttiger Seite 1 To preserve human life by making high quality resuscitation available to all Outcome after CPR in Germany ROSC ( Return

More information

ECMO for cardiac arrest patients: Update 2017

ECMO for cardiac arrest patients: Update 2017 ECMO for cardiac arrest patients: Update 2017 Lim Swee Han MBBS (NUS), FRCS Ed (A&E), FRCP (Edin), FAMS Senior Consultant, Department of Emergency Medicine, Singapore General Hospital Adjunct Associate

More information

SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC

SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC The following is a summary of the key issues and changes in the AHA 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac

More information

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia

More information

To ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW

To ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW To ECMO Or Not To ECMO Challenges of venous arterial ECMO Dr Emily Granger St Vincent s Hospital Darlinghurst NSW The Start: 1972 St Vincent s Hospital The Turning Point ECMO program restarted in 2004

More information

System Utilization 2013

System Utilization 2013 System Utilization 2013 8000 7000 Contra Costa County 911 Ambulance Response and Transport By Month 2012 Through 2013 (2013 Data excludes SRVFD) Response 6000 5000 Transport 4000 3000 2000 1000 0 1/1/2012

More information

Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care

Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care รศ.ดร.พญ.ต นหยง พ พานเมฆาภรณ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม System

More information

Out-of-Hospital Cardiac Arrest In North Carolina. James G. Jollis, MD, FACC Co-Medical Director Regional Approach to Cardiovascular Emergencies

Out-of-Hospital Cardiac Arrest In North Carolina. James G. Jollis, MD, FACC Co-Medical Director Regional Approach to Cardiovascular Emergencies Out-of-Hospital Cardiac Arrest In North Carolina James G. Jollis, MD, FACC Co-Medical Director Regional Approach to Cardiovascular Emergencies Disclosure Research funding from Medtronic Foundation, Medicines

More information

Objectives: This presentation will help you to:

Objectives: This presentation will help you to: emergency Drugs Objectives: This presentation will help you to: Five rights for medication administration Recognize different cardiac arrhythmias and determine the common drugs used for each one List the

More information

Regionalization of Post-Cardiac Arrest Care

Regionalization of Post-Cardiac Arrest Care Regionalization of Post-Cardiac Arrest Care David A. Pearson, MD, FACEP, FAAEM Department of Emergency Medicine Disclosures I have no financial interest, arrangement, or affiliations and no commercial

More information

Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017

Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Jon Rittenberger, MD, MS Department of University of Pittsburgh Employers: Disclosures - Rittenberger University of Pittsburgh UPMC

More information

SHOCKING UPDATES IN ACUTE CARDIAC LIFE SUPPORT (ACLS)

SHOCKING UPDATES IN ACUTE CARDIAC LIFE SUPPORT (ACLS) SHOCKING UPDATES IN ACUTE CARDIAC LIFE SUPPORT (ACLS) Reagan Collins, PharmD, BCCCP Clinical Pharmacy Specialist in Critical Care and Nutrition Support The University of Texas MD Anderson Cancer Center

More information

VanderbiltEM.com. Cardiac Arrests. AAEM Practice Changing Articles Resuscitation Results Resuscitation 2014;85: /13/2015

VanderbiltEM.com. Cardiac Arrests. AAEM Practice Changing Articles Resuscitation Results Resuscitation 2014;85: /13/2015 2/3/2 AAEM Practice Changing Articles Resuscitation 24-2 VanderbiltEM.com Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville,

More information

Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms. Introduction to the Algorithms

Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms. Introduction to the Algorithms Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms Introduction to the Algorithms Cardiac Arrest Algorithms Prehospital Medication Profiles Perspective regarding the EMT- Intermediate

More information

Disclosures. Pediatrician Financial: none Volunteer :

Disclosures. Pediatrician Financial: none Volunteer : Brain Resuscitation Neurocritical Care Monitoring & Therapies CCCF November 2, 2016 Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto Disclosures Pediatrician

More information

JUST SAY NO TO DRUGS?

JUST SAY NO TO DRUGS? JUST SAY NO TO DRUGS? THE EVIDENCE BEHIND MEDICATIONS USED IN CARDIAC RESUSCITATION NTI 2014 CLASS CODE 148 Nicole Kupchik RN, MN, CCNS, CCRN, PCCN Objectives 1. Discuss the historical evidence supporting

More information

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia

More information

Curricullum Vitae. Dr. Isman Firdaus, SpJP (K), FIHA

Curricullum Vitae. Dr. Isman Firdaus, SpJP (K), FIHA Curricullum Vitae Dr. Isman Firdaus, SpJP (K), FIHA Email: ismanf@yahoo.com Qualification : o GP 2001 (FKUI) o Cardiologist 2007 (FKUI) o Cardiovascular Intensivist 2010 - present o Cardiovascular Intervensionist

More information

ECG Changes in Patients Treated with Mild Hypothermia after Cardio-pulmonary Resuscitation for Out-of-hospital Cardiac Arrest

ECG Changes in Patients Treated with Mild Hypothermia after Cardio-pulmonary Resuscitation for Out-of-hospital Cardiac Arrest ECG Changes in Patients Treated with Mild Hypothermia after Cardio-pulmonary Resuscitation for Out-of-hospital Cardiac Arrest R. Schneider, S. Zimmermann, W.G. Daniel, S. Achenbach Department of Internal

More information

New Therapeutic Hypothermia Techniques

New Therapeutic Hypothermia Techniques New Therapeutic Hypothermia Techniques Joseph P. Ornato, MD, FACP, FACC, FACEP Professor & Chairman, Emergency Medicine Virginia Commonwealth University Health System Richmond, VA Medical Director Richmond

More information

Department of Surgery, Division of Cardiothoracic Surgery

Department of Surgery, Division of Cardiothoracic Surgery Review of In-Hospital and Out-of-Hospital Cardiac Arrests at a Tertiary Community Hospital for Potential ECPR Rescue Amanda Broderick 1, Jordan Williams 1, Alexandra Maryashina 1, & James Wu, MD 1 1 Department

More information

Post-Cardiac Arrest Syndrome. MICU Lecture Series

Post-Cardiac Arrest Syndrome. MICU Lecture Series Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought

More information

SYSTEMS BASED APPROACH TO OUT-OF-HOSPITAL CARDIAC ARREST

SYSTEMS BASED APPROACH TO OUT-OF-HOSPITAL CARDIAC ARREST SYSTEMS BASED APPROACH TO OUT-OF-HOSPITAL CARDIAC ARREST Kenneth A Scheppke, MD Chief Medical Officer Palm Beach County Fire Rescue State EMS Medical Director Florida Department of Health CASE REPORT 42

More information

Consider Treatable Underlying Causes Early

Consider Treatable Underlying Causes Early Page 1 of 8 Cardiac Arrest Timeout Checklist Assign roles for Pit Crew CPR o Compressors x 2 o Airway o Lead responsible for coordinating team, making decisions o Medications Continuous compressions at

More information

Advanced Cardiac Life Support (ACLS) Science Update 2015

Advanced Cardiac Life Support (ACLS) Science Update 2015 1 2 3 4 5 6 7 8 9 Advanced Cardiac Life Support (ACLS) Science Update 2015 What s New in ACLS for 2015? Adult CPR CPR remains (Compressions, Airway, Breathing Chest compressions has priority over all other

More information