EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST
|
|
|
- Ruth Bridges
- 5 years ago
- Views:
Transcription
1 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
2 ANNUAL SUDDEN CARDIAC ARREST EVENTS 350,000 USA 750,000 Europe 50,000 Italy 75% out-of-hospital 20% without prior symptoms < 5% survive 95% die without treatment
3 Refractory Cardiac Arrest Failure to obtain ROSC after at least 30 min of ACLS in normothermia This definition is used to stop resuscitation in a hopeless survival situation: Failure of ROSC Failure to obtain a satisfactory cerebral activity in these conditions ILCOR, AHA, ERC 2005
4 Critical Early Minutes of CA 100 Survival Rate (percent) Survival reduced by about 10% each minute defibrillation delayed Time to Defibrillation (minutes)
5 Arrest Time: Pathophysiology Cerebral blood flow achieved with CPR is inversely proportional to arrest time CPR started in 2 minutes - CBF to 50% normal CPR after 5 minutes - CBF 28% normal CPR after 10 minutes - CBF = 0%
6 Post-Ischemic Encephalopathy After ROSC is achieved Immediate post-ca no-reflow phenomenon (blood sludging) Delayed protracted cerebral hypoperfusion (vasospasm) Multifocal inhomogeneous cerebral hypoperfusion Resuscitation 1992;23:1-20 Stroke 1992;23:45-53 Circulation 1995;92:2572-8
7 Conventional Approach
8
9 CLINICAL FINDINGS Cardiac Arrest NO Flow Cardiac Massage LOW Flow
10 -Interrupt injurios process; RESUSCITATION -Restoring cardiopulm. and cerebral function; -Mitigate reperfusion injury RESUSCITATION Increasing ROSC (Minimally interrupted CPR, Hands-on Defibrillation, Epinefrine ) -Supported Circulation (ECPR) -Cerebral Protection (Intra-Arrest Cooling, Therapeutical Hypothermia)
11 RESUSCITATIVE E.C.L.S. E.C.P.R : First used in children for rescue therapy; -improved survival with refractory cardiac arrest - Long arrest times (>95min) in children; -Mid-late 1990s: Investigations in adults
12 Survival rate 20% >50% brain Death
13 E-CPR TRIALS -2003, Chen et al. -57 pts with a variety of resuscitation times; -Overall Survival rate 31,6 (18 of 57); -One survivor of three (CPR>60 min) had severe neurological deficit; -Survivors shorter duration of CPR; -96,5% survivors had witnessed arrest; -100% survival with CPR < 30 min
![51 patients (42 + 15 years) No flow: 3 [1-7] min Low flow: 120](/docs-images/94/119299069/images/14-8.jpg "[102-149] min ECLS failed in 9 (18%) patients Strong correlation")
14 51 patients ( years) No flow: 3 [1-7] min Low flow: 120 [ ] min ECLS failed in 9 (18%) patients Strong correlation with: Serum lactates > 16,3 mmol/l Low flow time > 100 min Time to ECLS Survival: 2 (4%) avec GOS 4 and 5 Death: MOF (47%), BD (20%), HS (14%)
15 IN HOSPITAL CARDIAC ARREST 38 patients 30 day survival 13 (34%) 1 year survival 10 (26%) Witnessed CA 35 (92%) Bystander CPR 35 (92%) Time to ECMO 25 min Therap. Hypot. 4 (11%) ECMO hours 9 (5-62) Hospital Stay d 18 (2-34) Out of HOSPITAL CARDIAC ARREST 39 patients 30 day survival 5 (13%) 1 year survival 5 (13%) Witnessed CA 32 (82%) Bystander CPR 28 (72%) Time to ECMO 59 min Therap. Hypot. 21 (54%) ECMO hours 10 (3-40) Hospital Stay d 22 (1-42)
16 The outcomes of patients treated with ECLS were better for IHCA than OHCA, but the difference in outcomes disappeared after adjusting for patient factors and time delay in starting ECLS
17 E-CPR: Key-Points -Multiple studies, mostly retrospective analysis; -varying results, but promising approach; -Criteria for success: a) No-flow time close to 0 min b) Bystanders CPR c) Short low-flow time to ECMO initiation d) Brain Protection Strategy (Hypothermia)
18 The key to improving outcome in patients who have suffered cardiac arrest is achieving early return to supported circulation with BRAIN protective strategy.
19 RESUSCITATION PROGRAM Multidisciplinary C.A. Network with TEAM APPROACH Restore Perfusion -Early CPR by EMS; -Continuous ECM -Rapid ECLS Institution Brain Protection -intra-arrest Cooling - Therapeutical Hypotermia and remove the Cardiac Arrest causes
20 Automatic ECM
21
22 Time to do exams Mobility and Transport of patients
23 Resuscitative Hypothermia Fever Accelerates Injury Hypothermia Preserves Tissue º 32º
24
25 Witnessed CA Castren et al. Circulation 2010 IA cooling (96) vs control (104)
26 Out-Hospital Cardiac Arrest ROSC Rapid core Cooling 25 ml/kg No ROSC Therapeutic Hypothermia
27 FRENCH ALGORITHM
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:
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
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
CPR What Works, What Doesn t
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;128:417-35
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
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
Resuscitation Science : Advancing Care for the Sickest Patients
Resuscitation Science : Advancing Care for the Sickest Patients William Hallinan University of Rochester What is resuscitation science? Simply the science of resuscitation : Pre arrest Arrest care Medical
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,
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
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)
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,
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
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
ECPR: An emerging strategy for cardiac arrest
ECPR: An emerging strategy for cardiac arrest Steven Brooks MD MHSc FRCPC Associate Professor Department of Emergency Medicine, Queen s University November 2016 Conventional CPR is ineffective Conventional
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
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
Beth Cetanyan, RN AHA RF Aka The GURU
* Beth Cetanyan, RN AHA RF Aka The GURU *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing
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,
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
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
The Evidence Base. Stephan A. Mayer, MD. Columbia University New York, NY
Hypothermic for Cardiac Arrest The Evidence Base Stephan A. Mayer, MD Director, Neuro-ICU Columbia University New York, NY Disclosures Columbia University Clinical Trials Pilot Award Radiant Medical, Inc.
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
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
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
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
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?
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?
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
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
Objectives. Trends in Resuscitation POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE?
POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE? Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest Care Discuss oxygenation & hemodynamic taregts
All under the division of cardiovascular medicine University of Minnesota
The Team 1) Demetris Yannopoulos M.D. Medical Director, 2) Kim Harkins, Program Manager 3) Lucinda Klann, CARES Data Manager 4) Esther Almeida, Administrative Assistant All under the division of cardiovascular
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.
THE EVIDENCED BASED 2015 CPR GUIDELINES
SAUDI HEART ASSOCIATION NATIONAL CPR COMMITTEE THE EVIDENCED BASED 2015 CPR GUIDELINES Page 1 Chapter 7 ACS CHAPTER DIAGNOSTIC INTERVENTIONS IN ACS Prehospital ECG ILCOR Treatment Recommendation: We recommend
Disclosures. Overview. Cardiopulmonary Arrest: Quality Measures 5/29/2014. In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes
Disclosures In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes Research support from UCOP CHQI award J. Matthew Aldrich, MD Anesthesia & Critical Care UCSF Overview Epidemiology
University of Washington. From the SelectedWorks of Kent M Koprowicz
University of Washington From the SelectedWorks of Kent M Koprowicz 2007 Site variation in EMS Treatment, Transport and Survival in relation to Restoration of Spontaneous Circulation (ROSC) for Adult Out-of-Hospital
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
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
Resuscitation Guidelines update. Dr. Luis García-Castrillo Riesgo EuSEM Vice president
Resuscitation Guidelines update Dr. Luis García-Castrillo Riesgo EuSEM Vice president There are no COIs to disclose in this presentation. CPR Mile Stones 1958 -William Kouwenhoven, cardiac massage. 1967
CrackCast Episode 8 Brain Resuscitation
CrackCast Episode 8 Brain Resuscitation Episode Overview: 1) Describe 6 therapeutic interventions for the post-arrest brain 2) List 5 techniques for initiating therapeutic hypothermia 3) List 4 mechanisms
EPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS
EPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS Andrea Semplicini Medicina Interna 1 Ospedale SS. Giovanni e Paolo - Venezia Azienda ULSS 12 Veneziana Dipartimento Medicina
RACE CARS: Hospital Response. David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012
L MODULE 9 RACE CARS: Hospital Response David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012 2 Objectives: Post-cardiac arrest syndrome Therapeutic hypothermia
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
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
The 2010 evidence-based guidelines: the process, the challenges
The 2010 evidence-based guidelines: the process, the challenges Jerry Nolan Co-Chair, ILCOR Royal United Hospital Bath, UK European Society of Cardiology Stockholm 30 Aug 2010 The 2010 guidelines: the
Cardio Pulmonary Cerebral Resuscitation
Cardio Pulmonary Cerebral Resuscitation Brain Under Pressure October 3, 2017 Canadian Critical Care Forum Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto
Cardiopulmonary Resuscitation in Adults
Cardiopulmonary Resuscitation in Adults Fatma Özdemir, MD Emergency Deparment of Uludag University Faculty of Medicine OVERVIEW Introduction Pathophysiology BLS algorithm ALS algorithm Post resuscitation
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
The Merits of Mechanical CPR
The Merits of Mechanical CPR Experiences with LUCAS Mark D. Frank Incidenz of sudden cardiac arrest - in Europe ca. 350000 humans p.a. - approx. 315000 are dying - in Germany approx. 100000 p.a. - ROSC
State of the art lecture: 21st Century Post resuscitation management
State of the art lecture: 21st Century Post resuscitation management ACCA Masterclass 2017 Prof Alain CARIOU Intensive Care Unit - Cochin Hospital (APHP) Paris Descartes University INSERM U970 - France
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
INDUCED HYPOTHERMIA A Hot Topic. R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences
INDUCED HYPOTHERMIA A Hot Topic R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences Conflicts of Interest Sadly, we have no financial or industrial conflicts of interest
Targeted Temperature Management: An Evolving Therapy for Cardiac Arrest
Targeted Temperature Management: An Evolving Therapy for Cardiac Arrest By Meagan Dunn, BScN, MSc,, RN, CNE NP Forum April 8, 2016 Objectives To understand: What Therapeutic Temperature Management (TTM)
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
3/6/2017. Endovascular Selective Cerebral Hypothermia First-in-Human Experience
Endovascular Selective Cerebral Hypothermia First-in-Human Experience Ronald Jay Solar, Ph.D. San Diego, CA 32 nd Annual Snowmass Symposium March 5-10, 2017 Introduction Major limitations in acute ischemic
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
POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association
POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association - 2016 Nicole Kupchik MN, RN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest
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
Controversies in Chest Compressions & Airway Management During CPR. Bob Berg
Controversies in Chest Compressions & Airway Management During CPR Bob Berg No Financial Conflicts of Interest Employment: University of Pennsylvania AHA Volunteer AHA GWTG-R & Systems of Care committees
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
The evidence behind ACLS: the importance of good BLS
The evidence behind ACLS: the importance of good BLS Benjamin S. Abella, MD, MPhil, FACEP CRS Center for Resuscitation Science Clinical Research Director Center for Resuscitation Science Vice Chair of
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
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
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
The relative importance or values of the main outcomes of interest: Outcome. Survival to Hospital Discharge
Problem Is there a problem priority? Yes The existing evidence, though observational, indirect, imprecise, and thus very low quality, shows a consistent association between hypotension and adverse outcome.
Post-Arrest Care: Beyond Hypothermia
Post-Arrest Care: Beyond Hypothermia Damon Scales MD PhD Department of Critical Care Medicine Sunnybrook Health Sciences Centre University of Toronto Disclosures CIHR Physicians Services Incorporated Main
Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System A Regional Approach: Developing Continuity From Scene to CCU
Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System A Regional Approach: Developing Continuity From Scene to CCU R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest
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
Ipotermia terapeutica nel bambino: manca l evidenza?
Ipotermia terapeutica nel bambino: manca l evidenza? Andrea Moscatelli UOSD Terapia Intensiva Neonatale e Pediatrica Dipartimento Integrato di Alta Intensita` di Cura e Chirurgia Istituto Giannina Gaslini
Rowan County EMS. I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l. Christopher Warr NREMT-P Lieutenant.
Rowan County EMS I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l Christopher Warr NREMT-P Lieutenant Rowan County EMS christopher.warr@rowancountync.gov September 9, 2012 2:44 11:44:00 Mr.
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,
ACLS AND MORE. Ryan Clark D.O. Medical Education Fellow University of Massachusetts Medical School Baystate Medical Center
ACLS AND MORE Ryan Clark D.O. Medical Education Fellow University of Massachusetts Medical School Baystate Medical Center FOCUS 1. The death of the pulse check 2. PEA and why you can stop memorizing the
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
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage. Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA The traditional view: asah is a bad disease Pre-hospital mortality
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
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
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
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
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
TOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO
TOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO DISCLOSURE I have no relationships with commercial companies
Any man s death diminishes me, because I am involved in mankind. - John Donne
Any man s death diminishes me, because I am involved in mankind - John Donne Cardiac Arrest in 2011 Where are we? Or where should we be? Michael W. Dailey, MD FACEP Associate Professor of Emergency Medicine
Controversies in Cardiogenic Shock. Timothy D. Henry, MD Cedars-Sinai Heart Institute
Controversies in Cardiogenic Shock Timothy D. Henry, MD Cedars-Sinai Heart Institute Key Issues Cardiac Arrest-Cardiogenic shock interaction New SCAI Classification Refractory Shock Shock with Multivessel
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
occlusions. Cerebral perfusion is driven fundamentally by regional cerebral
Appendix Figures Figure A1. Hemodynamic changes that may occur in major anterior circulation occlusions. Cerebral perfusion is driven fundamentally by regional cerebral perfusion pressure (CPP). In response
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
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
Neurological Prognostication After Cardiac Arrest Murad Talahma, M.D. Neurocritical Care Ochsner Medical Center
Neurological Prognostication After Cardiac Arrest Murad Talahma, M.D. Neurocritical Care Ochsner Medical Center Financial Disclosure None 1 Introduction Each year, 356,000 Americans are treated by EMS
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,
Bridging With Percutaneous Devices: Tandem Heart and Impella
Bridging With Percutaneous Devices: Tandem Heart and Impella DAVID A. BARAN, MD, FACC, FSCAI SYSTEM DIRECTOR, ADVANCED HEART FAILURE, TX AND MCS SENTARA HEART HOSPITAL NORFOLK, VA PROFESSOR OF MEDICINE
Don t let your patients turn blue! Isn t it about time you used etco 2?
Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P
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
Cardiocerebral Resuscitation and the community
Cardiocerebral Resuscitation and the community Why and How to implement in your community! 1 2 Hey guys I have an idea! I propose that if patients become unresponsive and stop breathing that we not breath
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
Changing Demographics in Death After Devastating Brain Injury
Changing Demographics in Death After Devastating Brain Injury Andreas H. Kramer MD MSc FRCPC Departments of Critical Care Medicine & Clinical Neurosciences Foothills Medical Center, University of Calgary
2015 Interim Training Materials
2015 Interim Training Materials ACLS Manual and ACLS EP Manual Comparison Chart Assessment sequence Manual, Part 2: The Systematic Approach, and Part BLS Changes The HCP should check for response while
Reperfusion Effects After Cardiac Ischemia
Reperfusion Effects After Cardiac Ischemia Dave Milzman, MD, FACEP Professor and Assistant Dean for Clinical Research Georgetown University School of Medicine Research Director, Depts of Trauma and Emerg
In the setting of liver failure & transplantation?
ECMO: In the setting of liver failure & transplantation? Dr. Robert Loveridge MA LL.M MRCP FRCA FFICM Consultant in adult & liver intensive care medicine King s College Hospital NHS Foundation Trust What
Tina Yoo, PharmD Clinical Pharmacist Alameda Health System Highland Hospital
Tina Yoo, PharmD Clinical Pharmacist Alameda Health System Highland Hospital 1 Review changes in the 2015 AHA ACLS guidelines with emphasis on changes in therapeutic hypothermia Provide overview of ACLS
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
PALS NEW GUIDELINES 2010
PALS NEW GUIDELINES 2010 DR WALEED ALAMRI PEDIATRIC EMERGENCY CONSULTANT FEB 24, 2011 Pediatric Basic Life Support Change in CPR Sequence (C-A-B Rather Than A-B-C) 2010 (New): Initiate CPR for infants
Post-resuscitation care for adults. Jerry Nolan Royal United Hospital Bath
Post-resuscitation care for adults Jerry Nolan Royal United Hospital Bath Post-resuscitation care for adults Titration of inspired oxygen concentration after ROSC Urgent coronary catheterisation and percutaneous