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 participants Evidenced based practice to clinical area OHCA = Out of Hospital Cardiac arrest

Using Social Media to Summon Rescuers Evidence to support the use of social media by dispatchers to notify potential rescuers of a possible cardiac arrest nearby One study showed significantly higher rate of bystander initiated CPR

Basic Life Support Changes Single rescuer to start chest compressions before giving rescue breaths (C A B rather than A B C) to reduce delay to 1 st compression Single rescuer CPR ratio still 30:2

BLS Changes (Cont d) High quality CPR Adequate compression depth & rate Allow full chest recoil (no leaning) Minimize interruptions Avoid excessive ventilations

BLS Changes (Cont d) Chest compression rate Increased rate to 100 120 min Fast rates = higher survival scores Had been at least 100 Depth: at least 2 inches Most studies show compressions are often too shallow

Bystander Administered Narcan For suspected opioid overdoes Trained rescuers can give IM or intra nasal Narcan

Shock First vs. CPR First If Defibrillator is immediately available, shock immediately But do CPR until pads are applied & defib is charged

Impedance Threshold Devices The routine use of the ITD as an adjunct during conventional CPR is NOT recommended

Mechanical Compression Devices The evidence does NOT demonstrate a benefit with the use of mechanical piston devices for chest compressions versus manual CPR

Vasopressin is Out! Vasopressin with Epi = no advantage Vasopressin alone = is not better the Epi To simplify algorithm: Vasopressin removed

Give within 1 3 minutes after confirming a nonshockable rhythm Early administration of Epi increases ROSC, survival to hospital discharge, & neurologically intact survival If given later; poorer outcomes Early Epinephrine

Extracorporeal CPR Cardiopulmonary bypass Consider for select patients in cardiac arrest with reversible conditions (the younger; the better) Start ASAP

Coronary Angiography Should be performed emergently for OHCA patients with suspected cardiology etiology of arrest & ST elevation

Inducing Hypothermia Start on ALL comatose adults patients with ROSC after cardiac arrest X24 hours Prevent any fever even after cooling No benefit to prehospital cooling by EMS

Hypotension after Resuscitation Systolic B/P <90 mm/hg or MAP <65 mm/hg associated with higher mortality rate Systolic B/P >100 mm/hg associated with better recovery

Oxygen Administration??? Recommend that oxygen be withheld from patients with possible Acute Coronary Syndrome (ACS) who have normal oxygen saturation (meaning no hypoxemia)

Lipid Rescue Therapy Indicated for cardiac arrest after local anesthetic injections Also for overdoses of anti epileptic drugs, cardiovascular drugs

Cardiac Arrest in Pregnancy During CPR, need to relieve aortocaval compression If fundus height is above umbilicus, manual left uterine displacement (tilting) should be done Decision to emergently C section should be made within 4 minutes of arrest!

Pediatric Advanced Life Support CPR Rate same as adult 100 120 Start compressions for rate less than 60 1 breath every 3 5 seconds

Pediatric Advanced Life Support Compression depth at least 1/3 of A/P diameter of chest 1.5 inches in infants 2 inches in children At least 2 inches in children after reaching puberty

Pediatric Advanced Life Support Pediatric febrile illnesses, restricting volumes of aggressive IV fluids improves survival Initial fluid bolus of 20 ml/kg is reasonable Contradicts traditional thinking for septic kids

Pediatric Advanced Life Support Amiodarone or Lidocaine is equally acceptable for VF or pulseless VT Previously only Amiodarone was recommended

Hypothermia & PALS Comatose children resuscitated from OHCA: Maintain 5 days of normothermia, or 2 days of initial continuous hypothermia, followed by 3 days of normothermia Always avoid any fever

Additional Changes Educational components Teamwork & leadership First aid education

Including First Aid Training: For Professionals and Lay Rescuers Stroke recognition Hypogylcemia Open chest wounds Concussion Dental avulsion Spinal motion reduction Patient positioning Oxygen use Chest pain Anaphylaxis Hemostatic dressings

Thank you! Terry Foster, RN 859 301 2159 Terry.foster@stelizabeth.com