Transcript Introduction to High-Performance CPR

Introduction to HighPerformance CPR
Chris Fraser
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Disclaimer
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Objectives
 Importance
of maximizing CPR.
 Compression to ventilation ratio 30:2
◦ Complete chest wall recoil
◦ Danger of hyperventilation
 CPR
First vs shock first
 Compressions 100 to 120 per min (switch
every 2 min)
◦ Fit ventilations in without delaying
Compressions
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
Minimize delays when shocking
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Working Together
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The Experts Evolving View
“Poor-quality CPR should be considered a preventable
harm. In healthcare environments, variability in clinician
performance has affected the ability to reduce healthcare
associated complications, and a standardized approach has
been advocated to improve outcomes and reduce preventable
harms. The use of a systematic continuous quality
improvement (CQI) approach has been shown to optimize
outcomes in a number of urgent healthcare conditions.”
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Experts View (continued)
“Despite this evidence, few healthcare
organizations apply these techniques to cardiac
arrest by consistently monitoring CPR quality and
outcomes. As a result, there remains an
unacceptable disparity in the quality of
resuscitation care delivered, as well as the
presence of significant opportunities to save
more lives.”
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Future Training
WE CAN’T EXPECT TO WIN “RACES”
WITHOUT MEANINGFUL PRACTICE
AND AN ONGOING ITERATIVE PROCESS
OF MEASURING AND IMPROVING…
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The Measure of Success
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Duty Cycle
Systole
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Diastole
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The Numbers
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More Numbers
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The Message IS
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Demonstration
Video
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The Take Away Message
“Quality CPR is a means to improve survival from
cardiac arrest. Scientific studies demonstrate when
CPR is performed according to guidelines, the
chances of successful resuscitation increase
substantially. Minimal breaks in compressions,
full chest recoil, adequate compression depth,
and adequate compression rate are all
components of CPR that can increase survival from
cardiac arrest. Together, these components
combine to create high performance CPR (HP
CPR)”
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•
•
•
•
C-A-B
Minimize interruptions in compressions
Compress at least 100/min
Allow complete chest wall recoil/decompression
between compressions
• Rhythm assessment every 2 minutes
• Rotate compressors every 2 minutes
• Hover over patient with hands ready during
defibrillation so compressions can start immediately
after the shock (or analysis) has occurred
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BLS Owns the Resuscitation!

Out of hospital Cardiac Arrest is a BLS event

Includes ALS and BLS providers

Interventions that work are Basic Life Support
interventions

Everybody (ALS, BLS, Driver, Attendant) has
the same chance to positively effect the
outcome

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There is NO reason to “wait” for ALS to
resuscitate someone
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CPR 1
AIRWAY
VENTILATION
2
BOSS
4
1
6
AIRWAY
ASSISTANT
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CPR 2
3
ACCESS
MEDS
MONITOR
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THE END
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BACK UP
Material
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The Building Block To Success
Improved
survival
Intubation
Rapid
rhythm
analysis
Switch
compressor
s every 2
min.
Compress
Minimize
pauses
Hover
hands
Minimize
interruptions
Administer
drugs
Prioritize
compression
s C-A-B
Full recoil
> 2 inches
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Paramedic
Advanced Life
Support
IV
placement
EMT CPR Foundation
Rate between
100 and
120/min
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•
•
•
•
•
•
•
EMTs own CPR
Minimize interruptions in CPR at all times
Ensure proper depth of compressions (>2 inches)
Ensure full chest recoil/decompression
Ensure proper chest compression rate (100-120/min)
Rotate compressors every 2 minutes
Be ready to compress as soon as patient is cleared by:
Hovering hands over chest during shock administration
• Intubate or place advanced airway with ongoing CPR
• Place IV or IO with ongoing CPR
• Coordination and teamwork between EMTs and
paramedics
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THE PAINFUL TRUTH
• Perceived performance does not always match observed
performance.
• Aufderheide et al. showed that duty cycle, chest compression
depth and complete recoil were performed significantly less well
when directly observed than EMT perceptions of their performance.
• Wik et al. showed that chest compression rate and depth were both
significantly below AHA guidelines by trained EMS providers, and
no flow time (when there was neither a pulse nor CPR being given)
was almost 50% in directly observed performance evaluations.
• The likelihood of ROSC increases significantly with higher mean
chest compression rate (in a hospital study 75% of patients
achieved ROSC with 90 or more chest compressions/minute
compared to only 42% with 72 or fewer chest
compressions/minute).
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Crew Management
• Eastern Airlines 401 crashed into the Everglades in
December of 1972 as a result of the flight crew's failure
to recognize a deactivation of the autopilot during their
attempt to troubleshoot a malfunction of the landing gear
position indicator system (an indicator light) Fatigue and
poor crew resource management (CRM) contributed to
the accident. EA 401 gradually lost altitude while the
flight crew was preoccupied and eventually crashed.
The effect of this crash on the airline industry continues
today and has resulted in the development of Crew
Resource Management (CRM). CRM is a technique that
requires air crews to divide the work in the cockpit
amongst available crew ensuring that someone
continues focusing on flying the plane while
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troubleshooting continues.
Management Skills
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Measure of Performance
Illustration of proposed
resuscitation “report cards.”
Routine use of a brief tool to
document resuscitation quality
would assist debriefing efforts
and quality improvement efforts
for hospital and emergency
medical services systems.
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Copyright © American Heart Association
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Meaney P et al. Circulation 2013;128:417-435
Legacy CPR
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High Performance CRP
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