Transcript Slide 1

Philips in CPR
New Technologies Supporting
AHA Guidelines
Jim Hendrix
EMS Marketing Manager
Philips Medical Systems
Section 4: Adult Basic Life Support
(Circulation. 2005;112:IV-18-IV-34.)
© 2005 American Heart Association.
Leading the Way in Intelligent
Resuscitation
•
CPR Coaching
• Step-by-Step instructions for bystander-initiated
CPR and the minimally-trained rescuer
•
SMART CPR for trained first responders
• First AED to analyze presenting VF rhythm &
advise initial therapy of either a defibrillation
shock or CPR followed by a shock
•
Q-CPR
• CPR Measurement and Feedback for ALS
professionals
•
Quick Shock on all HeartStart Defibrillators
• Shock after CPR in <10s, while heart is still
“primed”
CPR Coaching Since 2002
•
Available on HeartStart FRx, HeartStart OnSite
and HeartStart Home Defibrillators
•
After shock, user is instructed to begin CPR and
“for help with CPR press the flashing blue button”
•
Step-by-step instructions including:
• Airway Opening
• “Timed” Breath Prompts
• Compression Metronome
•
Two minute CPR timer
What is SMART CPR?
• SMART CPR offers the opportunity
for CPR first, before a shock
• Evaluates heart rhythm,
automatically advises rescuer on
initial therapy
– Immediate shock for hearts that
are likely to benefit
– CPR first for the hearts less likely
to benefit from a shock
• An alternative to “one-size fits all”
therapy
Defibrillating VF Doesn’t Always Restore
Circulation
Likely return of
circulation with
a shock
Traditional AED Therapy:
Time after collapse:
Unlikely to return to
circulation with shock
Shocks then CPR
~4-5 min
Asystole or
“Flatline”
No shock advised
~10 min
The Responder’s Dilemma
•
•
The responder doesn’t know on arrival if the patient’s heart is receptive to a shock
What should they do? Shock first or CPR first?
Exactly how many minutes
did it take me to get here?
How long ago?
Applying the Latest Clinical Research
to Help More Patients
•
Designed to advise CPR first to patients with
rhythms typical of long-duration arrest, without
altering treatment for the most successful
patient group*
•
More informed, refined treatment decisions
•
Supports a protocol the literature suggests may
have better outcome
*Snyder, DE, et al. Wolf Creek Conference on Resuscitation. June 2005
Promising Alternative Therapy
Protocol
Likely return of
circulation with
a shock
Unlikely to return to
circulation with shock
Asystole or
“Flatline”
Therapy of choice:
Shock first
Time:
CPR first, then shock
~4-5 min
No shock; perform CPR
~10 min
Wik L, et al. JAMA, 2003, 289;1389-1395
Cobb LA, et al. JAMA,1999, 281;1182-1188
Weisfeldt & Becker JAMA, 2002, 288; 3035-3038
What is Q-CPR?
• Q-CPR is the first and only CPR
measurement and feedback tool
seamlessly integrated into an ALS
monitor/defibrillator (Philips HeartStart
MRx) to promote high-quality CPR
delivery by professional emergency
responders in hospitals and EMS.
Real-Time Feedback
Compressions:
1. Incomplete Release
2. Compression depth shallow
3. Compression rate slow or fast
4. Compression depth
5. Duty Cycle
Ventilations:
1.Volume low
2. Frequency high or low
3. Inflation time fast or slow
New Studies Validate the Value of Q-CPR
Monitoring and Feedback Technology to
Improve CPR Delivery by Trained Responders...
(Studies presented AHA)
•
Dr. Jo Kramer-Johansen of Ulleval University
Hospital, Oslo, Norway, reported on 108 cardiac
arrests in three ambulance services in Europe,
where the automatic verbal and visual feedback
features of Q-CPR improved the quality of CPR
delivered by the paramedics and emergency
medical technicians (EMTs). With the use of QCPR, the median percentage of chest
compressions within guidelines more than
doubled from 24% to 53%. Additionally, there
was a significant increase in the mean depth of
compressions in those utilizing Q-CPR (34+9 mm to
38+6 mm), and a reduction in mean compression
rate (121+18 to 109+12), which means that the
performance was closer to current AHA guidelines
for compression depth of 38 to 51mm and
compression rate of 100 per minute
New Studies Validate the Value of Q-CPR
Monitoring and Feedback Technology to
Improve CPR Delivery by Trained Responders
(continued)
•
Dr. Ben Abella, from the University of Chicago,
presented results showing that Q-CPR also
improved multiple parameters of CPR
quality for cardiac arrest patients treated
in-hospital. A related study on how the quality
of CPR affects the success rates of defibrillation,
by his colleague Dr. Dana Edelson, reported that
a modest increase in the depth of chest
compressions doubled the chance of
defibrillation success, which is associated with
more patients leaving the hospital alive. Dr.
Edelson’s study garnered her the Resuscitation
Science Symposium’s (ReSS) Young Investigator
of the Year award
Shock success by compression depth
Shock Success, Percent
Edelson et. al
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
93%
62%
50%
<1
n=10
P=0.02
1-1.5
n=13
n=14
1.5-2
>2
n=5
Compression Depth, Inches
System Components
Therapy/CPR Cable
Compression Sensor
MRx Defib Pads
What is Quick Shock?
• All Philips HeartStart AEDs can
deliver a shock less than 10
seconds after CPR
• A unique feature offered only by
Philips
• CPR primes the pump and Quick
Shock allows the rescuer to quickly
deliver a shock
CPR is an Important Part of
Resuscitation
•
•
CPR Helps
–
CPR prior to defibrillation shock can help restore normal
heartbeat in more patients, especially those with longer
duration VF1,2
–
Beneficial effect of CPR disappears in seconds, so time
to shock is very important 3,4
Quick Shock maximizes benefits of CPR
–
Minimizes interruption of CPR
–
Increases the chance that a shock will result in a successful
return of circulation & may improve survival
1Cobb
LA, et al. JAMA. 1999; 281(13):1182-1188
L, et al. JAMA. 2003 Mar 19; 289(11):1389-1395
3 Yu T, et al. Circulation. 2002; 106:368-372
4 Eftestol T, et al. Circulation. 2002;105:2270-2273
2Wik
Blood pressure
Effect of stopping compressions
on hemodynamics
Time
= chest compression
Illustration : Ben Abella
Kern et al Resuscitation 1998;39:179-88
Peer-reviewed Research
Supports Quick Shock
•
“Interruptions of precordial compression for rhythm
analyses that exceed 15 seconds before each shock
compromise the outcome of CPR and increase the
severity of post resuscitation myocardial dysfunction.”
•
“The interval between discontinuation of chest
compressions and delivery of a shock should be kept as
short as possible.”
•
Simply put, getting a shock to the heart as soon as
possible after CPR can save more lives
Yu T, et al. Circulation. 2002; 106:368-372
Eftestol T, et al. Circulation. 2002;105:2270-2273
Shock success by pre-shock pause
Edelson et. al
P<0.01
100%
100%
Shock Success, Percent
90%
74%
80%
67%
70%
60%
50%
38%
40%
30%
20%
10%
0%
=<10
10.1-20
20.1-30
Pre-Shock Pause, Seconds
>30
Survival Closely Linked to Speed of
Shock Delivery After CPR
Times measured from end of
Stop-CPR prompt, with AEDs at maximum energy
Survival
100%
80%
60%
40%
20%
0%
0
5
10
Time to shock
in seconds
HeartStart
HeartStartFR2+
OnSite, Home &
FRx, MRx 5 seconds 10 seconds
15
20
25
30
Auto
Survival data: Swine; 7 minutes of VF
Yu T, et al. Circulation. 2002; 106:368-372
In Summary
•
CPR Coaching
• Step-by-Step instructions for bystander-initiated CPR
and the minimally-trained rescuer
•
Q-CPR
• CPR Measurement and Feedback for ALS
professionals
•
SMART CPR for trained first responders
• First AED to analyze presenting VF rhythm & advise
initial therapy of either a defibrillation shock or CPR
followed by a shock
•
Quick Shock on all HeartStart Defibrillators
• Shock after CPR in <10s, while heart is still “primed”
Thank You!