11:1 Compression to Ventilation

VentMonkey

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I have not heard of this. I’m curious to know where you got it from though.

I’d be interested in some data as well. I mean, what’s the diff from say continuous compressions and what’s done now?

Haha, good ol’ EBM.
 

Jim37F

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Idk about 11:1, but we'll do essentially a 10:1, but it's more non-stop continuous compressions and the bagger squeezes the BVM on the upstroke of the 10th compression, and we don't slow/stop compressions for the BVM.
 

DesertMedic66

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Idk about 11:1, but we'll do essentially a 10:1, but it's more non-stop continuous compressions and the bagger squeezes the BVM on the upstroke of the 10th compression, and we don't slow/stop compressions for the BVM.
We have also been doing this for ~6 years.
 

EpiEMS

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Idk about 11:1, but we'll do essentially a 10:1, but it's more non-stop continuous compressions and the bagger squeezes the BVM on the upstroke of the 10th compression, and we don't slow/stop compressions for the BVM.

We have also been doing this for ~6 years.
Same here (and with the LUCAS, it's basically effortless).

@CCCSD, do you have a protocol reference?
 
OP
CCCSD

CCCSD

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Ill try and find it again,
The discussion came up while teaching a class as it seems this county is doing 11:1 (why 11 and not 10?) and all providers are supposed to do it. There are no testing standards. Nor can I find good data.
This is supposedly Seattle FD oriented.

Issue is that it’s not AHA Committee guidelines approved that I can see. So it creates problems when teaching Public Safety BLS.

I really don’t care what EMS wants, they can play that game at the EMT level, but when it goes counter to the established BLS Provider standards and tests, it screws things up for the Coppers.

Thanks for the input.
 

silver

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Ill try and find it again,
The discussion came up while teaching a class as it seems this county is doing 11:1 (why 11 and not 10?) and all providers are supposed to do it. There are no testing standards. Nor can I find good data.
This is supposedly Seattle FD oriented.

Issue is that it’s not AHA Committee guidelines approved that I can see. So it creates problems when teaching Public Safety BLS.

I really don’t care what EMS wants, they can play that game at the EMT level, but when it goes counter to the established BLS Provider standards and tests, it screws things up for the Coppers.

Thanks for the input.
Regardless of advanced airway or not?
 

Jim37F

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That's what they said about our 10:1 is that it was based on Seattle's program. I guess our Medical Director at the time had visited theirs and really liked that, so she implemented it here. Haven't heard anything about 11:1 though.

Once advanced airway is in place, it switches to normal ventilation rates, 1 squeeze ~6-8 seconds, or as guided by the medics.

Supposedly if we're on duty and by ourselves (Only real time I can picture that is while doing Messenger or Detail running mail and supplies around, we're not being dispatched to any calls, but can potentially Still Alarm something and/or hear on the radio we're only a block away from a reported Cardiac Arrest case I suppose. Haven't seen/heard of that one in particular happening but it's theoretically possible I suppose). Anyway, by ourselves we're supposed to do AHA 30:2 until more responders arrive and then switch to 10:1

There are "Sidewalk CPR" classes being given out all over the place where they encourage bystander to do nonstop compression only CPR, no stopping for ventilations which would match 10:1 a lot more closely than 30:2.

Personally I feel like if I ever actually end up in a situation where I'm by myself doing CPR, whether on or off duty, I'd just crank out continuous compressions until someone else with flashy lights can show up lol

I've only been on one case recently where PD was actually on scene first doing CPR prior to us, they even had their AED on and everything. And once Fire showed up, PD defaulted to us doing patient care until EMS showed up. There was one case where PD was first on, and had their AED on, but the patient was under a car, and EMS was on scene before us, so they already had patient care control (we basically just helped drag them out, on the board, Lucas, bag to the hospital).

So in most situations I can see, PD and Ocean Safety if they're doing 30:2 and Fire shows up, they're gonna let us go to 10:1 nonstop without any issues. And that's pretty much how it goes with EMS, we keep doing 10:1 with them. Once the Lucas is on, we hit the continuous button.

Police, Fire, and Ocean Safety, we all carry the same model AED so that's straightforward (EMS obviously has their LP15 monitors).

We do have a new Medical Director, but I haven't heard of them making any changes to our CPR algorithms. And we happen to be doing our annual skills refresher on that in a week or so, we did all the online portion stuff already, nothing new there.
 

Peak

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The only literature I could find doesn’t support 10:1 so I’d be curious to see anything that does.
 
OP
CCCSD

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Thanks Jim.
As I said, no issues for EMS doing it, but when they change a State mandated reg, then it needs clarification if it affects certification standards.
 

Aprz

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We do 11:1 where I work. Don't know the data. I think we started doing it like 2-3 years ago when we got a new medical director. From my own perspective, it is inconsistently followed and I have to remind other providers that that's what we do now.

Edit: I think they are aiming for that sweet spot 110 compressions/minute and 10 breaths/minute. With 10:1, you are either doing 100 compressions/minute or 11 breaths/minute I think? Kind of insignificant in my opinion, but I think think that's why 11:1. AHA is goal is 100-120 compressions per minute.
 

silver

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The only literature I could find doesn’t support 10:1 so I’d be curious to see anything that does.
This.

Seattle implemented multiple changes (protocols, culture, technology) in rapid succession to improve CPR quality, many were focused on decreasing interruptions. I feel like people are trying to replicate their success even though Seattle never demonstrated continuous compressions by EMS providers had more favorable outcomes.
 

DesertMedic66

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The only literature I could find doesn’t support 10:1 so I’d be curious to see anything that does.
Not sure on the evidence however it is not 10:1 in the normal sense of 30:2.

It’s continuous compressions with the breath being provided during the upstroke of the 10th compression so there is no stoppage of compressions or hands off chest time. We are also precharging our cardiac monitors before each rhythm check so we can quickly check a rhythm and immediately defib the patient and get back on the chest in under 5 seconds.

When it was first brought to our agency it was advertised as a form of CCR (CardioCeberal Resuscitation).
 

Peak

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Not sure on the evidence however it is not 10:1 in the normal sense of 30:2.

It’s continuous compressions with the breath being provided during the upstroke of the 10th compression so there is no stoppage of compressions or hands off chest time. We are also precharging our cardiac monitors before each rhythm check so we can quickly check a rhythm and immediately defib the patient and get back on the chest in under 5 seconds.

When it was first brought to our agency it was advertised as a form of CCR (CardioCeberal Resuscitation).

I get that, I couldn’t find any data to support this over the current AHA recommendations
 
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Thanks all for the excellent opinions and information.
 

EpiEMS

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I get that, I couldn’t find any data to support this over the current AHA recommendations
The best looking recent-ish study I could find was from NEJM in 2015, they seem to agree with you (excerpts from full text below):

Patients assigned to the group that received continuous chest compressions (intervention group) were to receive continuous chest compressions at a rate of 100 compressions per minute, with asynchronous positive-pressure ventilations delivered at a rate of 10 ventilations per minute. Patients assigned to the group that received interrupted chest compressions (control group) were to receive compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations; ventilations were to be given with positive pressure during a pause in compressions of less than 5 seconds in duration.
During the active-enrollment phase, 1129 of 12,613 patients (9.0%) in the intervention group (which received continuous chest compression) and 1072 of 11,035 (9.7%) in the control group (which received interrupted chest compressions) survived to hospital discharge (difference with adjustment for cluster and sequential monitoring, −0.7 percentage points; 95% confidence interval [CI], −1.5 to 0.1; P=0.07)
[Among patients with out-of-hospital cardiac arrest in whom CPR was performed by EMS providers, a strategy of continuous chest compressions with positive-pressure ventilation did not result in significantly higher rates of survival or favorable neurologic status than the rates with a strategy of chest compressions interrupted for ventilation.

There seems to be a paucity of good literature on this -- a 2017 Cochrane review only cited the 2015 NEJM paper in relation to prehospital care provider CCR.
 

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