CPAP for CPR

Reynolds One

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Last week at the EMS Expo in Vegas, a professor from UCLA's School of Emergency Medicine did a session on CPR. He suggested that we might see better results in CPR during cardiac arrest by using a CPAP. The idea being that, since the lungs hold 5 times as much blood as the heart, the CPAP will help increase intrathoracic pressure and force more blood through the pulmonary circulation and thus into the systemic circulation (I believe I'm summarizing it correctly).

Anyone heard this before? Any thoughts?
 

Summit

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Usually I think of excess positive pressure from ventilation impairing RA filling...
 

VentMonkey

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Usually I think of excess positive pressure from ventilation impairing RA filling...
+ 3. Also, this^^^. IIRC, CPAP’s biggest downfall is decreasing venous return, though arguably so could effectively bagging said patients with PPV.

I suppose at this point it may be worth a shot if you, or your medical director so chooses to implement such a protocol without extensive EBM.

The only CPAP—>PPV I am currently fond of is the transition of CPAP to PPV in the impending respiratory failure patient. That is, being able to attach a BVM (preferably with a PEEP valve attached) to an already placed CPAP mask that is hopefully sealed tightly until the patient can be intubated.
I see floppy, frothy, puking airways.
Also OP, this would not be ideal should you achieve viable ROSC. A definitive airway is/ will be needed.

If I had to guess which professor from UCLA it would be, it’s probably Baxter Larmon—who’s very smart—but also quite eccentric. Also, just some food for thought.
 

EpiEMS

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Reynolds One

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Not sure. He referenced a lot of studies, some of which he himself has conducted over recent years. I don’t think he referenced a study specifically related to CPAP and CPR.
 

VentMonkey

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Not sure. He referenced a lot of studies, some of which he himself has conducted over recent years. I don’t think he referenced a study specifically related to CPAP and CPR.
Baxter Larmon is well known, and respected, in the SoCal EMS realm. That said, he carries a bit of an enigmatically pompous demeanor about him.

I did a couple of refreshers at his paramedic alma mater of DFI/ UCLA, and while I overall enjoyed them, they all but catered specifically to his alumni. There’s even an exclusive alumni get together email everyone receives when you sign up.

All in all, I am glad I chose to pursue other ventures when obtaining both paramedic, and FP-C CE’s. After a while their topics seemed a bit trivial, for lack of a better word. I much rather prefer the SMACC, and FOAM-ed crowd and many of the outliers that are cited from them as credible EBM. A lot of it he will mention...a few years later.

This was all just my experiences though.
 

NPO

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Baxter Larmon is well known, and respected, in the SoCal EMS realm. That said, he carries a bit of an enigmatically pompous demeanor about him.

I did a couple of refreshers at his paramedic alma mater of DFI/ UCLA, and while I overall enjoyed them, they all but catered specifically to his alumni. There’s even an exclusive alumni get together email everyone receives when you sign up.

All in all, I am glad I chose to pursue other ventures when obtaining both paramedic, and FP-C CE’s. After a while their topics seemed a bit trivial, for lack of a better word. I much rather prefer the SMACC, and FOAM-ed crowd and many of the outliers that are cited from them as credible EBM. A lot of it he will mention...a few years later.

This was all just my experiences though.
I've never been to UCLA, and I've never met the professor you speak of, but it sounds like the FireFighter Paramedicine School I've been told that it is.
 

VFlutter

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Presumably for most cardiac arrests profound hypovolemia is not the issue and I doubt the minimal increase in circulating blood volume would outweigh the negative effects of the increased intrathoracic pressure.

And if you dive into the concept of hypotensive ventilator strategies you see High TV / Low RR approaches to minimize the amount of time venous return is impeded by ventilation and increased intrathoracic pressure.
 

Carlos Danger

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I think it is an interesting concept. The hemodynamics of CPR and CPAP are fairly complex and the actual clinical effects of different vent modes can vary substantially from patient to patient. You'd need a large RCT with very strong results to convince people that it's the right thing to do routinely. I'd be interested in reading something on this, if there is anything out there.
 

Alan L Serve

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Did this professor suggest what pressure the CPAP be set at?

Did he suggest biPAP to allow for exhalation in the event of good O2/CO2 exchange?
 

MonkeyArrow

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Presumably for most cardiac arrests profound hypovolemia is not the issue and I doubt the minimal increase in circulating blood volume would outweigh the negative effects of the increased intrathoracic pressure.
One would think, but similar early stage literature I've read on techniques that do this very thing seem positive. Specifically, I'm thinking of abdominal binding intra-arrest, which increases circulating volume secondary to shunting blood away from the abdominal aorta/inferior half of the body, I guess akin to a non-invasive IABP.
 

RocketMedic

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I think the only real effective CPR intervention is field ECMO or something like it.
 

VFlutter

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One would think, but similar early stage literature I've read on techniques that do this very thing seem positive. Specifically, I'm thinking of abdominal binding intra-arrest, which increases circulating volume secondary to shunting blood away from the abdominal aorta/inferior half of the body, I guess akin to a non-invasive IABP.
If that is the rationale then we should just start doing REBOA in the field. Interesting concept but I have my doubts.
 

EpiEMS

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Reynolds One

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Specifically, I'm thinking of abdominal binding intra-arrest, which increases circulating volume secondary to shunting blood away from the abdominal aorta/inferior half of the body, I guess akin to a non-invasive IABP.
Funny you mention that; that was another thing Larmon talked about - abdominal binding during CPR.
 

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