CPR for ten minutes?

[Skittles]

I'm still in EMT class... However, right before Christmas break, my instructor went to a class, research discussion thingy, where he came back to us with some interesting info.

This was done at a local, well respected teaching hospital. Apparently, they have discovered that CPR only for ten minutes, no AED, no clot-busting drugs, NOTHING, except for hands only CPR increased survival. No rescue breaths, just straight compressions. After 100 compressions, the person doing compressions switched with the person counting. For ten minutes. They even advised against transport for those ten minutes, because even in the hospital with the doctors who can do all the goodies would be doing the same thing.

Thoughts?

 

[STXmedic]

That knowledge has been around for awhile. Good, early, uninterrupted CPR + early defibrillation = best outcomes for survival. All of our wonderful "life-saving" drugs and procedures really haven't proven to be that beneficial.

 

[Skittles]

It was just weird. The class before we were getting it drilled into our heads that while one person was doing compressions, the other was hooking up the AED and attaching pads to analyze, getting the O2 and BVM ready and prepping the suction unit. He came back next class and said nope. Forget everything we just taught you. Also in our books (most recent orange book) it says that AED use in the first ten minutes gives best chances of survival.

ETA: They said no AED for the first ten minutes. No rescue breaths for the same. So would defib at minute 11 still be considered early, considering response times, time the pt was potential down before being found, etc.?

 

[VFlutter]

Our policy is definitive airway by 10mins of CPR. Usually we don't do much with the airway until that 10 min point. However we do a lot more than just CPR during that time. Usually drawing labs, ABGs, and throwing in a femoral and Arterial line. Also there is a lot of detective work going on in that first 10 minutes.

 

[STXmedic]

You will still get the AED on as soon as possible, thus the early defibrillation. Typically a round of CPR before the initial shock, dont wait for 10min to press the shock button. As far as BVM and other airway maneuvers and pharmacologic interventions, almost all systems will still be having you perform those as usual. BVM as soon as possible. IV/IO, epi or vaso, and anti arrhythmics as well. While there may be some advances in medicine, unfortunately EMS is typically well behind current science. And while I hate citing protocols, you will still need to work within them.*

I believe Williamson Co EMS is participating in a study using only a NRB for the first 10 minutes of an arrest before moving to more advanced measures. I'm not sure if any other systems are doing anything similar.

*Many people here will talk about using common-sense, standard medical practice, and slight deviations from protocols to provide the best benefit and care to the patient instead of blindly following protocols to a tee. However, many here are experienced, well-educated, and typically have good working relationships with their medical directors. Don't get yourself fired.

 

[STXmedic]

Our policy is definitive airway by 10mins of CPR. Usually we don't do much with the airway until that 10 min point. However we do a lot more than just CPR during that time. Usually drawing labs, ABGs, and throwing in a femoral and Arterial line. Also there is a lot of detective work going on in that first 10 minutes.

Sure... Rub it in... "Oh look at me, I'm in a hospital and have access to labs, fem lines, and manpower!" :glare:

 

[Skittles]

Absolutely, I will do everything I was trained to, including shocking as soon as possible, suctioning if there is vomit, O2 on the BVM, etc. I actually brought that point up in class, that a doctor at the ED could do more than I can, with their anti-clotting drugs and the like. I was terribly confused. However, I will follow protocol, and I will do what I was trained to, per my CPR card and emt-class, at least until standards change. It just really seems like it would be a waste of time, when I have more advanced treatments at my disposal.

 

[medicdan]

Skittles, if you're interested in more information about this procedure (and how/why it works), consider researching CCR-- Cardiocerebral resuscitation. The CARES registry has some high performance departments doing this, and showing promising statistics. It takes some system coordination, but is really quite simple. Contrary to what your instructor said, CPR, and the current ECC/AHA guidelines are the standard in the vast majority of cities, and you should only perform CCR if in a system with specific protocols covering it, and physician oversight.

 

[medicdan]

Also note, some systems allow for additional interventions in the first few minutes, most notably, opening the airway, inserting an OPA, and placing an NRB at 15lpm, with the thinking that the chest compressions allow positive and negative pressure gradients within the chest, and passive gas exchange within the lungs.

 

[joegrizzly]

If you're interested in more information about this procedure (and how/why it works), consider researching CCR-- Cardiocerebral resuscitation.

That is amazing, obviously protocols and SOPs come first but I'm stoked to have read about this. Thank you.

Ninja edit: I'll post my link to where I read up on CCR and if anyone finds anything better please give it a post. http://www.medscape.com/viewarticle/707616

 

[VFlutter]

Sure... Rub it in... "Oh look at me, I'm in a hospital and have access to labs, fem lines, and manpower!" :glare:

Be jealous

I love having arterial lines during codes. Gives you great feedback on the quality of compressions.

 

[mycrofft]

i'm still in emt class... However, right before christmas break, my instructor went to a class, research discussion thingy, where he came back to us with some interesting info.

This was done at a local, well respected teaching hospital. Apparently, they have discovered that cpr only for ten minutes, no aed, no clot-busting drugs, nothing, except for hands only cpr increased survival. No rescue breaths, just straight compressions. After 100 compressions, the person doing compressions switched with the person counting. For ten minutes. they even advised against transport for those ten minutes, because even in the hospital with the doctors who can do all the goodies would be doing the same thing.

Thoughts?

bs..............

EDIT: One person doing "compressions only" may be able to get better efficiency by skipping inflations (depends on how quickly he can do them) but if 911 shows up and you wave them off someone needs to net you. WHat sort of nonsense is "the hospital can't do anything more than one person doing hands-only CPR....
Oh, I've been punked again haven't I. Dammit!

 

[slewy]

ETA: They said no AED for the first ten minutes. No rescue breaths for the same. So would defib at minute 11 still be considered early, considering response times, time the pt was potential down before being found, etc.?

The main reason for taking an EMT-B class is to prepare the students to pass the NREMT, so that your teacher is trying to confuse you is wrong. You need to have a solid base foundation before taking the test, so follow the book, and not your teacher on this one. I know the teachers says a lot of time about how you need to do something different from the book, but you will learn that in the field. Make sure to follow the book exactly because the NREMT questions are exact replicas. The whole reason you are taking the EMT class is to prepare yourself for the NREMT.

Follow the steps that will be on NREMT for full arrest:
1.Scene safe & BSI
2.Is this only patient? will you need resources?
3. consider c spine
4. Shake and shout
5. Check pulse
5. No pulse, 30 compressions
6. 2 rescue breaths
7.After 2 minutes of CPR, reassess
8. When AED comes on scene attach and use
9. Resume CPR

 

[Christopher]

The main reason for taking an EMT-B class is to prepare the students to pass the NREMT, so that your teacher is trying to confuse you is wrong. You need to have a solid base foundation before taking the test, so follow the book, and not your teacher on this one. I know the teachers says a lot of time about how you need to do something different from the book, but you will learn that in the field. Make sure to follow the book exactly because the NREMT questions are exact replicas. The whole reason you are taking the EMT class is to prepare yourself for the NREMT.

Follow the steps that will be on NREMT for full arrest:
1.Scene safe & BSI
2.Is this only patient? will you need resources?
3. consider c spine
4. Shake and shout
5. Check pulse
5. No pulse, 30 compressions
6. 2 rescue breaths
7.After 2 minutes of CPR, reassess
8. When AED comes on scene attach and use
9. Resume CPR

An EMT class is not meant to prepare you for the NREMT exam, unless it is a crappy class.

It is meant to prepare you to be an EMT.

 

[Christopher]

I'm still in EMT class... However, right before Christmas break, my instructor went to a class, research discussion thingy, where he came back to us with some interesting info.

This was done at a local, well respected teaching hospital. Apparently, they have discovered that CPR only for ten minutes, no AED, no clot-busting drugs, NOTHING, except for hands only CPR increased survival. No rescue breaths, just straight compressions. After 100 compressions, the person doing compressions switched with the person counting. For ten minutes. They even advised against transport for those ten minutes, because even in the hospital with the doctors who can do all the goodies would be doing the same thing.

Thoughts?

10 minutes? Bizarre. They probably were talking about airway management.

Continuous chest compressions plus early appropriate defibrillation, probably within the first 2-4 minutes, is what the literature shows. The literature also shows a clear negative trend with increasing delays in defibrillation.

I would be very surprised if it ended up they did not defib for 10 minutes. Very surprised. If anything researchers are moving to 1 minute cycles.

 

[VFlutter]

What teaching hospital is it? Do you have a link for information? I can't imagine not defibrillating at all until 10 mins. I missed that at first.

I did my clinicals at a progressive teaching hospital and their codes still revolve around early and frequent defibrillation for shockable rhythms. Maybe 10mins of straight compressions for asystole?

 

[RichLew]

Slightly off topic, but still related to working a code... "apneic oxygenation" is anyone else familiar with this or know of any departments that use it?

 

[Christopher]

Slightly off topic, but still related to working a code... "apneic oxygenation" is anyone else familiar with this or know of any departments that use it?

We use it during pre-intubation and peri-intubation via nasal cannula. Dr. Levitan came up with NO-DESAT (Nasal Oxygenation During Efforts Securing A Tube) and Drs. Levitan and Weingart began pushing it hard in their PreOx/ApOx/DeOx/ReOx paper. (Keep in mind ApOx is meant for oxygenation rather than ventilation.)

North Carolina has added NO-DESAT to the 2012 intubation procedure as well.

It probably has limited use in a code due to a lack of physiologic perfusion to produce adequate gradients, but you'll find a similar approach with an OPA+NRB for passive oxygenation during CPR.

 

[Brandon O]

10 minutes? Bizarre. They probably were talking about airway management.

Continuous chest compressions plus early appropriate defibrillation, probably within the first 2-4 minutes, is what the literature shows. The literature also shows a clear negative trend with increasing delays in defibrillation.

I would be very surprised if it ended up they did not defib for 10 minutes. Very surprised. If anything researchers are moving to 1 minute cycles.

I agree. I suspect the research mentioned by the OP was misunderstood by either the instructor or by himself. Otherwise this would be quite a game-changing study.

 

[Summit]

Regional protocols have use doing 200 compressions first.

"In unwitnessed cardiac arrest, give first 2 minutes of CPR without interruptions for ventilation. During this time period passive oxygenation is preferred with OPA and NRB facemask. If arrest is witnessed by EMS, immediate defibrillation is first priority" and thus get a monitor on and ALS can shock VF/VT ASAP, but PEA/Asystole, 2 minutes of straight compressions before you go to epi, then they want another two minutes of straight CPR without ventilation before more drugs, airway interventions, or BVM.