CPR for ten minutes?

[Brandon O]

Regional protocols have use doing 200 compressions before AED.

"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.

Yes, this concept was taught in the 2005 protocols -- if you didn't see it and no bystander CPR was provided, start with a couple minutes of compressions to "prime the pump." Further research suggested it may or may not be beneficial, so the 2010 recommendations deemphasized it. However, I've never seen anything that supported 10 minutes.

 

[Handsome Robb]

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

I may or may not work for one of the agencies that participates in CARES and uses CCR.

It's a pretty cool system. You should see the look on fire's faces when I throw then a NRB and OPA then tell them to move on.

Like everything CCR has indications and contraindications.

 

[Veneficus]

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 would be very surprised if an ethical committee would even consider letting somebody do that.

From experience, "new and novel" ideas are not well received in medical research. It takes baby steps.

This is talking about something that goes against all the current knowledge.

I think something was misunderstood or not reported here properly.

 

[TheLocalMedic]

One thing that I have seen getting attention lately is the idea of continuous CPR at all times. This includes during defibrillation... just keep right on going through the shocks. I don't know all the details, or the actual safety of the practice, but that seems to be an interesting idea and "keeps the pump primed".

 

[Summit]

Yes, this concept was taught in the 2005 protocols -- if you didn't see it and no bystander CPR was provided, start with a couple minutes of compressions to "prime the pump." Further research suggested it may or may not be beneficial, so the 2010 recommendations deemphasized it. However, I've never seen anything that supported 10 minutes.

It is interesting to me that in their latest protocol update, they added the second set of 200 straight compression.

 

[Brandon O]

It is interesting to me that in their latest protocol update, they added the second set of 200 straight compression.

I'm not sure what you're referring to here.

 

[Summit]

I'm not sure what you're referring to here.

To clarify, the recent update calls for not one, but two cycles of no-ventilation/passive oxygenation CPR (compressions only with a NRB and OPA) unless there is an indication of non-cardiac etiology (eg asphyxiation of any cause) before switching to 30:2 ratio or attempting a King/ETT.

 

[Shishkabob]

I don't do CPR. That's what firefighters are for. h34r:


I haven't done a single compression in the last 5+ arrests.

 

[Brandon O]

To clarify, the recent update calls for not one, but two cycles of no-ventilation/passive oxygenation CPR (compressions only with a NRB and OPA) unless there is an indication of non-cardiac etiology (eg asphyxiation of any cause) before switching to 30:2 ratio or attempting a King/ETT.

If you're referring to the 2010 AHA guidelines, I don't think this is correct. The guidelines decline to offer any specific recommendations on this subject, due to ambiguous evidence; instead they simply emphasize that in most cases, it's usually a moot point because compressions can be offered simultaneously while the defibrillator is readied.

"There is insufficient evidence to recommend for or against delaying defibrillation to provide a period of CPR for patients in VF/pulseless VT out-of-hospital cardiac arrest. In settings with lay rescuer AED programs (AED onsite and available) and for in-hospital environments, or if the EMS rescuer witnesses the collapse, the rescuer should use the defibrillator as soon as it is available (Class IIa, LOE C). When more than one rescuer is available, one rescuer should provide chest compressions while another activates the emergency response system and retrieves the defibrillator."

http://circ.ahajournals.org/content/122/18_suppl_3/S685.full

"When an out-of-hospital cardiac arrest is not witnessed by EMS personnel, EMS may initiate CPR while checking the ECG rhythm and preparing for defibrillation. There is insufficient evidence to determine if 1 ½ to 3 minutes of CPR should be provided prior to defibrillation. CPR should be performed while a defibrillator is being readied (Class I, LOE B). One cycle of CPR consists of 30 compressions and 2 breaths. When compressions are delivered at a rate of about 100 per minute, 5 cycles of CPR should take roughly 2 minutes (range: about 1 ½ to 3 minutes).

"EMS system medical directors may consider implementing a protocol that allows EMS responders to provide CPR while preparing for defibrillation of patients found by EMS personnel to be in VF. In practice, however, CPR can be initiated while the AED is being readied."

http://circ.ahajournals.org/content/122/18_suppl_3/S706.full

 

[shfd739]

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.

We do something similar. NRB until minute8-10 or so then intubation.

Codes are broken down into 2 minute blocks with assigned tasks to each partner, or delegated to other responders.

We're seeing some improved success with neuro intact post arrest discharges.

 

[Summit]

If you're referring to the 2010 AHA guidelines, I don't think this is correct.

I continue to be unclear :unsure:

I was referring to the recent update to the regional EMS protocol (which is well post-2010).

And these protocols do allow for shocking VF/PVT ASAP.

 

[Skittles]

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.

Stupid point, but I'm a girl.

Hershey medical center is where it was being done. When I go back to class Tuesday, I will ask of he knows of any resources provided by Hershey to the public about this. And he wasn't trying to confuse us, or tell us to not follow protocol or current CPR standards. More of a point of interest discussion

 

[Skittles]

One thing that I have seen getting attention lately is the idea of continuous CPR at all times. This includes during defibrillation... just keep right on going through the shocks. I don't know all the details, or the actual safety of the practice, but that seems to be an interesting idea and "keeps the pump primed".

This was also mentioned. It's possible I misunderstood, but the nothing but compressions for ten minutes, not even AED was quite clear and adamant.

 

[Brandon O]

Stupid point, but I'm a girl.

Hershey medical center is where it was being done. When I go back to class Tuesday, I will ask of he knows of any resources provided by Hershey to the public about this. And he wasn't trying to confuse us, or tell us to not follow protocol or current CPR standards. More of a point of interest discussion

Sorry girl! Let us know what you hear, sounds like interesting stuff.

 

[Handsome Robb]

This was also mentioned. It's possible I misunderstood, but the nothing but compressions for ten minutes, not even AED was quite clear and adamant.

That doesn't make any sense to me. Not saying you're wrong, just that from what I've been taught and read, it doesn't add up.

CPR and early defibrillation are the two interventions proven effective to increase survival to discharge rather than everything else included in ACLS.

 

[downunderwunda]

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

Shake & shout has been amended after a nurse in the UK used it to get off a shaken baby murder charge…

 

[RustyShackleford]

CPR and no defib.....remind me never to arrest in central pa

 

[Handsome Robb]

I don't believe it until I see studies. Compressions and early defibrillation save lives, not compressions by themselves.

As far as transporting, I don't transport with CPR in progress. If we get ROSC then they lose it again we continue to work until it comes back or it doesn't.

 

[Christopher]

I don't believe it until I see studies. Compressions and early defibrillation save lives, not compressions by themselves.

As far as transporting, I don't transport with CPR in progress. If we get ROSC then they lose it again we continue to work until it comes back or it doesn't.

I'm sure they meant compressions without ventilations for 10 minutes.

 

[NomadicMedic]

And we brought this year old thread back from the dead, why?