Cpr-hd

[emtdansby]

Has anyone heard of this type of CPR? The company I am currently working for uses this CPR algorithm for cardiac arrest patients. It's standard ACLS with the exception of bagging the pt. Our system involves placing a NRB at 15 lpm on the pt and performing compressions. We stop compressions for 5 sec every 2 min to check the rhythm and shock/not shock. After 8 min (or 4 cycles of compressions) an advanced airway is placed. Thoughts on this system?

 

[Chris07]

I believe it is known as Cardio Cerebral Resuscitation (CCR). As far as I know it's not really main stream yet but it does look very interesting.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900071/

 

[DesertMedic66]

Has anyone heard of this type of CPR? The company I am currently working for uses this CPR algorithm for cardiac arrest patients. It's standard ACLS with the exception of bagging the pt. Our system involves placing a NRB at 15 lpm on the pt and performing compressions. We stop compressions for 5 sec every 2 min to check the rhythm and shock/not shock. After 8 min (or 4 cycles of compressions) an advanced airway is placed. Thoughts on this system?

Due you place an advanced airway on all codes after the 8 minute mark? Or just if the patient is in PEA/VT/VF?

It seems as if most places have protocols saying after 2 rounds of meds (10 minutes) and the patient is not in VF/VT/PEA then all CPR stops and the corner comes out for a visit.

 

[Thricenotrice]

Due you place an advanced airway on all codes after the 8 minute mark? Or just if the patient is in PEA/VT/VF?

It seems as if most places have protocols saying after 2 rounds of meds (10 minutes) and the patient is not in VF/VT/PEA then all CPR stops and the corner comes out for a visit.

This is how my protocols work as well. Additionally, only if the PEA is less than 20/min do we discontinue. But we also still give atropine on PEA/Asystole :/ (though not right now due to the atropine shortage)

 

[emtdansby]

We refer to it as CPR-HD. I have heard of CCR and believe it is very similar. Every pt, no matter what the rhythm, gets an advanced airway after 8 min. After working the patient for 20 min, we make a transport decision based on certain factors. The main factors are age and what rhythm the patient is in. If the pt is not a child and has been in a asystole for more than 2 min, we contact the ME. Other than that, we transport to the closest facility.

 

[emtdansby]

Here is our CPR-HD algorithm, every two min compressions are swapped between the paramedic and basic, the one not doing compressions has specific tasks.

 

[medicdan]

View attachment 1489

Here is our CPR-HD algorithm, every two min compressions are swapped between the paramedic and basic, the one not doing compressions has specific tasks.

I like how well laid out your care is, this is the pit crew approach, modified, it seems. The image quality isn't great, I'd love to see a better pic...
Do you do this for ALL arrests, no matter the presumed etiyology? I can imagine focusing on oxygenation and ventilation in presumed respiratory arrests or drownings, no?

 

[emtdansby]

We do have different protocols for drowning and respiratory arrest. Once respiratory arrest causes cardiac arrest, we go with our CPR-HD protocol. I'll type up the algorithm so everyone can see the system

 

[NomadicMedic]

I'm also very interested in seeing the Medic/Basic roles.

 

[emtdansby]

0-2mins
Paramedic-EKG, IO, Epi
Basic-compressions

2-4mins
Paramedic-compressions
Basic-OPA,15 lpm via NRB, set up remaining Epi's, CBG

4-6mins
Paramedic-Epi, Medical History, Events leading to arrest
Basic-compressions

6-8mins
Paramedic-compressions
Basic-Set up advanced airway, setup amio

8-10mins
Paramedic-place advanced airway, Epi
Basic-compressions

10-12mins
Paramedic-compressions
Basic-BVM 8-10/min

12-14mins
Paramedic-Amio, Epi, BVM
Basic-compressions

14-16mins
Paramedic-compressions
Basic-BVM

16-18mins
Paramedic-Amio, BVM
Basic-compressions

18-20
Paramedic-compressions
Basic-BVM

20 min
Consider transport or termination of efforts

We have a stop watch to keep us on time. When approaching the 2 min mark, the crew member not doing compressions will charge the defib, at the 2 min mark, compressions are stopped just long enough for the paramedic to read the rhythm and decide to either shock or not. This is designed for two man CPR and really helps us to stay coordinated and standardizes cardiac arrest treatment company wide.

As you can see, it's not until 8-10min that we actually start bagging the patient. Recent studies done by AHA, studies that pushed them to compression only CPR for bystanders, showed that the O2 remaining in the blood and lungs can sustain a person in cardiac arrest for 4-6min without being bagged. We took that, added the NRB with passive oxygenation, and stretched it to 8-10 mins.

 

[Handsome Robb]

We do have different protocols for drowning and respiratory arrest. Once respiratory arrest causes cardiac arrest, we go with our CPR-HD protocol. I'll type up the algorithm so everyone can see the system

Wait. I have an issue with this. Above this post you said you have different protocols then stated once it develops into cardiac arrest you do your "CPR-HD".

We're part of the CCR study where I work.

CCR is basically what you're describing. Sounds like a combo of pit crew and CCR. With that said, cardiac arrest with a presumed respiratory etiology is a contraindication for cardiocerebral resuscitation.

 

[Brandon O]

This specific model for compression-focused resuscitation (8 minutes hands-only with NRB, then do what you want) has been used in a couple places near me as well. Seems to be gaining traction.

I'm curious what HD stands for, though.

 

[shfd739]

This specific model for compression-focused resuscitation (8 minutes hands-only with NRB, then do what you want) has been used in a couple places near me as well. Seems to be gaining traction.

I'm curious what HD stands for, though.

Highly defined.

Each crew member has "defined" tasks to perform

 

[Brandon O]

Wow. I love me a good acronym, but that's worthy of the US military.

 

[Handsome Robb]

Used CCR today.

Asystole to ST with a beautiful bp with one round of Epi and good CPR.

Pretty cool when it works.

 

[FR Wrath]

I work for this same company that OP does. If the presumed etiology is not cardiac, then this protocol goes out the window and we do it old fashioned (tubing earlier rather than later).

 

[medicdan]

I work for this same company that OP does. If the presumed etiology is not cardiac, then this protocol goes out the window and we do it old fashioned (tubing earlier rather than later).

Makes sense, thanks.

 

[emtdansby]

I work for this same company that OP does. If the presumed etiology is not cardiac, then this protocol goes out the window and we do it old fashioned (tubing earlier rather than later).

Thanks bid, I had been looking through the protocols to find an answer.

 

[chaz90]

Seeing as you have this entire protocol written for only two providers, it appears that your service could benefit immensely from adding an Autopulse or Lucas. Have you guys looked at that at all?

 

[NomadicMedic]

Chaz, don't be surprised if you see a variation of this in the street. We've been working on a pilot of this here. Waiting for med directors approval.