Differences between pit crew CPR and ACLS

ExpatMedic0

ExpatMedic0

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Forgive me if this is a silly question, but would someone mind explaining the key differences between "Pit Crew CPR" and going through a resuscitation with the normal AHA ACLS algorithms and standards? I have never worked anywhere where they claim to use pit crew CPR, but after reading about it, and how it claims to boast a much higher ROSC, I was curious...
Also if you have experience with it, can you give me some feedback and pros and cons? Thanks in advance
 
Pit Crew CPR and the AHA standard are the same engine with a different tune. We still do 30:2, follow the same oxygenation strategy, and allow medics to continue on with their ACLS interventions unless if the patient requires compressions from someone at that very moment. What makes the difference in Pit Crew CPR seems be the pace (No Downtime), measurement of providers/collection of data, and the emphasis on interventions that matter (or what we would call BLS).

I view Pit Crew as a trendy term that naturally rose out of making resuscitation more efficient, like the Golden Hour did for transport time. After all, we're just describing how resuscitation should be run and enforcing it with metrics and extra training.

Seems a little silly that it's around at all, we don't call a team getting together in the Emergency Department to receive a critical patient "Pit Crew ____", do we?
 
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We do pit crew CPR differently. We do asynchronous CPR. We don't stop compressions to ventilate. On the upstroke of every 10th compression we ventilate once.

The only time we hold compressions is to do a pulse and monitor check.
 
Pit crew CPR's foundational principle is that everyone has a specific job to do (i.e. person 1 compressions, person 2 monitor, person 3 airway etc.) in order to have an organized and efficient approach to the resuscitation. It places emphasis on early defibrillation and high quality, uninterrupted compressions, in order to achieve higher rates of ROSC and survival to discharge. In addition it utilizes the use of passive oxygenation, instead of positive pressure ventilation, during the first few minutes of the arrest.

This video demonstrates pit crew cpr being used at both the BLS and ALS levels.
 
So the Pit Crew approach appears to emphasize uninterrupted compression and assigned task, however the specifics of this vary from agency to agency; does this sound correct? If I am understanding correctly, then I am still struggling to see the difference between doing ACLS %100 by the book vs pit crew cpr... These are components within AHA BLS and ACLS correct? Would the pit crew approach then stand apart by putting more of an emphasis on those key areas and additional CME for resuscitation beyond ACLS to ensure all crews are more efficient and by allowing minor differences by an agency?
 
ExpatMedic0 said:
So the Pit Crew approach appears to emphasize uninterrupted compression and assigned task, however the specifics of this vary from agency to agency; does this sound correct? If I am understanding correctly, then I am still struggling to see the difference between doing ACLS %100 by the book vs pit crew cpr... These are components within AHA BLS and ACLS correct? Would the pit crew approach then stand apart by putting more of an emphasis on those key areas and additional CME for resuscitation beyond ACLS to ensure all crews are more efficient and by allowing minor differences by an agency?
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ACLS is still followed, for the most part. Medication admin is the same, compression rate, things like that.

Really the goal is seamless ACLS with an emphasis on the more proven aspects of the algorithm...continuous compressions and timely defib.
 
The biggest differences are at the BLS level- like continuous chest compressions and passive oxygenation, but there are also differences on the ALS side, like delayed intubation, and in some cases, a delay or even removal of the administration of epinephrine.
 
It's worth noting that there is no set "pit crew CPR standard." How agencies choose to go about this is entirely up to them. Some places don't meds as quickly, some places don't intubate at all, some places intubate through compressions, the list go on.
 
redundantbassist said:
The biggest differences are at the BLS level- like continuous chest compressions and passive oxygenation, but there are also differences on the ALS side, like delayed intubation, and in some cases, a delay or even removal of the administration of epinephrine.
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Where did you see removal of EPI? That does not make much sense to me.
 
DesertMedic66 said:
We do pit crew CPR differently. We do asynchronous CPR. We don't stop compressions to ventilate. On the upstroke of every 10th compression we ventilate once.

The only time we hold compressions is to do a pulse and monitor check.
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You don't have "Res-Q" pods? Blinks every 6 seconds I believe when you are supposed to give a breathe. Also enhances negative pressure in the chest and reduces intracranial pressure.
 
Chewy20 said:
You don't have "Res-Q" pods? Blinks every 6 seconds I believe when you are supposed to give a breathe. Also enhances negative pressure in the chest and reduces intracranial pressure.
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Some newer research has shown that Res-q-pods do not effective outcomes, though they do a good job of reminding providers of how fast to bag. Given that they are 70-90 dollars and the benefit comes from a timed blinking light, many places (all of our region for instance) have elected to stop purchasing them.

http://www.nejm.org/doi/full/10.1056/NEJMoa1010821
 
Chewy20 said:
You don't have "Res-Q" pods? Blinks every 6 seconds I believe when you are supposed to give a breathe. Also enhances negative pressure in the chest and reduces intracranial pressure.
Click to expand...

Tigger said:
Some newer research has shown that Res-q-pods do not effective outcomes, though they do a good job of reminding providers of how fast to bag. Given that they are 70-90 dollars and the benefit comes from a timed blinking light, many places (all of our region for instance) have elected to stop purchasing them.

http://www.nejm.org/doi/full/10.1056/NEJMoa1010821
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Tigger answered it. There hasn't been a good study that shows they effect outcomes. 70-90 for a light that blinks every so often is a little to pricey to be used just for that function.
 
DesertMedic66 said:
Tigger answered it. There hasn't been a good study that shows they effect outcomes. 70-90 for a light that blinks every so often is a little to pricey to be used just for that function.
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Touche. Have not looked much into the research behind it. Guess we gotta waste our budget somehow ;)
 
Chewy20 said:
Touche. Have not looked much into the research behind it. Guess we gotta waste our budget somehow ;)
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We took a class on it during medic school and then right after the class looked some studies and were told "you guys will probably never see this".
 
We've got Res-Q-pods and we're using them until the stock runs out.
 
If I remember correctly from the studies we looked at (I think just one or 2) there was no benefit or harm from the devices.
 
Chewy20 said:
You don't have "Res-Q" pods? Blinks every 6 seconds I believe when you are supposed to give a breathe. Also enhances negative pressure in the chest and reduces intracranial pressure.
Click to expand...

They are heavily used in our area. I think it all depends on what study your medical director wants to believe in. The Res-Q pump is now the new kid on the block.
 
If you watch the resQpod "pig in VF" video, it looks pretty impressive.
 
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