NO CPR is better than moving CPR...true or false?

[jpregulman]

So obviously if you have a LUCUS or similar that is best for the back of the squad. However any CPR is better than no CPR. It however might be better if you were sitting down. Our rig has a "CPR seat" that has a good angle for doing CPR on the go, however in the hospital the nurse will jump on the bed and so CPR while the roll him in.

 

[NomadicMedic]

I believe the only time manual CPR should be performed in the back of a moving ambulance is in the case of an arrest that occurs while transporting. We will stay on scene and work codes until we get ROSC or we call it. If we DO transport an arrest, its with the LUCAS device performing compressions. It's simply pointless to endanger the crew members by allowing them to stand up and perform ineffective CPR in a moving vehicle. I'd be curious to see the effectiveness of CPR performed while sitting. And how does the next provider get into that seat at the 2 minute compressor change point?

 

[TheLocalMedic]

I believe the only time manual CPR should be performed in the back of a moving ambulance is in the case of an arrest that occurs while transporting. We will stay on scene and work codes until we get ROSC or we call it.

+1

I completely agree. HOWEVER, that being said, I have a funny and hypocritical story...

I was working a code a few weeks ago with an old fire medic. The guy had been down for roughly 10 mins without CPR prior to our arrival and we had shocked the fine V-fib that we found him in straight to asystole. We had gone two rounds, had the first Epi on board and suddenly the fire medic announces, "All right, let's get ready to transport him!"

:glare:

So I tell him flat out that I don't transport working codes, that I wanted to either get a pulse back before we transported or just call him on scene. So even though he's staring at me like I've got a second head growing out of my neck, he just goes with it and we work the guy for another couple of rounds.

And here's where I looked like a hypocrite... As we're working all kinds of family start showing up and pitch a fit. I mean, literally screaming and tearing their hair out and rolling on the ground. So even though I'm just about ready to call this guy, I figure that maybe we ought to scoot out of there before things got any crazier. You know, do the whole cosmetic CPR thing just to show them we're doing everything we can.

So off we go, loading the guy up and hauling him off to let the ER call the code with this fire medic smirking at me the whole time.

Sigh... so alright, I guess there are times that I'll transport a working code. But that's more the exception than the rule, and I'd much rather stay and work on scene. Sometimes though, there are other considerations to take into account, and the guy was already toast, so I wasn't really worried about getting good compressions in the ambulance.

 

[CPRinProgress]

I actually got a "save" a couple days ago. We worked on scene for 10 minutes then left. I was surfing the ambulance and I got ROSC while moving. The guy made it through surgery where they placed stents, he had a 90 percent blockage. He died three days later

 

[Brandon O]

I actually got a "save" a couple days ago. We worked on scene for 10 minutes then left. I was surfing the ambulance and I got ROSC while moving. The guy made it through surgery where they placed stents, he had a 90 percent blockage. He died three days later

Other than the patient dying, sounds like a resounding success.

 

[Handsome Robb]

One of my coworkers got dinged by QA/I today for transporting a patient with CPR in progress code 3.

Cited crew safety though not quality of compressions.

Not to be an *** but its not a save unless they walk out of the hospital, in my opinion.

 

[Medic Tim]

One of my coworkers got dinged by QA/I today for transporting a patient with CPR in progress code 3.

Cited crew safety though not quality of compressions.

Sounds like the right priority. Our safety comes first.

 

[VFlutter]

Not to be an *** but its not a save unless they walk out of the hospital, in my opinion.

None of my patients walk out of the hospital. They get a wheelchair ride outside and are free to walk from there.

 

[CPRinProgress]

One of my coworkers got dinged by QA/I today for transporting a patient with CPR in progress code 3.

Cited crew safety though not quality of compressions.

Not to be an *** but its not a save unless they walk out of the hospital, in my opinion.

Yes It felt cool to get him back but since he never even regained consciousness it takes away from the experience. I agree that they should have to walk away for it to be a save.

 

[18G]

I'm all about performing a quality resuscitation onscene and calling it if no ROSC after so long. But should it be 20mins? Where is the evidence that says nobody is coming back after an arbitrary 20min resuscitation? There are many cases of neurologically intact ROSC after 45-90min resuscitations. How do we determine who these people will be?

Perhaps a better practice is to use an automated compression device to deliver quality, uninterrupted compressions and then transport safely (non-emergency) to a hospital. My unit has a vent so if we had a LUCAS device, we could be seatbelted in during the whole transport while a quality resuscitation is performed in the moving ambulance.

Just some things to think about. And there is the new concept of placing certain arrest patients on ECMO in the ED.

 

[chaz90]

I'm all about performing a quality resuscitation onscene and calling it if no ROSC after so long. But should it be 20mins? Where is the evidence that says nobody is coming back after an arbitrary 20min resuscitation? There are many cases of neurologically intact ROSC after 45-90min resuscitations. How do we determine who these people will be?

Perhaps a better practice is to use an automated compression device to deliver quality, uninterrupted compressions and then transport safely (non-emergency) to a hospital. My unit has a vent so if we had a LUCAS device, we could be seatbelted in during the whole transport while a quality resuscitation is performed in the moving ambulance.

Just some things to think about. And there is the new concept of placing certain arrest patients on ECMO in the ED.

It's more about terminating resuscitation in the field if the pt. remains asystolic after some amount of time. I've seen codes with persistent V-Fib or even PEA worked long past 20 minutes for good reason. I'm also a huge proponent of using capnography to guide termination. EtCO2<10 mm Hg with quality compressions and ventilations, and the patients simply don't survive.

 

[CPRinProgress]

It's more about terminating resuscitation in the field if the pt. remains asystolic after some amount of time. I've seen codes with persistent V-Fib or even PEA worked long past 20 minutes for good reason. I'm also a huge proponent of using capnography to guide termination. EtCO2<10 mm Hg with quality compressions and ventilations, and the patients simply don't survive.

Im Training to be an EMT in Jersey, why when the EtCO2 is low does the pt not suvive?

 

[Brandon O]

Im Training to be an EMT in Jersey, why when the EtCO2 is low does the pt not suvive?

CO2 is the product of cellular metabolism. High levels in exhaled air suggest that you're successfully moving blood into the tissues and they're successfully turning it into energy. Low levels suggest you're either not perfusing well or there's already so much cellular damage that the machinery is broken.

Kinda like saying "when there's no exhaust from the tailpipe, the engine's not doing well."

 

[chaz90]

It's a sign of metabolic activity decreasing to the point of gas exchange barely even occurring. If the body is "far dead" on the continuum of cardiac arrest, no CO2 is even being produced. You can pump in oxygen and circulate blood around, but the cells themselves have died and are no longer undergoing cellular respiration.

 

[CPRinProgress]

It's a sign of metabolic activity decreasing to the point of gas exchange barely even occurring. If the body is "far dead" on the continuum of cardiac arrest, no CO2 is even being produced. You can pump in oxygen and circulate blood around, but the cells themselves have died and are no longer undergoing cellular respiration.

thanks I have heard medics talk about that on codes and I never really understood it.

 

[chaz90]

thanks I have heard medics talk about that on codes and I never really understood it.

Oh, there's much more to it than that. Use of capnography during cardiac arrest is the most simplistic, low hanging fruit available, but doesn't begin to realize it's potential. Research it more, and you'll be very impressed at the utility waveform capnography has to offer. It's extremely underutilized in EMS.

 

[CritterNurse]

Or you can just buy a mechanical CPR machine and get effective compressions...

Unless you're in the state of Maine. For some reason they're not approved here.