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

[NomadicMedic]

No CPR while en route for me, unless its with a Lucas Device. It's simply too dangerous for the provider and doesn't benefit the patient.

 

[Medic Tim]

I'm for CPR during transport. I had my second save this past Wednesday. Worked up and shocked en-route, and we dropped off the patient with a bp of 160/90, and in sinus tach @ 104.

Not trying to be a jerk but a bp at the er does not = a save. it is great you were able to do it twice but unless they are walking out of the hospital it is not a save.
Another way to look at it is, your pt (maybe) survived in spite of the care you gave.

 

[retarmyeng06]

Whatever happened to responder safety being the #1 priority? Assuming scene safety was considered on arrival at the scene then it remains the best place to work a code unless an unforeseen event intervenes. In which case loading and moving to a safe location where CPR can be resumed is the next best option IMHO. Considered thought cannot logically bring anyone to believe that standing next to, kneeling by, or straddling a pt. in a moving vehicle (with its lights and siren on no less) is in the least bit safe. :deadhorse:

 

[mycrofft]

Speaking of dead horses, I thought the whole "my ambulance is as good as your emergency room" had been stomped here? Let us set that aside.

Now, as for moving CPR being ineffective, I heard "some studies" mentioned but not cited. Citations, please!

Being unsafe for the practitioner: if you work where enroute CPR is done, can you please tell us how many instances of injury you personally know of? Not heard of, unless it was say a safety briefing about a particular incident by your company, but either you or your partner were injured, or you know someone who was injured. ("If it is so unsafe, show me the bodies").

If enroute CPR wedged between the squad bench and the litter in a moving ambulance (not a careening one) is so unsafe, how can riding on top of the patient on a 30 inch wide hospital gurney rolling down a hallway and making 90 deg turns, negotiating doorways, etc., be any safer or effective? (For instance, hand placement...). Or in a rolling ambulance?

Personally, I feel that atraumatic pusleless states in the field not caused by a finite stimulus (i.e., poison, asphyxiation, electrocution) and even those without prompt initiation of the "Chain of Survival", are a foregone/fatal conclusion and we are playing for points as we help make the public statement that SOMEONE is going to come if you need help. At that, the vast majority of cases then don't deserve CPR on a strictly scientific basis (in America about 90% of atraumtic cases of pulselessness are due to lethal coronary conditons incompatible with further life, according to the article I read the last time ths was discussed*); ergo, rolling cpr is not justifed as it can potentially offer threats to practitioners.

But let's practice using common observation and science, because the finding that on-scene ALS has about the same chance as Emergency Dept ALS cannot be generalized to any other cases as a whole.

Or, let's tear down the hospitals and buy one hell of a lot more ambulances:rofl:.

EDIT: My mistake. See this from American CDC:
http://www.cdc.gov/nchs/fastats/lcod.htm Almost five to one cardiac versus accidental trauma, not counting suicide nor any other sort of species of mechanism (i.e., chronic lower respiratory disease, cancer, etc etc) suggests the rati may be a little lower afterall, but nt certainly.

 

[RustyShackleford]

I have never heard of "not transporting a working code" We always load and go, and work the code on the way to the hospital. I see how CPR wouldn't be as good, and the dangers to providers. So can you all enlighten me? It seems like the thing to do is work it on scene for "X" amount of time, and only transport if ROSC. If no ROSC call it on scene. Am I correct?

We are about 50/50 ALS and BLS, our basics can't call on scene. If they arrive and the patient is obviously dead (rigor, lividity ect) then they can call the Dr and he will advise. However, if the patient was witnessed, or CPR is in progress, then they load and do CPR until they meet ALS rig or the ER.

We are obviously a rural department, so I am just curious about the protocols involved in this.

You work acls codes on route? We do it on scene if the arrest happens on route to ed we pull over and run the arrest algorithm then make a running decision on transport or termination.

 

[Hunter]

I've yet to read an answer to the topic. Is no cpr better than moving cpr?

 

[med109]

You work acls codes on route? We do it on scene if the arrest happens on route to ed we pull over and run the arrest algorithm then make a running decision on transport or termination.

Yes we do. If it is something that should be worked, we load and go. We work it the entire trip to the ER (11 minutes at the very least), once at the ER they work it through atleast one more round of meds and then call it. In 12 years I have NEVER stayed on scene and worked one, and I have NEVER pulled over if someone codes enroute. I have only had a Dr tell us to stop one time.

If it is a BLS crew, the Dr just recently told us to load the patient, call for ALS and remain onscene and begin CPR, and get an IV if possible. Once ALS arrives they jump in the rig and away we go. Working it the whole trip.

 

[medic417]

I've yet to read an answer to the topic. Is no cpr better than moving cpr?

CPR is better than no CPR though moving CPR has been proven to be less effective than stationary CPR.

 

[RustyShackleford]

Yes we do. If it is something that should be worked, we load and go. We work it the entire trip to the ER (11 minutes at the very least), once at the ER they work it through atleast one more round of meds and then call it. In 12 years I have NEVER stayed on scene and worked one, and I have NEVER pulled over if someone codes enroute. I have only had a Dr tell us to stop one time.

If it is a BLS crew, the Dr just recently told us to load the patient, call for ALS and remain onscene and begin CPR, and get an IV if possible. Once ALS arrives they jump in the rig and away we go. Working it the whole trip.

Hmmm that seems redundant to me, als in the hospital isn't going to trump the als that you did on scene, I'm sorry to say but grandma in asystole at home isn't going to magically come alive because a nurse or doctor gives them epi instead of yourself. Which is why we work on scene unless there is extenuating ie age, mechanism, possible reversible causes.

 

[VirginiaEMT]

I'm for CPR during transport. I had my second save this past Wednesday. Worked up and shocked en-route, and we dropped off the patient with a bp of 160/90, and in sinus tach @ 104.

What's the patient's condition now?

 

[mycrofft]

The one field save I was a party to was CPR enroute after we got started at her home, which included getting the food bolus out of her airway. A transient cause of asphyxia, corrected, allowed recovery thanks to time bought with CPR in a moving ambulance (we were BLS only).
Oddly, we got a no-code order via radio phone enroute, but she was already off compressions and responding to tactile stimuli. Left the hospital about a week later, ribs wired, lots oa parenteral nutrition and TLC on board, was the mascot of the tele unit.

 

[Rialaigh]

Compressions not as effective, maybe, depends on who is doing the compressions.

Responder safety, now that is one that is a pet peeve of mine. I can't take any of complaints of responder safety seriously on here. Not because you are not correct, but because the same people that will state responder safety as a reason to not do CPR in a truck are the same ones who get in the truck and don't put a seatbelt on regardless of what seat they are in. That...is bull poopy...

Do I think transport is the best option. Sometimes. Do I live in an area where you get the ambulance on scene and the transport time to a cardiac intervention hospital is sometimes only 2-5 minutes, yes. Would I rather transport then, probably. In general it is better to work and call it in the field though.

 

[JMorin95]

Truth is CPR doesn't work. It's all luck as to whether or not someone lives.

 

[Rialaigh]

Truth is CPR doesn't work. It's all luck as to whether or not someone lives.

Your suposed to look for the groundhogs shadow to see...

now where do I find that on a person...someone told me once

 

[TheLocalMedic]

Truth is CPR doesn't work. It's all luck as to whether or not someone lives.

Truth is, good CPR and early defibrillation actually save lives. Saying that it's all luck just reveals that you don't understand the mechanics behind what we practice.

 

[JMorin95]

Truth is, good CPR and early defibrillation actually save lives. Saying that it's all luck just reveals that you don't understand the mechanics behind what we practice.

I understand the mechanics. I am just saying that if it truly worked we would have a higher success rate. Most people have an underlying condition that we can only reverse temporarily if at all.

 

[NomadicMedic]

Luck? Maybe partly. CPR and early defib work well in cases of Sudden Cardiac Arrest (ie: VF arrests) but we've got a better chance of a good outcome when it's witnessed and there is good bystander CPR.

Now, playing the ACLS game on 90 year old cancer patients is pointless.

 

[mycrofft]

Hmmm that seems redundant to me, als in the hospital isn't going to trump the als that you did on scene, I'm sorry to say but grandma in asystole at home isn't going to magically come alive because a nurse or doctor gives them epi instead of yourself. Which is why we work on scene unless there is extenuating ie age, mechanism, possible reversible causes.

(accent mine...Mycrofft)

I was all good-to-go-off when I read your last sentence. Good save! Just, for the new people, be SURE you are talking asystole, not just "I can't get a pulse".

 

[mycrofft]

I understand the mechanics. I am just saying that if it truly worked we would have a higher success rate. Most people have an underlying condition that we can only reverse temporarily if at all.

The success rate statistically improved around here after the 2005 then 20230 changes per our local FD medical supervisor.

If you took the American potpourri of field-diagnosed cardiac arrest:

(-------------------------------------------------------------------------------------)

Here's my guesstimate.

These many
(-----------------------------------------------------------------)
especially if over say forty years old, are victims of MI due to coronary artery disease which leaves a lethal degree of necrotic myocardium. Dead is dead. RIP.

These many:
(-------------)
were not truly, permanently asystolic. Either the problem was very transient (electric shock, apnea from a seizure or temporary airway embarrassment) or there was a pulse and the responder and bystanders missed it. (We no longer even teach laypersons to take pulses anymore). It's my gut feeling that many or most of "saves" (besides outright fakers) are in this class, who might only need an airway opened or someone to keep well-meaning bystanders away.h34r:

And THESE many:
(------)
are down and truly bioelectrically asystolic, but will respond to prompt initiation of the "Chain of Survival (detection/recognition, call ALS, initiate CPR, AED, and prompt arrival and initiation of ALS/transport).

This little wedge of the pie includes the youngest, fittest patients who have the greatest potential to survive and thrive.

I don't need the whole pie, I'm going to swing for the fences when t's possible.


PS: Here's a thought. No, I'll make a new thread!

 

[JMorin95]

Until our CPR is good enough to warrant at least a fifty percent chance of survival, you can not officially it works. Her in my area we have a seventeen percent save rate with the AHA guidelines plus making it common practice to have at least 6-9 respond to any code. With only two providers the chance of a save is ten percent or less.