No ETI.

aquabear

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For our agency, endotracheal tube placement is the "preferred airway device." We also approach intubation differently than most ground EMS agencies (only using VL, utilizing a bougie every time, regular ETI and SALAD training, not stopping compressions during attempts) and as a result, we consistently have a FPS rate greater than 90%.
 

MSDeltaFlt

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I am an old school medic and I do love dropping a tube and getting an EJ. That being said I also believe the national standard of care for the standard adult cardiac arrest is SGA's and IO's. And here's the reason why, in my honest and humble opinion (granted opinions are like butt holes, everybody's got one and most of them stink). You can't kill a dead man. And the odds of getting said dead man back are not in your favor.

The goal is early defibrillation and quality chest compressions. And chest compressions are like Pringles - once you pop you just can't stop. That is until the patient is not responding.

So, drop your King, I-Gel, Combi, whatever and drill them and keep going. If you get ROSC get your ETT if you can. If you don't get ROSC work it and call it.

Dead is dead. There has been only one person in history that wasn't God to walk on water and he didn't make it very far.

Do the best you can and let it go.
 

E tank

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Conclusion — during optimal CPR the V/Q (ventilation/perfusion) ratio is still heavily in favour of ventilation and we are already providing additinal O2, so the last thing we need is MORE ventilation. The focus should therefore be on perfusion. .
Just a point of order, if you'll forgive the hair splitting...ventilation is a function of CO2 elimination, which requires, by definition, cardiac output.

So, that the bag is being assiduously squeezed is no indicator of adequate "ventilation". That said...who cares? Acidosis from accumulated CO2 is pretty well tolerated by almost everyone, with a couple of notable exceptions.

But the squeezing the bag is better than apneic oxygenation and improving O2 delivery through bag squeezing is a good goal (understanding that while true ventilation while doing this may be a bridge too far, oxygenation is not).

And when we say perfusion, while we immediately think blood flow, the critical element is the oxygen in the flowing blood.
 

Tigger

Dodges Pucks
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I am an old school medic and I do love dropping a tube and getting an EJ. That being said I also believe the national standard of care for the standard adult cardiac arrest is SGA's and IO's. And here's the reason why, in my honest and humble opinion (granted opinions are like butt holes, everybody's got one and most of them stink). You can't kill a dead man. And the odds of getting said dead man back are not in your favor.
I think this mindset has hindered resuscitation care. If we examine every treatment under the premise of "it won't hurt because they're dead," we're potentially setting our patients up for poor neurologic outcomes, which should be the primary goal of all cardiac arrest management.
 

MSDeltaFlt

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AHA Releases Latest Statistics on Sudden Cardiac Arrest
Submitted by SCAFoundation on Thu, 02/01/2018 - 6:16pm

There are more than 356,000 out-of-hospital cardiac arrests (OHCA)[1] annually in the U.S., nearly 90% of them fatal, according to the American Heart Association’s newly released Heart Disease and Stroke Statistics - 2018 Update. According to the report, the annual incidence of EMS-assessed non-traumatic[2] OHCA in people of any age is estimated to be 356,461.
There are a number of ongoing challenges to understanding the epidemiology of cardiac arrest in the U.S. Despite being a leading cause of death, there are currently no nationwide standards for surveillance to monitor the incidence and outcomes of cardiac arrest. Thus, registries and clinical trials are used to provide best estimates.[3]
Following are highlights from the report:
Adults
  • Estimates suggest the incidence of OHCA among adults is 347,322.
  • Overall, survival to hospital admission after EMS-treated non-traumatic cardiac OHCA was 29%, with higher survival rates in public places (39.5%) and lower survival rates in homes/residences (27.5%) and nursing homes (18.2%)
  • Survival to hospital discharge was 10.8% among adults (9% with good neurological function).
  • Large regional variations in survival to hospital discharge (range, 3.4%-22%) and survival with functional recovery (range, 0.8%-20.1%) are observed in 132 counties in the U.S. Variations in the rates of layperson CPR explained much of this variation.
  • Among adults treated by EMS, 25% had no symptoms before the onset of arrest.
  • The majority of OHCA’s occur at a home or residence (68.5%), followed by public settings (21%) and nursing homes (10.5%).
  • Cardiac arrest was witnessed by a bystander in 37% of cases, and an EMS provider in 12% of cases. For 51% of cases, the collapse was not witnessed.
  • Among EMS-treated OHCA patients, 19.8% had an initial rhythm (Ventricular Fibrillation or Ventricular Tachycardia) that is shockable by an automated external defibrillator (AED).
  • Among 10.9 million registered participants in 40 marathons and 19 half-marathons, the overall incidence of cardiac arrest was 0.54 per 100,000 participants. Those with cardiac arrests were more often male and were running a marathon versus a half-marathon. Among runners with cardiac arrest, 71% died; those who died were younger (39+9) than those who survived 49+10).
Dead is dead. And it is usually final. Don't waste time trying to get the ETI and EJ. If you can great but dont' waste time. Quality chest compressions and early defibrillation are key. Drill them and get your SGA.
 

EpiEMS

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As an aside, the PA ALS 2019 protocol revisions remove routine intubation from the standard arrest protocol.

Looks like I'm not crazy.
Wouldn't be surprised to see this happening nationally - my protocols have said that ETI and SGAs are equivalent in the setting of OOCHA for a couple of years now.
 
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