Refractory V-Fib to cath lab

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cruiseforever

cruiseforever

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Our medical director has given us a new protocol for refractory v-fib. If the pt. is still in v-fib after a total of three shocks that are delivered by 1st reponders or ALS. We are to load and go with the pt. to a hospital that has set up a program for treating a pt. in refracotyr v-fib.

We need to have a Lucas or Autopulse on the pt. to transport the pt.. If we do not have one, we are not to use the protocol.

Tranport times have to be 40 minutes or less.

Once at the hospital, the pt. will be placed on ECMO and them moved to the cath lab to have the artery opened. We had our first case last week. The crew said the process flowed well. Have yet to hear if it will be a postive outcome for the pt.

Is anyone else doing this? If so what has been your experience with it?
 
Carlos Danger

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Wow. Seems like an incredible expenditure of resources.
 
NomadicMedic

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That's interesting... is double sequential defibrillation anywhere in that protocol?

Is this for any patient who remains in sustained VF, or patients that regain an organized rhythms and then revert to VF?
 
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medicsb

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This is one of those things that I find interesting (and promising), but I'm also quite skeptical. ECMO takes time to set-up (from equipment to final placement), and it generally requires a cardiothoracic surgeon. Though some EM docs have trained to do it (E.g. Sharp Memorial Hosp in San Diego), they are exceptions and it would be exceedingly hard to train every EM doc to do it. In my opinion, this is something that should only be done as part of a study. At least with prospective data gathering (though ideally, it would be randomized). I heard mention of a system implementing a similar protocol but sans ECMO, and I'm still skeptical.

At this point, I'd rather see energy and money put toward improving pre-hospital care - increasing bystander CPR rates, public access defib, increasing compression fraction by human compressors (mechanical is no better and more expensive), etc. before throwing more gadgets and expensive personnel into the mix.
 
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triemal04

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There are a few places that are taking refractory vf to the cath lab with ongoing compressions (through a mechanical device) and I think there's been a couple articles published with the initial results, but not with ECMO as far as I know. It does take both buy in from EMS agencies, hospitals administrators, ER's, AND cardiologists, as well as the creation of a logistical plan so it runs smoothly...and that's without throwing ECMO in.

I would be curious to know if it would really be worth it when all things are considered, or if the time/money wouldn't be better spent on upping the numbers for citizen CPR, dispatch aided CPR, public access AED's, AED's in police cruisers, and better performance by EMS agencies.
 
teedubbyaw

teedubbyaw

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Better hope you're close to the hospital. Better survival rate? Sure. Neurological outcome? No. Especially with manual compressions? Shoooot.
 
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GloriousGabe

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Why not give you protocols for administering those clot busting drugs in the field? It'd tke care of the block and save valuable time.
 
ERDoc

ERDoc

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GloriousGabe said:
Why not give you protocols for administering those clot busting drugs in the field? It'd tke care of the block and save valuable time.
Click to expand...
Because deadly drugs in the hands of undereducated providers is a setup for disaster.
 
ERDoc

ERDoc

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Besides 'busting clots' do you know what else those drugs do?
 
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GloriousGabe

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ERDoc said:
And that is exactly why you shouldn't be giving them.
Click to expand...

I promise I won't. But for those who might want to know more (such as what they are and why not to give them) can you enlighten?
 
ERDoc

ERDoc

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Or even better, you do the research and enlighten us.
 
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GloriousGabe

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ERDoc said:
Or even better, you do the research and enlighten us.
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OK, I'll try. I don't see why you can't just explain it. You say it's dangerous but refuse to explain why. Why?
 
ERDoc

ERDoc

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You learn better when you have to do the research. It would be a disservice to spoon feed you. You tell me why they are dangerous.
 
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luke_31

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Not only do they break up clots, they inhibit the clotting cascade which can cause side effects such as uncontrollable bleeding and that is just a well known common side effect. Giving these "clot busters" uses an extensive checklist just to see if the patient is eligible. Most systems don't have paramedics administering these drugs, because once given there is no quick remedy antidote if you mess up and give it to a patient who shouldn't receive it.
 
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GloriousGabe

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luke_31 said:
He's a MD I think he would know what the answer is supposed to be, just looking to see if you are able to do the research for yourself.
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Most doctors I know are glad to explain things. They do it all the time.
 
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