Someting this new Medic never heard of

[Melbourne MICA]

Rich

MM are you guys doing any post resuscitation hypothermia Tx?

Yes we are and have been doing so for some time. The programme started out as a trial a couple of years ago and continues now as part of our resus protocol.

In an nutshell it involves cooling to 33deg C with cold Nacl, sedation with Midaz and paralysis with Panc. There is also a big emphasis on post ROSC pefusion management - in fact we are getting a new expanded guideline soon entirely dedicated to this aspect of arrests.

We're getting very good resus numbers - don't quote me but if I remember correctly our survival to hospital numbers for arrest pts are now 31%. New ILCOR plus aggressive post ROSC Mx and maybe cooling is producing good outcomes.

MM

 

[Melbourne MICA]

Remember, PEA is a condition NOT a rhythm. One should emphasizing the cause of why the patient is presenting this. Aystole is a terminal rhythm and more and more research is beginning to demonstrate there is poor outcomes hence the reasoning of stopping resuscitation measures, when verified.

I am hopeful for hypothermic resuscitation as an old provider realizing the differences in cellular metabolism in death of hypothermic and normal temperature. The problem I foresee is the continuation of this within the hospital setting. Yes, most have coolant pads and other such equipment, but since this is so new and in comparison the research is still out on how successful it is; I doubt we see a 100% change for some time.

R/r 911

Its a good point about the hospital side Ryders.

Our "RICH" - (rapid infusion of cold Hartmanns) trial was botched by the hospitals who often failed or forgot to continue the cooling process for the required period.

As far as the EMS part went our numbers were spot on and the pt %'s looked good. So now the hospitals have had to start their own part of the trial again. Our cooling as I said to Bonedog is now part of the guideline.

I guess we'll see whether the combined programmes (as it should have been originally) will produce real improvements in neuro scores for the pts.

Lets face it - looking at the way EMS is portryaed by some doctors and politicians- "the great EMS swindle" as it was called by one doc, and the way our own services are now perceiving it we need all the specific points scoring EMS/ALS/ stuff we can get.

Though we do other great stuff, being able to tell people their family member actually has a fair chance of surviving an arrest and coming out the other end with their marbles is a huge PR bonus for us.

MM