mycrofft
Still crazy but elsewhere
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Shirley you jest?
Stairs + Cardiac Arrest
- Thread starter cointosser13
- Start date
Shirley you jest?
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A study our department just released and presented at the ACEP Convention:
http://www.ncbi.nlm.nih.gov/m/pubmed/22834854/
Of patients who were transported without ROSC: 0.69% survival rate for patients not in asystole; 0% survival rate for asystolic patients.
http://www.ncbi.nlm.nih.gov/m/pubmed/22834854/
Of patients who were transported without ROSC: 0.69% survival rate for patients not in asystole; 0% survival rate for asystolic patients.
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Yes, I know... Made for some interesting discussion in my Lifeguard class when we went over some Lifeguarding history, and that was some 20 years ago. :blink:
OP
OP
cointosser13
Forum Crew Member
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Well what if you did use an automatic thumper (we call it the LUCAS at our place), while going down the stairs. With the automatic thumper, and somebody doing artificial ventilations, would that factor in a better chance of ROSC if the patient is positioned 30 or so degrees down (head first) while going down the stair. Or factors like that are too small and just don't matter? Would anything change?
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Dude, we can guess all day long, but no one has done any kind of research on if carrying a patient head up or head down with automated CPR makes any difference in cerebral perfusion. All we can provide for you on this topic is a bunch of opinions. Again, the bigger deal here is avoiding doing any kind of chest compressions (automated or otherwise) while moving the patient down stairs. Picture the scenario you're laying out here. You mentioned a 300 lb patient; coming from an upper level; being carried down stairs with a LUCAS, and someone else is supposedly trying to provide ventilations as well? This is a bad looking situation that could be very easily avoided. Don't make things harder on yourself.
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The point of Lucas devices isn't to make it easier to transport arrests, it's to reliably ensure high quality compressions. Even with mechanical arrests we still should not make a habit of transporting arrests unless certain circumstances are met.
NomadicMedic
I know a guy who knows a guy.
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Yes. The question was answered, (transporting a patient head first, down stairs, while working a code is a bad idea) but more importantly, the rational behind most of us electing to terminate efforts and NOT transporting arrests was explained.
EpiEMS
Forum Deputy Chief
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Thanks for posting this!
I wish more places would realize the futility (and added risk) of emergent transport without ROSC.
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It's not really an "aggressive stance" to not transport every arrest when you look at the numbers that STX just posted.
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Couldn't be all that effective I'd imagine. If I remember right you guys have ALS on the mountain, seems like it be worth working it on the hill and if you get ROSC then work on a careful transport down or possibly flying them, that's how some mountains out here operate.
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If it were me that's how I'd do it. Cause the helo isn't gonna take them and most of my ground counterparts, myself included, would be very opposed to transporting someone with CPR in progress from the hill considering its a curvy 45 minute ride to the closest ED.
Christopher
Forum Deputy Chief
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You make it sound like staying on scene is somehow a flippant choice...
EMS owns out-of-hospital cardiac arrest. It is our responsibility to resuscitate patients in the field, not the hospital's. The reality of the situation is your patients arrest too far away from the ED, so we have to do it where we find them.
This is not an aggressive stance, well Ok maybe it was "aggressive" in 2005 or 2006...my EMT class in the very beginning of '07 stressed working patients where you found them.
As for answering the OP's question...when you have to start describing the logistics of moving someone anywhere during active resus the answer is obvious: don't freaking move them. Move the resuscitation to the patient.
It is ridiculous that we even wonder about this anymore.
Down here just south of you we still have issues because several of the counties around here require online medical control to call a code once you have started working it. And there are several area doctors that want to pronounce everything themselves and refuse to call a code in the field regardless of transport time (once you have started working them). It's a old fashioned protocol issue down here
Christopher
Forum Deputy Chief
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Rarely we're asked to transport by an MD unfamiliar with modern resuscitation...and we usually can help them make the right call: "Are you sure? We've worked them for 45 minutes, persistent asystole for the last 10 minutes, and EtCO2 is now sub 10 mmHg. We're not likely going to improve anything by driving 15 minutes to your facility. Is there something we're missing?"
Woopsie post