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Which type of CPR

Discussion in 'ALS Discussion' started by vc85, Nov 22, 2018.

  1. vc85

    vc85 Forum Crew Member

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    So in the NYS Collabrative Protocols two types of CPR are authorized for cases without an advanced airway

    The first is the standard 30:2 and the second is continuous compressions with asynchronous ventilation. I double and triple checked and this can be done even without intubation

    Given the choice which one would you do and is there any research on which has better outcomes (assuming both are done high quality)
     
  2. StCEMT

    StCEMT Forum Deputy Chief

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    I didn't know 30:2 was still a thing....
     
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  3. vc85

    vc85 Forum Crew Member

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    It was at least as of my last CPR update. Usually I go continuous though especially if crew members are fumbling around with the BVM
     
  4. mgr22

    mgr22 Forum Asst. Chief

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    30:2 is the AHA-recommended ratio for adult patients without advanced airway devices.
     
  5. StCEMT

    StCEMT Forum Deputy Chief

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    I know that, but I've never seen a place actually follow it.
     
  6. Jim37F

    Jim37F Forum Deputy Chief

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    We just did a CPR refresher ar the station last week...our protocols call for uninterrupted continuous compressions. Basically the only time our medical director wants us off chest is for rhythm analysis and shocks (if applicable), ideally 10 seconds or less. Rotate compressors every 60 seconds, next guy on chest is "hover hands" ready to slide in so there is no break in chest compressions.

    Ventilations are given on the upstroke of every 10th compression. Ideally the medic will get the tube with compressions ongoing, but as the highest scene authority they can (and will) have us pause CPR to tube 'em. I've also seen a medic attempt the tube, not get it, then guide his EMT partner on getting her first King airway while we were still doing compressions.
     
  7. hometownmedic5

    hometownmedic5 Forum Asst. Chief

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    I have never, not one of my innumerable participations, seen a textbook code in the field. Never. Regardless of what the plan was when you started, its going to end up being a hodgepodge of ratios and procedures drawn from the various iterations of cardiac arrest management that the participants have been trained in over their careers as applied by people at various levels of physical stamina. Even in the hospital where there is a nearly endless pool of compressors, they seem to make it up as they go along in terms of counts, time, intervals, sequences and so on.
     
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  8. mgr22

    mgr22 Forum Asst. Chief

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    Me neither, but it's still a thing once every two years :)
     
  9. Tigger

    Tigger Dodges Pucks Community Leader

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    We will if there is a confirmed respiratory cause, or at least until the patient is intubated.
     
  10. VFlutter

    VFlutter Flight Nurse

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    Asynchronous ventilation with compressions, sans advanced airway, is probably about as effective as a NRB + OPA. I personally wouldn't bother.
     
  11. NPO

    NPO Forum Deputy Chief

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    We do not follow AHA guidelines.

    We do "CCR".

    Continuous compressions at 100 per minute, via Lucas 2. Oxygen via nasal cannula at 10lpm.

    We intubate (not SGA, that is our backup, not primary device) after 3 rounds, unless there is a suspected respiratory etiology.

    I personally much prefer this method vs 30:2.
     
  12. Bullets

    Bullets Forum Knucklehead

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    We also do CCR as a BLS agency for the first 10 minutes of care or until ALS arrived to place and advanced airway
     
  13. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

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    Ventilating while doing continuous CPR as described above is possible and doable but the timing has to basically be perfect for that ventilation to be delivered. If the timing isn't perfect, it won't be any worse than NRB with OPA doing passive oxygenation... Now I haven't done any research on this, but I personally feel that a slightly modified version of continuous CPR with BVM ventilation could work but you'd have to be able to vary the compression rate. 100/min would be done most of the time and slow down for about 1 beat to about 60/min with a ventilation timed for the upstroke when you change rates. Basically you're going from doing a compression every 0.6 seconds to single long second to allow the breath to go in and then back to the faster 0.6 sec interval. That can be done every 10 or 15 compressions but it has to be regularly scheduled (so to speak) and pre-briefed, and practiced so there's ZERO delay in delivering that breath on that long upstroke.

    Just my thought on that... right or wrong.
     
  14. TomB

    TomB Forum Captain

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    My department does 30:2 and we have excellent outcomes. You can also perform what the Seattle group calls "BLS Continuous" which is continuous chest compressions with a small breath interposed every 10th compression. It has been studied and there was no difference in outcomes.

    https://www.nejm.org/doi/full/10.1056/NEJMoa1509139

    Tom

     
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