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February 19, 2016
Perspectives on current resuscitation guidelines, techniques
DALLAS — Resuscitation guidelines for pediatric patients and pregnant women in cardiac arrest, as well as the efficacy of innovative techniques used during resuscitation, were discussed by five medical directors at the 2016 Gathering of Eagles XVIII EMS State of the Science program.
In the first presentation, Peter Antevy, MD, representing the Greater Broward County (Fla.) EMS medical directors association, answered three questions — should fluid be given to children in shock, should atropine be given before intubation, targeted temperature management after ROSC — in his presentation about pediatric resuscitation.
Kathleen Schrank, MD, medical director for the city of Miami, discussed the management of cardiac arrest in pregnant patients. The AHA for the first time addressed cardiac arrest in pregnancy with in-hospital and EMS recommendations.
Jeffrey Goodloe, MD, NRP, medical director for the City of Tulsa and Oklahoma City, and Joe Holley, MD, medical director for the City of Memphis (Tenn.), discussed the efficacy of active compression devices for CPR and use of an impendence threshold device. The co-presenters discussed how the devices improve venous return during compressions which enhances cerebral blood flow.
The emerging role of intrathoracic pressure regulation or modulation during resuscitation was the subject of a presentation by R.J. Frascone, medical director for St. Paul, Minn. He described the thoracic pump theory for compression and decompression and how that physiology affects blood flow.
The final presenter, Paul Pepe, MD, closed the session with a discussion of head-elevated CPR, which is also known as gravity assisted CPR. Pepe described the flaws of supine chest compressions which may increase atrial and venous pressures in the brain. Researchers are attempting to determine if patient head elevation will improve blood flow to the brain in a way meaningful to patient survival.
Memorable medical director quotes on resuscitation guidelines
"Focus is on getting mom to survive to get the baby to survive. Peri mortem c-section has a clear survival benefit for mom."
"The bottom line is active compression-decompression makes a difference in neurologically intact survival."
"You can generate lots of force with this device (ACD) and there are times you need to be careful … you are not trying to jack-up a car. Use the force gauge to get optimum effect of the device."
"Standard CPR is inefficient by its very nature and completely reliant on chest wall recoil. ACD CPR was much easier to teach than standard CPR during the trial (ResQTrial)."
"The optimal angle (for heads-up CPR) seems to be about 30."
Key takeaways on out-of-hospital cardiac arrest resuscitation
Cardiac arrest during pregnancy
Active compression device
Visit GatheringofEagles.us to view the presenter's slides.