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Paris Hotel and Casino  Las Vegas, Nevada. Science Driving the Future of Basic Life Support. Presented by: Dana Edelson, MD, MS, FAHA, FHM Medical Director of Rescue Care and Resiliency University of Chicago Medicine. Presenter Disclosure Information. Dana Edelson

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Science driving the future of basic life support

Paris Hotel and Casino  Las Vegas, Nevada

Science Driving the Future of Basic Life Support

Presented by:

Dana Edelson, MD, MS, FAHA, FHM

Medical Director of Rescue Care and Resiliency

University of Chicago Medicine


Presenter disclosure information
Presenter Disclosure Information

Dana Edelson

Science Driving the Future of Basic Life Support

FINANCIAL DISCLOSURE:

  • Employed by the University of Chicago

  • Grants from the National Institutes of Health, Philips Healthcare, American Heart Association, Laerdal Medical

  • Ownership interest in Quant HC and intellectual property for analytics related to predicting in-hospital cardiac arrest

    UNLABELED/UNAPPROVED USES DISCLOSURE:

  • None


History of Resuscitation

Liss. Ann Emerg Med 1986; 15:65-72.

Rolling Method (1856)

Bellows Method (1500s)

Barrel Method (1700s)

Side to side compression (1831)

Prone compression (1903)

1500

1600

1700

1800

1900

QCPR & IHCA |




QCPR & IHCA |


January 19, 2005

  • Baseline CPR Quality

QCPR & IHCA |


Abella, JAMA, 2005

  • Baseline CPR quality by trained rescuers

QCPR & IHCA |


  • Chest compression: deeper seems better yet again

Mean Compression Depth, mm

QCPR & IHCA |


  • Caution: an increase in depth often comes with

QCPR & IHCA |


Idris, Circulation, 2012

  • Fast but not too fast…

QCPR & IHCA |


  • -Edelson, 2006; Rea, 2006; Sell, 2010; Christensen, 2009; Cheskes, 2013

  • Pauses in chest compression are bad

Shock Success, Percent

n=17

n=18

n=10

n=8

Pre-Shock Pause, Seconds

QCPR & IHCA |


  • Worsen hemodynamics

  • Associated with poor outcomes

  • Clinical data sparse

    • Aufderheide, 2004

    • Niles, 2011

  • Hyperventilation and leaning are detrimental in animals

QCPR & IHCA |


Updates on feedback, debriefing and mechanical CPR for improving CPR quality and patient outcomes

  • Now that you can measure…

QCPR & IHCA |


Impact of feedback on compression depth improving CPR quality and patient outcomes

Abella, Resus, 2007

Hostler, BMJ, 2011

IHCA

OHCA

QCPR & IHCA |


Impact of feedback on compression rate improving CPR quality and patient outcomes

Abella, Resus, 2007

Hostler, BMJ, 2011

IHCA

OHCA

QCPR & IHCA |


Feedback + situational training improving CPR quality and patient outcomes

Bobrow, Ann Emerg Med, 2013

QCPR & IHCA |


Debriefing improving CPR quality and patient outcomes

QCPR & IHCA |


QCPR & IHCA | improving CPR quality and patient outcomes


Results: CPR at goal over time improving CPR quality and patient outcomes

Abella, Resuscitaton, 2007

Edelson, Arch Int Med, 2008

Feedback + debriefing

QCPR & IHCA |


Results: Return of circulation improving CPR quality and patient outcomes

Edelson, Arch Int Med, 2008

p=0.03

QCPR & IHCA |


  • Wolfe, Crit Care Med, 2014

QCPR & IHCA |


  • Wolfe, Crit Care Med, 2014

QCPR & IHCA |


QCPR & IHCA |


June 14, 2006 improving CPR quality and patient outcomes

Hallstrom et al.

Multicenter, randomized

Early discontinuation

↓ survival to discharge:

9.9%5.8% (p=0.06)

↓ neurologically intact survival:

7.5%3.1% (p=0.006)

Ong et al.

Richmond, VA.

historical control

↑ROSC: 20.2%34.5%*

↑Survival to discharge:

2.9%9.7%*

*p<0.05

QCPR & IHCA |

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QCPR & IHCA | improving CPR quality and patient outcomes

26


  • Circ improving CPR quality and patient outcomes Trial Outcomes – no difference

Compression fraction 0.80 in both groups!!!

QCPR & IHCA |


QCPR & IHCA | improving CPR quality and patient outcomes

28


  • High-quality improving CPR quality and patient outcomes CPR should be recognized as the foundation on which all other resuscitative efforts are built

  • Continually adjust resuscitative efforts based on the patient’s physiological response

  • Capture CPR performance data in every cardiac arrest and use an ongoing CPR CQI program to optimize future resuscitative efforts

  • Final Consensus Recommendations

  • Meaney et al, Circulation, 2013

QCPR & IHCA |


Recommendations ( improving CPR quality and patient outcomes cont)

Meaney et al, Circulation, 2013

  • Target CPR performance metrics:

    • CCF >80%

    • Compression rate of 100–120/min

    • Compression depth of ≥50 mm in adults with no residual leaning

      • (At least one third the anterior-posterior dimension of the chest in infants and children)

    • Avoid excessive ventilation

      •  (Only minimal chest rise and a rate of <12 breaths/min)

QCPR & IHCA |

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  • New data supports import of high quality CPR improving CPR quality and patient outcomes

  • Compression rate recommendations should likely include an upper limit

  • Data in support of real-time feedback is strengthened, though still no outcome benefit

  • Data in support of debriefing now includes a possible pediatric survival benefit

  • High quality manual CPR is equivalent to integrated automatic load-distributing band CPR

  • Conclusions

QCPR & IHCA |


  • Thank you improving CPR quality and patient outcomes

QCPR & IHCA |

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Acknowledgements
Acknowledgements improving CPR quality and patient outcomes

  • Ben Abella, MD, MPhil

  • Lance Becker, MD

  • Trevor Yuen

  • Brian Robertson-Dick, MD

  • Meredith Borak, RN, MSN

  • Matt Churpek, MD, MPH, PhD

  • Frank Zadravecz, MPH

  • Nicole Twu, MS


Questions
Questions? improving CPR quality and patient outcomes


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