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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
slide3
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 |

slide6
Resuscitation Eras

QCPR & IHCA |

slide7

January 19, 2005

  • Baseline CPR Quality

QCPR & IHCA |

slide8
Abella, JAMA, 2005
  • Baseline CPR quality by trained rescuers

QCPR & IHCA |

slide9
Previously by Kramer-Johanson J, 2006; Edelson DP, 2006; Stiell, 2012
  • Vadeboncoeur, Resuscitation, 2014
  • Chest compression: deeper seems better yet again

Mean Compression Depth, mm

QCPR & IHCA |

slide10
A decrease in rate (Vadeboncoeur, 2014)
  • An increase in leaning (Robertson-Dick, 2010)
  • Caution: an increase in depth often comes with

QCPR & IHCA |

slide11
Idris, Circulation, 2012
  • Fast but not too fast…

QCPR & IHCA |

slide12

-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 |

slide13
Worsen hemodynamics
  • Associated with poor outcomes
  • Clinical data sparse
    • Aufderheide, 2004
    • Niles, 2011
  • Hyperventilation and leaning are detrimental in animals

QCPR & IHCA |

slide14
Updates on feedback, debriefing and mechanical CPR for improving CPR quality and patient outcomes
  • Now that you can measure…

QCPR & IHCA |

slide15
Impact of feedback on compression depth

Abella, Resus, 2007

Hostler, BMJ, 2011

IHCA

OHCA

QCPR & IHCA |

slide16
Impact of feedback on compression rate

Abella, Resus, 2007

Hostler, BMJ, 2011

IHCA

OHCA

QCPR & IHCA |

slide17
Feedback + situational training

Bobrow, Ann Emerg Med, 2013

QCPR & IHCA |

slide18
Debriefing

QCPR & IHCA |

slide20
Results: CPR at goal over time

Abella, Resuscitaton, 2007

Edelson, Arch Int Med, 2008

Feedback + debriefing

QCPR & IHCA |

slide21
Results: Return of circulation

Edelson, Arch Int Med, 2008

p=0.03

QCPR & IHCA |

slide22
Pediatric Debriefing Data
  • Wolfe, Crit Care Med, 2014

QCPR & IHCA |

slide23
Pediatric Debriefing Outcomes
  • Wolfe, Crit Care Med, 2014

QCPR & IHCA |

slide25

June 14, 2006

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 |

25

slide27
Circ Trial Outcomes – no difference

Compression fraction 0.80 in both groups!!!

QCPR & IHCA |

slide29
High-quality 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 |

slide30

Recommendations (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 |

30

slide31
New data supports import of high quality CPR
  • 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 |

slide32
Thank you

QCPR & IHCA |

32

acknowledgements
Acknowledgements
  • 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
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