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In-hospital Cardiac Arrest: First and foremost, Chest Compressions

In-hospital Cardiac Arrest: First and foremost, Chest Compressions

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In-hospital Cardiac Arrest: First and foremost, Chest Compressions

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  1. In-hospital Cardiac Arrest:First and foremost, Chest Compressions Charles L Campbell MS MD Associate Professor of Medicine University of Kentucky College of Medicine

  2. No Disclosures

  3. Outline • IHCA • Hospitals Vary in Outcome • Why • What is recommended • How should it be done • Does it really matter

  4. IHCA is pretty common… • ˜200,000 in the US • Survival is 18-20% • There is tremendous variability among hospitals • Get with the Guidelines • 135,896 • 20% with Ventricular fibrillation or Ventricular tachycardia • 64% occur in an ICU • Median Survival Varies • 8.3% at the lowest Decile • 31.4 at the highest JAHA. 2014;3:e000400

  5. JAHA. 2014;3:e000400

  6. JAHA. 2014;3:e000400

  7. JAHA. 2014;3:e000400

  8. What seems to work? • Performing ACLS correctly is associated with an improvement in outcome • MUSC study • Compared guideline adherence for survivors vs. non-survivors • 75 survivors • 75 non-survivors • Survivors older and with more cormorbidities Resuscitation. 2013;85:82-87

  9. Resuscitation. 2013;85:82-87

  10. Resuscitation. 2013;85:82-87

  11. Resuscitation. 2013;85:82-87

  12. Resuscitation. 2013;85:82-87

  13. Each 10% improvement in adherance results in a ˜30% increase in ROSC. Resuscitation. 2013;85:82-87

  14. What is Happening • Weisfeldt and Becker • Electrical Phase • 4 min • Defibrillation alone may be effective • Circulator Phase • Chest compressions are necessary • Metabolic Phase • Stone Heart JAMA.2002;288:3035-3038

  15. Time course of VF

  16. Circulation. 2005;111:1136-1140 and e294

  17. Hypothermia during VT/VF J Cardiovascular Magnetic Resonance. 2011;13:17

  18. What is Recommended • Defibrillation • Chest Compressions • Oxygenation • Medications • Procedures

  19. NEJM 2008;358:9-17

  20. Chest Compressions • Place patient on a firm surface • Backboard • Deflation of air mattress • Had in the middle of the chest • 5 cm of depression • Allow complete recoil • Lifting the hand completely of the chest can improve recoil Circulation. 2010;122:S685-705

  21. How Fast • Rate 100-120 cpm • Deliver >80 per minute • That means minimal interruption • Duty Cycle • Time between the start of one compression and the start of the next • Target is 50% • As much time relaxing as compressing Circulation. 2010;122:S685-705

  22. Circulation. 2005;428-434

  23. Circulation. 2005;428-434

  24. Circulation. 2005;428-434

  25. ROC consortium (9 sites) • OHCA in which monitors/defib measured chest compression rates • 3098 cases analyzed Circulation. 2012;125:3004-12

  26. Circulation. 2012;125:3004-12

  27. Compression rate vs Compressions Delivered Circulation. 2012;125:3004-12

  28. Circulation Qual Outcomes.2013;6:148-156

  29. Compression Depth

  30. Resuscitation. 2005;64:363-372

  31. Circulation Qual Outcomes.2013;6:148-156

  32. Recoil Matters…

  33. Resuscitation. 2006;71:341-351

  34. Resuscitation. 2006;71:341-351

  35. Resuscitation. 2006;64:353-362

  36. Circulation Qual Outcomes.2013;6:148-156

  37. Resuscitation, 2007;73:54-61

  38. Resuscitation, 2007;73:54-61

  39. Resuscitation, 2007;73:54-61

  40. Resuscitation. 2009;80:743-751

  41. Non-Shockable Rhythms

  42. Circulation. 2012;125:1787-94

  43. Circulation. 2012;125:1787-94

  44. Chest Compressions and Defibrillation

  45. Resuscitation. 2006;71:137-145

  46. Resuscitation. 2006;71:137-145

  47. Survival from OHCA improved after the implementation of a protocol that required 90 seconds of CPR prior to the delivery of a shock via an AED • 24% to 30% • Particularly in those in whom the intial response interval was > 4 min. JAMA. 1999;281:1182-1188

  48. Resuscitation. 2008;77:10-15

  49. Resuscitation. 2008;77:10-15

  50. Resuscitation. 2008;77:10-15