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Advances in Cardiac Arrest Management: V-Fib, Defibrillation, and CPR Protocols

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This article discusses recent changes in the management of cardiac arrest, specifically focusing on V-fib and defibrillation strategies. It highlights the ineffectiveness of stacked shocks, the necessity for immediate biphasic shocks, and the critical role of high-quality CPR in the first few minutes post-arrest. Recommendations include the use of AEDs in community settings, avoiding airway interventions during initial CPR, and ensuring immediate vascular access. The article also addresses pharmacological interventions and intubation priorities, stressing the importance of efficient and timely responses in emergency situations.

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Advances in Cardiac Arrest Management: V-Fib, Defibrillation, and CPR Protocols

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  1. Changes in Cardiac Arrest Management

  2. Pathophysiology of V-Fib Arrest

  3. Defibrillation • No more stacked shocks • Takes too long • All shocks maximum energy. • EMS probably should not use AED’s • Biphasic increases efficacy

  4. Defibrillation • Primary treatment for V-fib at 3 minutes and under • Should be delayed until good CPR for 2 minutes if down time over 3 minutes • Biphasic should be used • AED’s good in 3 minutes, bad after • One shock only with no pulse checks after

  5. Pulse Checks • Deadly!! • Only check pulses when rhythm appears to have converted thru CPR on ECG or signs of life • ECC says check before shock delivered after 5 cycles of 30:2 CPR

  6. Vascular Access • Avoid ET drugs whenever possible • Peripheral IV’s OK • Central IV’s slightly better, but compression interruption frequent with placement • Interosseous recommended when peripheral IV’s not obtainable

  7. Pharmacology • No improvements evident based on science with drugs to improve outcome • Epinephrine every 5 minutes • No added benefit to Vasopressin • Amiodarone and Lidocaine equal effectiveness

  8. What about intubation? • In first 6 minutes, not a priority (V-fib) ASAP in PEA and Asystole. • Understand that positive pressure breaths decrease cardiac output. • Some air exchange from CPR plus gasping. • Once intubated, 1 second breaths,six per minute. NO MORE.

  9. Airway Combitube or ET equivalent RSA Mentality-view and see cords place ET, otherwise immediate Combitube first try.

  10. Recommendations Bystander CRR program 911 CRR phone instruction Defib in first 2-3 minutes CRR before shocks otherwise

  11. Recommendations • AED’s in community, not on ambulance • 200 uninterrupted compression • No airway first 3 rounds of CRR • Immediate vascular access- IO if needed • Epinephrine 1mg as soon as possible

  12. Recommendations • When airway is placed, use non-visualized airway or RSA technique if intubating • No pause to put in airway • Never a pause after defib to check pulse or rhythm.

  13. Testimony and Example • A great example

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