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Opportunities and Challenges in Telecommunicator CPR (T-CPR)

Paris Hotel and Casino  Las Vegas, Nevada. Opportunities and Challenges in Telecommunicator CPR (T-CPR). Presented by: Dr. Bentley Bobrow Dr. Thomas Rea Micah Panczyk . Presenter Disclosure Information. Ben Bobrow, MD Opportunities and Challenges in Telecommunicator CPR

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Opportunities and Challenges in Telecommunicator CPR (T-CPR)

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  1. Paris Hotel and Casino  Las Vegas, Nevada Opportunities and Challenges in Telecommunicator CPR (T-CPR) Presented by: Dr. Bentley Bobrow Dr. Thomas Rea Micah Panczyk

  2. Presenter Disclosure Information Ben Bobrow, MD Opportunities and Challenges in Telecommunicator CPR FINANCIAL DISCLOSURE: • Heart Rescue Project Grant from Medtronic Foundation involving community-based translation of resuscitation science UNLABELED/UNAPPROVED USES DISCLOSURE: • None

  3. Presenter Disclosure Information Thomas Rea, MD Opportunities and Challenges in Telecommunicator CPR FINANCIAL DISCLOSURE: • Heart Rescue Project Grant from Medtronic Foundation involving community-based translation of resuscitation science. Medical Director for Association of Public Safety Communication Officials. UNLABELED/UNAPPROVED USES DISCLOSURE: • None

  4. Presenter Disclosure Information Micah Panczyk Opportunities and Challenges in Telecommunicator CPR FINANCIAL DISCLOSURE: • No disclosures to report UNLABELED/UNAPPROVED USES DISCLOSURE: • None

  5. Presentation Slide Title

  6. A Little Math 424,000/365 = 1162 1162/24 = 48

  7. Signs of Cardiac Arrest • Sudden, unexpected collapse • Unconsciousness, NO sign of life • Abnormal breathing (gasping) common • Brief seizure - lack of oxygen to brain

  8. The Race is On … Chances of survival decrease 7-10% for every minute without CPR Survivall 5 10 15 20 Nagao Current Opinion in Critical Care 2009

  9. Urban Response Timeline – Arizona 2012 0:9:16-0:11:16 0:11:16-0:13:16 0:09:16 Travel First shock To patient 0:01:00-0:02:00 0:01:00-0:02:00 0:05:32

  10. T-CPR and OHCA Survival

  11. Expanding and Improving T-CPR: The Three-Phase Model

  12. PHASE 1: Identifying OHCA Over the Phone

  13. Taking the Lead: Controlling the Call • Active Listening: The First Seconds - Caller often volunteers 2/3 of critical information • Callers are often frantic • - Be ASSERTIVE 4 - Be CALM5 • Tell them help is on the way • Get and use caller’s name

  14. AHA’s Two Question Model • Is the patient conscious? • If necessary, ask if “responsive” or “awake” • If necessary, ask to speak to patient • Is the patient breathing NORMALLY? • Allows you to catch Agonal Breathing • If “no” to both, start CPR instructions1,2 Be assertive: Don’t ask – TELL • “You need to do CPR, I will help you”

  15. What to Avoid • Extra questions which delay the identification of cardiac arrest and initiation of CPR

  16. What is agonal breathing? • Agonal breathing is an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular respirations followed by irregular pauses. They may also be characterized asgasping, labored breathing, accompanied by strange vocalizations. • The cause for agonal breathing is a lack of oxygen to the brain stem.

  17. Survival • The presence of agonal breathing indicates a more favorable prognosis than in cases of cardiac arrest without agonal breathing: • 27% of patients with agonal breathing were discharged alive compared with 9% without them (p<.001) • Clark Ann Emerg Med 1992 • 28% vs 8% (adjusted OR 3.4 95% CI 2.2, 5.2) • Bobrow Circ 2008

  18. How do bystanders describe agonal breathing? • Audible: sounds like snoring • Description: ”he’s making noises” ... ”humming” ... like a humming sound” • Description: ”he’s gasping for air” • Description: ”he’s soring like he’s in a deep sleep” • Descriptor: ”she’s moaning” • Descriptor: ”she’s groaning

  19. PHASE 2: Barriers and Tactics

  20. Assertiveness is Key!

  21. Justification

  22. PHASE 3: Continuous Coaching

  23. The Right Instructions • AHA recommends Compression-Only CPR … • For adults with non-respiratory cause of arrest • Easier to perform • Compression-Only CPR associated with better long-term survival than CPR with rescue breathing2 • AHA recommends CPR with Rescue Breathing … • For children 8 years old and younger • For adults with respiratory cause of arrest • Drowning • Choking 1. Svenson et al N Engl J Med 2010 2. Dumas et al Circulation 2012

  24. Sample Script: CPR Instructions

  25. Focus: Creating & Maintaining CPR Quality “Continuous Coaching”

  26. CPR Quality Matters!

  27. Recommendation on AEDs Ask if an AED is available only if the event is in a public place with more than one rescuer present. If using an AED, instruct the rescuers to bare the patient’s chest.

  28. Continuous Coaching: Tactics & Tips • Count out rate at 100 beats/minute • The beat to the disco classic “Stayin’ Alive” • Let caller take over counting • Allows you to monitor and speed rate if needed • Remind rescuer to press “hard and fast” • Shhhhh! Don’t talk too much! • Let rescuers focus on what they’re doing! • Tell them to switch if tired & multiple rescuers • Stay with caller until EMS takes over

  29. Review • OHCA frequency and survival rate • T-CPR is associated with improved survival • The Three Phases of T-CPR • 2 question identification • Overcoming barriers • Continuous coaching

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