New ACLS????

[GreenDiverDown]

Here are a few of the studies that address the issue of doing 90 to 120 seconds of CPR before defibrillation in patients that have been down for more than 5 minutes...

Two that support...

http://jama.ama-assn.org/cgi/conten...d9a6f0ddec4fa182c2e370bb&keytype2=tf_ipsecsha

http://jama.ama-assn.org/cgi/conten...c26f6bee03bccf5fa654e73e&keytype2=tf_ipsecsha


and one that doesn't...

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&list_uids=15675903&dopt=Abstract

 

[Dive-aholic]

Great information. Thanks for the articles, Stephen, but they address the issue of CPR prior to defib not compressions after defib. The question is why are we doing 2 minutes of CPR without evaluating the outcome of a shock. And how effective is that?

I don't call codes, but I strongly urge the docs I work with to call them. The last code I was a part of was down for over 45 minutes before it was called! I had already suggested calling it, then the doc jumped in and started doing compressions himself (part of the new standards you know). When he got tired and asked for suggestions, I gave mine. He finally complied.

 

[GreenDiverDown]

Great information. Thanks for the articles, Stephen, but they address the issue of CPR prior to defib not compressions after defib. The question is why are we doing 2 minutes of CPR without evaluating the outcome of a shock. And how effective is that?

Food for thought...


http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=16154679&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=16046942&dopt=Abstract

http://circ.ahajournals.org/cgi/con...42fc1b9f826b03a82907c8a9&keytype2=tf_ipsecsha

and here's one from your neck of the woods...

http://circ.ahajournals.org/cgi/content/full/circulationaha;112/9/1259

 

[Dive-aholic]

Okay, more good information, but all of these studies are focusing on AEDs. I realize ILCOR has been focusing a lot on lay person CPR - hence compression only CPR. And the AED focus seems to be along the same lines. I agree the changes that are being introduced are great in that area - less for the lay person to have to think about. This is especially good since AEDs are everywhere now.

But what about in hospital codes or even codes attended to by paramedics who have the capability and knowledge to not only shock the heart but also evaluate the post shock rhythm without having to rely on a computer to do it? I'm having a hard time believing that a 5-10 second delay after a shock to evaluate rhythm and pulse is going to have that much of an effect, especially in a semi controlled setting like an ICU or ER. I could be wrong, but those are the studies I'd like to see.

 

[GreenDiverDown]

But what about in hospital codes or even codes attended to by paramedics who have the capability and knowledge to not only shock the heart but also evaluate the post shock rhythm without having to rely on a computer to do it? I'm having a hard time believing that a 5-10 second delay after a shock to evaluate rhythm and pulse is going to have that much of an effect, especially in a semi controlled setting like an ICU or ER. I could be wrong, but those are the studies I'd like to see.

http://jama.ama-assn.org/cgi/conten...4f115a07f7a1fab3a7669e95&keytype2=tf_ipsecsha

http://jama.ama-assn.org/cgi/conten...54eaf16dc54752dfc1f901ba&keytype2=tf_ipsecsha

These articles support the assertion that international guidelines are not followed much of the time and that... among other things... there is excessive no-flow time during CPR.

Does it matter?

The weakness in these articles is in how the quality of CPR is measured. If the measure is in adherance to international criteria put forth by the AHA, then we are doing a poor job. But if the measure of quality is in how many people we actually save, then we simply do not know how these individual criteria affect outcome.

Do these recommendations really matter? Maybe. Maybe not. I'm not defending the AHA and I don't necessarily agree with many of their recommendations. As Lynne pointed out, the evidence is lacking. We have a long way to go... but at least we're trying.

Check out this article...

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=15325448&dopt=Abstract

Do you think the improved survival is because these skilled teams adhered to AHA guidelines? No, these patients did better because they got juiced... fast.

 

[Dive-aholic]

I agree...with you and the articles. I've seen too many in hospital codes that were very ineffective...especially in regards to compressions. People are afraid to crack ribs. It is difficult to assess CPR. It's not something that can be simulated. Although I do remember a seeing a movie several years ago in which interns/residents were stopping each others' hearts to run some type of experiment. I wish I could remember the name.

I agree, the faster we can juice them, the better their chances. I guess that's why we have AEDs everywhere now. And that's why we have these new standards as well.

 

[TSandM]

Flatliners, I think the movie was called. It was eerie.

 

[Dive-aholic]

That was it! Yes, it was eerie!

 

[Wildcard]

So Im still not seing anything that is going to make me start pumping again after defib when it converts to a viable rythem with a pulse, which is exactly what is being taught. If I have a pulse, Im not doing compressions. My paperwork may say otherwise.

 

[Cacia]

gasp...dry lab?

you can get away with that in Iraq, sonny