- Podcast 125 – The New Intra-Arrest (Cardiac Arrest Management)
- EMNerd: The Tell-Tale Heart
- Hemodynamic-Directed Dosing of Epinephrine for Arrest
- The Future of CPR
There has been a lot of interesting stuff that has come out since my SMACCgold talk. This podcast will bring you up to date on the crap running though my mind. Beware: very little evidence lies here.
The Syndromes of Cardiac Arrest
Refractory Vfib/Vtach (Electrical Storm)
See EMNERD's ALPS Post
- Dual-Sequential Defib
Amazing session on EMRAP by Zack Shinar (membership required)
Study of Dual-Sequential shows early double better than single (Resuscitation. 2019 Jun;139:275-281)
Driver et al. (Resuscitation. 2014 Oct;85(10):1337-41 PMID 25033747)
500 mcg/kg IVP, can add a drip starting at 50 mcg/kg/min
See this great EMPharmD Post
- Take them to the Lab
- ECMO anyone?
Note: I (we) have probably been misunderstanding this Vasoplegia, it is imperative you read this post (choosing the correct DBP); you should also probably listen to that podcast.
- High-Dose Epi
- Methylene Blue
What's the dose? Who knows? I give 2 mg/kg (but not in pts on SSRIs)
- Junctional Tourniquet
We did an episode on this topic on the EDECMO podcast (ignore the ECG stratification stuff–since been debunked).
- Cerebral ox
- Ultrasound (preferably TEE)
Time Zero Prognostication
- What can we use??
- This retrospective study from France indicates that if the pt has the following 3: 1. OHCA not witnessed by emergency medical services personnel, 2. nonshockable initial cardiac rhythm, and 3. no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine then there was no RONF and the pts should be put on the donation path. (Ann Intern Med. 2016 Dec 6;165(11):770-778. doi: 10.7326/M16-0402. Epub 2016 Sep 13. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation)
Blood Gases during Cardiac Arrest
- 30 seconds to rhythm check
- Rhythm Check
- Administer Epi
Precharge the Defib (blogpost), (Podcast)
Shock during compressions!!!
Update: POCUS Post-Check
Some folks have finally put in the literature what I have been discussing for years: use ultrasound to do pulse check
- Check a rhythm on EMS' monitor
- Transfer on the EMS stretcher
Consciousness during CPR
and here is a study in the journal, Resuscitation
More on DBP (in Kids)
Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation. 2017 Dec 26. pii: CIRCULATIONAHA.117.032270. doi: 10.1161/CIRCULATIONAHA.117.