The Future of CPR
I got to interview two cutting edge researchers on what CPR will look like in the next decade; their answers were fascinating.
They discuss the use of the impedance threshold device and the active-compression/decompression device to augment flow during CPR. See the results of the ResQ trial listed below to see what this does in cardiac arrest patients.
Note: Dr. Lurie is the founder, chief medical officer, and a major shareholder of the company that manufactures these two devices. Dr. Yannopoulos has no conflicts of interest.
Reperfusion Injury Protection
Stutter CPR is giving 3 cycles of 20 seconds of compressions/ventilations, 20 seconds of pause. In pigs, this has markedly reduced the reperfusion injury when resuscitating a patient with prolonged arrest.
Sodium nitroprusside (in addition to small doses of epi and flow-enhanced CPR) increases flow to the heart and the brain. May also blunt reperfusion injury to heart and brain. In addition adenosine and cyclosporine A may have a role as well.
Note: None of this is ready for clinical use–this may be the future, it is not the present
- A presentation on the topic by Dr. Yannopoulos
- Read the ResQ Trial (Lancet 2011;377(9762):301–311)
More on the ROC-Primed Trial and the ResQ Trial (MP3 File–Right Click and choose Save As)
More on Dosing and Intra-Arrest Hypothermia and Cath (MP3 File–Right Click and choose Save As)
- Recent 15-minute pig cardiac arrest study provides continued evidence of ischemic post-conditioning (Resuscitation Volume 84, Issue 8, August 2013, Pages 1143–1149)
- Review article on the physiology of CPR
And Now to the Podcast…
- EMCrit 277 – COVID Pulmonary Physiology with Martin Tobin - July 9, 2020
- EMCrit 276 – The Rapid Code Status Conversation with Kei Ouchi - June 25, 2020
- EMCrit 275 – NeuroCritical Care with Neha Dangayach - June 10, 2020