I've been waiting for this one for a long time. I get to interview Dr. Stephen Bernard on the topic of post-arrest care.
Professor Stephen Bernard
Senior Intensivist, The Alfred Hospital
Professor Stephen Bernard is a senior Intensive Care Physician at the Alfred Hospital and Director of Intensive Care at Knox Private Hospital in Victoria, Australia. He is also Medical Advisor to Ambulance Victoria.
Last Week, I posted Part I of this interview on Post-Arrest Care 2013
This is Part II.
My discussion with Dr. Bernard was based on a talk he gave at the Australasian College for Emergency Medicine
SBP of 120 mm hg? The paper was just published ahead-of-print
The other paper Dr. Bernard Mentioned is Gaieski et al. (Resuscitation 2007;73:29-39)
If cooling to 36, it is a lot easier to get away with standard sedation practice as the hypothermia-slowed metabolism is no longer a big problem
Cath lab with ECMO or LUCAS2 for refractory arrest
It can be done! And if we can do it, is “stay-and-play” on scene still a good strategy?
CHEER trial (CPR, Hypothermia, ECMO and Early Reperfusion)
15 F arterial cath and a 17-19 F venous catheter under ultrasound guidance, with the only pause during compressions being the initial vessel puncture and 1st wire advancement
The animal data look good, but need human trials that show benefit. If you do it, then these patients may need a deeper degree of hypothermia (33 C?).
Prehospital Hypothermia and is Quicker Better?
Dr. Bernard's trial did not show benefit for prehospital cooling [cite source='pubmed']20679551[/cite]
and the in-press study by Kim et al. showed the same [cite source='pubmed']24240712[/cite]
More from Steve can be found at the EDECMO Podcast Site
Now, on to the Podcast…
- EMCrit 283 – Dexmedetomidine (Precedex) – You'd have to be Delirious Not to Use It - October 16, 2020
- EMCrit 282 – Hicks on the Labors of Trauma (Blunt) - September 30, 2020
- EMCrit 281 – Why Can't Emergency Medicine and Trauma Surgery Just Get Along? - September 4, 2020