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Importance of maximizing CPR.
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Compression to ventilation ratio 30:2
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Complete chest wall recoil
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Danger of hyperventilation
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CPR First vs shock first
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Compressions 100 to 120 per min (switch every 2 min)
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Fit ventilations in without delaying
Compressions
Minimize delays when shocking
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The Experts Evolving View
“Poor-quality CPR should be considered a preventable harm . In healthcare environments, variability in clinician performance has affected the ability to reduce healthcare associated complications , and a standardized approach has been advocated to improve outcomes and reduce preventable harms. The use of a systematic continuous quality improvement (CQI) approach has been shown to optimize outcomes in a number of urgent healthcare conditions.”
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Experts View (continued)
“Despite this evidence, few healthcare organizations apply these techniques to cardiac arrest by consistently monitoring CPR quality and outcomes. As a result, there remains an unacceptable disparity in the quality of resuscitation care delivered, as well as the presence of significant opportunities to save more lives.”
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The Measure of Success
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Systole
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Diastole
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The Take Away Message
“Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when
CPR is performed according to guidelines, the chances of successful resuscitation increase substantially.
Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest.
Together , these components combine to create high performance CPR (HP
CPR) ”
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• C-A-B
• Minimize interruptions in compressions
• Compress at least 100/min
• Allow complete chest wall recoil/decompression between compressions
• Rhythm assessment every 2 minutes
• Rotate compressors every 2 minutes
• Hover over patient with hands ready during defibrillation so compressions can start immediately after the shock (or analysis) has occurred
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Out of hospital Cardiac Arrest is a BLS event
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Includes ALS and BLS providers
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Interventions that work are Basic Life Support interventions
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Everybody (ALS, BLS, Driver, Attendant) has the same chance to positively effect the outcome
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There is NO reason to “wait” for ALS to resuscitate someone
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AIRWAY
VENTILATION
2
4
CPR 1
6
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AIRWAY
ASSISTANT
5
CPR 2
3
ACCESS
MEDS
MONITOR
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1
BOSS

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The Building Block To Success
Improved survival
Intubation
IV placement
Paramedic
Advanced Life
Support
Rapid rhythm analysis
Switch compressor s every 2 min.
Minimize pauses
Administer drugs
Hover hands
Prioritize compression s C-A-B
Compress
> 2 inches
Minimize interruptions
Full recoil
Rate between
100 and
120/min
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• EMTs own CPR
• Minimize interruptions in CPR at all times
• Ensure proper depth of compressions (>2 inches)
• Ensure full chest recoil/decompression
• Ensure proper chest compression rate (100-120/min)
• Rotate compressors every 2 minutes
• Be ready to compress as soon as patient is cleared by:
Hovering hands over chest during shock administration
• Intubate or place advanced airway with ongoing CPR
• Place IV or IO with ongoing CPR
• Coordination and teamwork between EMTs and paramedics
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• Perceived performance does not always match observed performance.
• Aufderheide et al. showed that duty cycle, chest compression depth and complete recoil were performed significantly less well when directly observed than EMT perceptions of their performance.
• Wik et al. showed that chest compression rate and depth were both significantly below AHA guidelines by trained EMS providers, and no flow time (when there was neither a pulse nor CPR being given) was almost 50% in directly observed performance evaluations.
• The likelihood of ROSC increases significantly with higher mean chest compression rate (in a hospital study 75% of patients achieved ROSC with 90 or more chest compressions/minute compared to only 42% with 72 or fewer chest
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• Eastern Airlines 401 crashed into the Everglades in
December of 1972 as a result of the flight crew's failure to recognize a deactivation of the autopilot during their attempt to troubleshoot a malfunction of the landing gear position indicator system (an indicator light) Fatigue and poor crew resource management (CRM) contributed to the accident. EA 401 gradually lost altitude while the flight crew was preoccupied and eventually crashed.
The effect of this crash on the airline industry continues today and has resulted in the development of Crew
Resource Management (CRM). CRM is a technique that requires air crews to divide the work in the cockpit amongst available crew ensuring that someone continues focusing on flying the plane while
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Measure of Performance
Illustration of proposed resuscitation “report cards.”
Routine use of a brief tool to document resuscitation quality would assist debriefing efforts and quality improvement efforts for hospital and emergency medical services systems.
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Copyright © American Heart Association Meaney P et al. Circulation 2013;128:417-435
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High Performance CRP
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