Resuscitation Science Symposium

[Guest guest]

Here is something from Orlando I heard over the weekend and I wanted

to share with everyone. . . I will post more as I find the time.

Arizona Studies New Resuscitation Approach

Thirty-eight fire departments covering 70% of Arizona's population

participated in the exam. Twenty-seven of the departments provided

prehospital care to cardiac arrest victims using the 2005 ACLS

guidelines. The remaining eleven fire agencies were trained in a new

procedure called cardiocerebral resuscitation (CCR).

CCR consists of 200 initial chest compressions at a

compression/ventilation ratio of 30:2 followed by a single

countershock, if needed. Immediately after delivering the shock,

providers delivered 200 additional chest compressions using the 30:2

compression/ventilation ratio. Epinephrine could be administered,

but IV insertion or drug administration could never interrupt CPR.

Endotracheal intubation was deferred until later in the resuscitation

effort.

During the study period, 1847 cardiac arrest patients were enrolled.

About 75% underwent a standards ACLS resuscitation attempt while the

remainder underwent the CCR attempt. Overall survival to hospital

discharge (primary endpoint) was significantly better in the CCR

group than in the ACLS group (9.2% vs. 3.5%, p < 0.001). Survival

(same definition) for patients in ventricular fibrillation was also

significantly improved in CCR group compared to the ACLS group (29.3%

vs. 11.1%, p < 0.001).

The authors conclude that Arizona fire departments using the CCR

protocol had significantly more survivors than departments using

standard ACLS algorithms.

Bobrow, et al. Statewide out-of-hospital cardiac arrest survival

improves after widespread implementation of cardiocerebral

resuscitation. Oral abstract presentation. Resuscitation Science

Symposium 2007, Orlando, FL.

In spite of the limitations, I think this study is important because

it supports the three-phase model of ventricular fibrillation, it

supports the concept that basic maneuvers may offer greater

advantages over advanced procedures, supports the decision to delay

intubation during attempted cardiac arrest resuscitation, and

suggests that a reorganization of the ACLS algorithms may be

necessary.

Kenny Navarro

Dallas

[Guest guest]

Kenny:

Three questions immediately come to mind.

1) What did the study define as cardiac arrest?? Only pulsless V-Fib?

2) You mentioned that the CCR group was allowed to to administer epinephrine.?

Was that group allowed to administer amiodarone, lidocaine, or any other " code

drugs " ?

3) You mentioned that different fire departments were providing CCR as opposed

to traditional ACLS.? Were the populations served by these departments different

from the control group?

Thanks!

-Wes Ogilvie

Resuscitation Science Symposium

Here is something from Orlando I heard over the weekend and I wanted

to share with everyone. . . I will post more as I find the time.

Arizona Studies New Resuscitation Approach

Thirty-eight fire departments covering 70% of Arizona's population

participated in the exam. Twenty-seven of the departments provided

prehospital care to cardiac arrest victims using the 2005 ACLS

guidelines. The remaining eleven fire agencies were trained in a new

procedure called cardiocerebral resuscitation (CCR).

CCR consists of 200 initial chest compressions at a

compression/ventilation ratio of 30:2 followed by a single

countershock, if needed. Immediately after delivering the shock,

providers delivered 200 additional chest compressions using the 30:2

compression/ventilation ratio. Epinephrine could be administered,

but IV insertion or drug administration could never interrupt CPR.

Endotracheal intubation was deferred until later in the resuscitation

effort.

During the study period, 1847 cardiac arrest patients were enrolled.

About 75% underwent a standards ACLS resuscitation attempt while the

remainder underwent the CCR attempt. Overall survival to hospital

discharge (primary endpoint) was significantly better in the CCR

group than in the ACLS group (9.2% vs. 3.5%, p < 0.001). Survival

(same definition) for patients in ventricular fibrillation was also

significantly improved in CCR group compared to the ACLS group (29.3%

vs. 11.1%, p < 0.001).

The authors conclude that Arizona fire departments using the CCR

protocol had significantly more survivors than departments using

standard ACLS algorithms.

Bobrow, et al. Statewide out-of-hospital cardiac arrest survival

improves after widespread implementation of cardiocerebral

resuscitation. Oral abstract presentation. Resuscitation Science

Symposium 2007, Orlando, FL.

In spite of the limitations, I think this study is important because

it supports the three-phase model of ventricular fibrillation, it

supports the concept that basic maneuvers may offer greater

advantages over advanced procedures, supports the decision to delay

intubation during attempted cardiac arrest resuscitation, and

suggests that a reorganization of the ACLS algorithms may be

necessary.

Kenny Navarro

Dallas

________________________________________________________________________

Email and AIM finally together. You've gotta check out free AOL Mail! -

http://mail.aol.com

[Guest guest]

Kenny, maybe I'm being obtuse, but what is so different for CCR than standard

ACLS in a non-witnessed arrest?

IIRC, the guidelines recommend 2 minutes of CPR for arrest intervals >4 minutes

(100 compressions/min x 2 minutes = 200 compressions). They recommend 1

countershock, not to interrupt chest compressions (preferable during that pause

after each 2 minute cycle), and to immediately resume compressions after the

countershock. The current AHA guidelines recommend deferring intubation until

later in the arrest, or at least doing it without interrupting compressions.

They also stress not interrupting compressions to start IVs or administer

medications.

Resuscitation Science Symposium

Here is something from Orlando I heard over the weekend and I wanted

to share with everyone. . . I will post more as I find the time.

Arizona Studies New Resuscitation Approach

Thirty-eight fire departments covering 70% of Arizona's population

participated in the exam. Twenty-seven of the departments provided

prehospital care to cardiac arrest victims using the 2005 ACLS

guidelines. The remaining eleven fire agencies were trained in a new

procedure called cardiocerebral resuscitation (CCR).

CCR consists of 200 initial chest compressions at a

compression/ventilation ratio of 30:2 followed by a single

countershock, if needed. Immediately after delivering the shock,

providers delivered 200 additional chest compressions using the 30:2

compression/ventilation ratio. Epinephrine could be administered,

but IV insertion or drug administration could never interrupt CPR.

Endotracheal intubation was deferred until later in the resuscitation

effort.

During the study period, 1847 cardiac arrest patients were enrolled.

About 75% underwent a standards ACLS resuscitation attempt while the

remainder underwent the CCR attempt. Overall survival to hospital

discharge (primary endpoint) was significantly better in the CCR

group than in the ACLS group (9.2% vs. 3.5%, p < 0.001). Survival

(same definition) for patients in ventricular fibrillation was also

significantly improved in CCR group compared to the ACLS group (29.3%

vs. 11.1%, p < 0.001).

The authors conclude that Arizona fire departments using the CCR

protocol had significantly more survivors than departments using

standard ACLS algorithms.

Bobrow, et al. Statewide out-of-hospital cardiac arrest survival

improves after widespread implementation of cardiocerebral

resuscitation. Oral abstract presentation. Resuscitation Science

Symposium 2007, Orlando, FL.

In spite of the limitations, I think this study is important because

it supports the three-phase model of ventricular fibrillation, it

supports the concept that basic maneuvers may offer greater

advantages over advanced procedures, supports the decision to delay

intubation during attempted cardiac arrest resuscitation, and

suggests that a reorganization of the ACLS algorithms may be

necessary.

Kenny Navarro

Dallas

________________________________________________________________________

Email and AIM finally together. You've gotta check out free AOL Mail! -

http://mail.aol.com