slides rosc lecture 2 part 3
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Study of resuscitation event review:
All residents and students rotating through
resuscitation team roles
Debrief teams on their events
Weekly 30-45 min resuscitationdebriefing/teaching sessions
Can also use CPR data for DEBREIFING
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0%
10%
20%
30%
40%
50%
60%
Baseline Feedback Feedback +
40%45%
59%
P=0.04
Edelson et al, 2008
Training effect co nfirm ed by Dine et al, 2008
CPR is much more important that medications
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CPR is much more important that medications
Intravenous drug administration during out-of-hospital cardiac arrest
Olasveengen et al, JAMA 2009
Randomized trial of epinephrine versus no epinephrineFor EMS treated cardiac arrest NO SURVIVAL BENEFIT!
http://www.google.com/imgres?imgurl=http://www.goodmoney.com/norflag.gif&imgrefurl=http://www.goodmoney.com/norway.htm&h=288&w=475&sz=4&tbnid=MXESPrIWofUxrM:&tbnh=78&tbnw=129&prev=/images?q=norway+flag&hl=en&usg=__N13G4IS7k1SvgCqXnFjG_7iVgUc=&sa=X&ei=0m5hTIKQFoOClAfG2-H9CQ&ved=0CCkQ9QEwAw -
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Manual CPR support devices
Mechanical CPR devices
Zoll AED, R series
Philips MRx
Autopulse
LUCAS
Different methods to ensure CPR quality
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Hallstrom et al, 2006 (ASPIRE)
Out-of-hospital, multicenter randomized trialSites in US, Canada
ROSC 92/373 (24.7%) 104/394 (26.4%)
D/C 37/373 (9.9%) 23/394 (5.8%)
Manual Autopulse
Major studies of the Zoll Autopulse device
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EMS leaders in Arizona recognized the
Importance of high quality CPR
Tripled survival to hospital discharge (3.8% 9.1%)
Minimally interrupted cardiac resuscitation by emergency medical
Services for out-of-hospital cardiac arrest
Bobrow et al, 2008
What can professional rescues do to improve CPR?
Interventions:
1. Delay intubation
2. 200 compressions before first shock3. Minimize pre and post shock pauses
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The million dollar (and million lives.) question:
What is the CPR quality like in YOUR
community EMS agency?
If your loved one collapsed right now, and you called 911would theEMS providers give resuscitation care following the Arizona protocol?
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1.Cardiac arrest is not hopeless!
2.CPR quality has big impact
3.Minimize ventilations
4.Maximize chest compression rate and depth
5.For professional responders: consider CPRfeedback tools and code debriefing
6. For the lay public: learn CPR!
Summarykey learning points
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Upcoming Coursera lectures in this program
Lecture 2: Rethinking CPR: quality of care andnew ideas about training
Lecture 3: Finding the AEDsthe role of social
media
Lecture 4: Therapeutic hypothermia and post-resuscitation care
Lecture 5: Frontiers in resuscitation: reperfusion
medicine and cardiac bypass
Lecture 6: Survivorship and end-of-life issuesafter cardiac arrest
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