QUIZ3rdJuly2019(answersbelow)

1. WhataretheprosandconsoftheLUCASdevice?

2. WhatisECMO?

3. WhatarethecriteriaforeCPRactivation?

4. Whatarethe3phasesofeCPR?

5. DescribeandinterpretthefollowingECG.

QUIZanswers3rdJuly2019

1. WhataretheprosandconsoftheLUCASdevice?The LUCAS was designed to replicate our manual chest compressions in terms ofrecommendedrateanddepth,sonotsurprisinglystudieshavenotshowntheLUCAScompressions to be superior tomanual compressions. Having said that, the cup issupposedtopullthechestwallupwardsinadditiontopushingdownwards.

Therearethefollowingbenefits:1. Patient transport - Patients canhave chest compressionswhile travelling in

anambulance,beingtransferredtotheangiographysuite,etc.2. Patientaccess-easiertoaccessthepatientforproceduressuchasECMO3. Continuousandreliablecompressions-theLUCASdoesn’tgettired4. Defibrillation-ShockscanbedeliveredduringLUCASchestcompressions

Thedrawbacks:1. ChestcompressionshavetopauseinordertoapplytheLUCAS.

MinimisedbyapplyingtheLUCASswiftlyduringarhythmcheck.2. Injurytopatient

In addition to skin and skeletal trauma, there are case reports ofsignificant and life-threatening abdominal trauma using mechanicalchest compression devices. At this stage, there is no clear evidencethat the LUCAS is any more traumatic than manual chestcompressions

PlatenkampM,OtterspoorLC.Complicationsofmechanicalchestcompressiondevices.NetherlandsHeartJournal.2014;22(9):404-407

2. WhatisECMO?ExtraCorporealMembraneOxygenation

VVECMO=Veno-VenousECMO:Venous blood is accessed from the large central veins, pumped through theoxygenator and returned to the venous system near the right atrium. It providessupport for severe respiratory failure where the circulation is powered entirely bynativecardiacfunction.

VAECMO=Veno-ArterialECMO:Venous blood is accessed from the large central veins, pumped through theoxygenator and returned to the systemic arterial system in the aorta. It providessupportforseverecardiacfailure(withorwithoutassociatedrespiratoryfailure).

3. WhatarethecriteriaforeCPRactivation?Monday–Friday8am–5pmANDfitallthecriteria:

• ThecardiacarrestislikelytobeofprimarycardiacorrespiratorycauseOrifnoncardiac,thecauseislikelyreversible(eghypothermia,overdose)

• Thecardiacarrestwaswitnessedbyabystanderorparamedic• Chestcompressionswerecommencedwithin10minutes• Thecardiacarrestduration(collapsetoarrivalinED)hasbeen<60minutes• Thepatientisaged16–70years• Therearenomajorcomorbiditiesthatwouldprecludereturntoindependent

living

4. Whatarethe3phasesofeCPR?

I. ACTIVATION• Batphonecallreceived• EDteamleaderdecidestomakeeCPRcall555• Teamassembles,rolesassigned,preparation

II. PRE-CANNULATION

• Arrival• StandardALSwithLUCASinplace• AirwaySecurewithEtCO2• IVaccessandbloodgas• Exposegroinandshave• ContactCathlab

III. CANNULATION

• Commencesatskinprep• LUCAScontinues,CEASEdefibrillation• Continuetoseekreversiblecauses• USguidedcannulationfemoralarteryandvein• ConfirmationofwireplacementonTOE• Heparin5000UIV• AttachmenttoECMOcircuit

OnceonECMOØ ConsiderfurtherdefibrillationattemptØ TransfertoCathLab

5. DescribeandinterpretthefollowingECG.Rate Regular178/minPwaves MaybeafewdissociatedPwavesQRS Slightlywide0.13sec RBBB LAD-90degrees ShortRSinterval BrugadacriteriaforRBBBmorphologyVT

- MonophasicRinV1- DeepSwaveinV6withR:S<1

ST NosignificantshiftTwaves AppropriateforRBBB

è VentriculartachycardiaQRSisonlyslightlywideRBBBmorphology

LADè ConsistentwithposteriorfascicularVT