Is there a doctor in the room? Whats new in basic life support? Dr. - - PowerPoint PPT Presentation

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Apr 26, 2023 150 likes •587 views

Is there a doctor in the room? Whats new in basic life support? Dr. Koen Ameloot Cardioloog/Intensivist That morning in your wai?ng room OOHCA is frequent Survival aMer OOHCA is poor 30 pt/d 15% 35% 5% 60 % Early Recogni?on

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‘Is there a doctor in the room?’ What’s new in basic life support?

Dr. Koen Ameloot

Cardioloog/Intensivist

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That morning in your wai?ng room…

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OOHCA is frequent

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30 pt/d 15% 60 % 35% 5%

Survival aMer OOHCA is poor

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Early Recogni?on How sudden is sudden cardiac death?

Preventable? Muller, circula?on 2006

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Early Recogni?on

1. Unconsciousness
2. Abnormal breathing

!! Gasping = CA !! Seizures…

How to recognize CA?

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Early Recogni?on

29% of CA are not recognized

by telephone

Unrecognized CA à worse

prognosis

Normal breathing never

present in true CA

How to recognize CA?

Berdowski, circula?on 2009

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Early CPR Basic life support doubles survival

NEJM 2015

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Early CPR Basic life support training works

NEJM 2015

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Early CPR Technology might help

NEJM 2015

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Early CPR Technology might help

NEJM 2015

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Early CPR What about CPR devices?

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Early CPR CPR devices do not improve outcome

LINC trial, JAMA, 2014

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That morning in your wai?ng room…

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Early CPR

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Early CPR

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Early CPR

In the center of the chest
30:2 ra?o
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

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Early CPR

In the center of the chest
30:2 raEo
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

Babbs, Resuscita?on 2002

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Early CPR

In the center of the chest
30:2 raEo
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

REA, NEJM 2010

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Early CPR

In the center of the chest
30:2 raEo
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

Svenson, NEJM 2010

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Early CPR

In the center of the chest
30:2 ra?o
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

Idris, Circula?on 2012

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Early CPR

In the center of the chest
30:2 ra?o
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

S?el, circula?on 2014

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Early CPR

In the center of the chest
30:2 ra?o
100-120/min
5cm compression depth
Chest wall recoil
Firm surface
Minimizing pauses

Cheskes, circula?on 2011

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Early defibrilla?on

Valenzuela, circula?on 1997

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Early defibrilla?on

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2 yrs aMer placement AED in Chicago Airport:

21 OOHCA (18 VF and 3 asystole)

No AED < 5 min 4/18 (22%) 0% Survival AED < 5 min 14/18 (78%) 78% survival

NEJM 2003

Early defibrilla?on

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VF VT Asystole PEA

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Amiodarone vs lidocaine vs placebo in out of hospital cardiac arrest. NEJM 2015

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BMJ 2016

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ROSC na 20’ ALS

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Post-ROSC

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Angiography for all?

1. Post-ROSC ECG is a bad

predictor of a coronary

cclusion
2. Associa?on between PCI

and beier prognosis aMer OOHCA (inclusionbias)

Spaulding, NEJM 1997

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Coronary Angiography

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Literature

Roberts, circula?on 2013

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Literature

Kilgannon, circula?on 2011

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Bernard, NEJM 2002 Nielsen, NEJM 2013

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#1 Timely referral before CA #2 Unconscious with abnormal breathing paiern #3 In the center of the chest, 30:2 ra?o, 5cm compression, 100-120/min, firm surface, allow recoil #4 BLS doubles survival #5 BLS training works #6 Early defibrilla?on with AED #7 Post-ROSC care with temperature control, early revasculariza?on and adequate oxygena?on