Out of Hospital Arrest: How are W e Doing in Lane County? By: - - PowerPoint PPT Presentation

Out of Hospital Arrest: How are W e Doing in Lane County?

By: Joshua Moore, FireFighter EMT-P Eugene Springfield Fire Department

Objectives:

1.

State the 5 links in the AHA “Chain of Survival.”

2.

How has ACT: C3 improved our local chain?

3.

How do you play a role in that chain?

4.

What improvements can you develop within your scope of practice?

2

Components of ACT: C3

• Community Awareness and

CPR training

• Chest Compressions Oriented

Dispatch Instructions

• CardioCerebral Resuscitation

Protocols for EMS Responders

• Hospital(s) Registry

Participation & Data Analysis

• AED Site Process, Database

& SmartPhone App

Chain of Survival: 5 Links.

• Early Access
• Early CPR
• Early Defibrillation
• Advanced Life Support
• Post- Cardiac Arrest Care

Public Aw areness & Training

"I f w e can get people to recognize cardiac arrest, perform CPR, and call 9 1 1 then our survival of sudden cardiac arrest w ill im prove." Craig Am an, Lieutenant Seattle Fire and Medic One, during cardiocerebral resuscitation lecture Aug 1 st, 2 0 1 2 .

Radio, TV, Print PSA. Public Training

1 . 1 7 studies have proven that arrest victim s receiving bystander CPR are 4 .5 tim es m ore likely to survive. 2 . The leading reasons given for not doing CPR:

• a. Afraid of doing CPR w rong.
• b. Exposure to body fluids.

Chest Com pression Oriented Dispatch I nstructions.

DART Study

• Circulation. 2 0 1 0 ;1 2 1 :9 1 - 9 7

 Old model took 4-6

min before compressions.

 New model less than

2 min.

 Easier for dispatch to

explain and public to respond.

 1700 patients, 18%

not in arrest with public compressions.

 2% FX, no visceral

• rgan damage.

 Benefits outweigh

risks.

Pit Crew Approach

1.

Prioritize cerebral perfusion and continuous chest compressions.

2.

Increase response to arrest calls; 9 personnel from 5.

3.

Each responder has specific tasks to perform based on apparatus assignment.

4.

Assigned Code Commander Role and Time Keeper/ Scribe Role.

5.

Work until ROSC or Dead in field. CardioCerebral Resuscitation (CCR)

• 1.) 200 preshock chest compressions.
• 2.) 200 uninterrupted postshock chest

compressions before pulse or rhythm checks.

• 3.) Delayed advanced airways for 3 cycles of

200 compressions and rhythm analysis.

• 4.) Attempted Intravenous or intraosseous

epinephrine before or during 2nd cycle of compressions.

• 5.) Excessive interruptions of chest

compressions are lethal.

• 6.) Pulse checks should be done towards the

end of 200 compressions and through rhythm analysis. Feeling compression pulse helps determine ROSC presence after compressions stop.

• 7.) Forced ventilations are mandatory after

15 minutes of chest compressions. However, they must be performed at a controlled TV and rate (Medic One (King County, WA provides ½ BVM TV at 6 vents/ min). Studies show 6-10 optimal. However, in observation trials Paramedics and ER docs average 37 ventilations/ minute.

• 8.) ETC02 monitors cell metabolism. Dead if

less than 10mmHg after 20 min resuscitation.

• Hypothermia induced in field.

Multiple registries are available nationally.

Data Analysis and Arrest Registry

• 1. Two Rural Counties in WI were the first to prove results of CCR.

They more than tripled survival rates without brain injuries. They maintained those survival rates for the 3 years of the study and 3 years follow-up period.

• 2. King County & Medic One has averaged 46% save rates over the

last 6 years and hit 50% save rate in 2011.

• 3. Tucson AZ and 25 other Arizona EMS agencies have adopted

compression CPR for citizens and CCR for EMS crews and have experienced a 3: 1 save rate over CPR and mouth to mouth

• models. They averaged 37-48% save rates over the last few

years.

• 4. Kansas City, MO switched to compression CPR for lay persons

and CCR for EMS crews and also raised save rates without hypoxic brain injuries by 350% .

Com ing soon…  AED Component.

• 1. Site Process Streamlined.
• 2. Site database production.
• 3. Smartphone Applications.

1 . W hat is priority of your codes? 2 . Can roles can be predeterm ined like a pit crew ? 3 . W hat vitals are you using for determ ination to cease efforts? 4 . Do your friends and fam ily know com pression CPR? 5 . How can you encourage sharing data am ong providers?

"Resuscitation implies a commitment on the side of life. To devote one's energies to the restoration of lives cut short before fulfillment is to declare that life is intrinsically valuable, that it is worth living."

• Peter Safar

I n Mem ory of Ray Garza