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Science Driving the Future of Basic Life Support

Paris Hotel and Casino  Las Vegas, Nevada. Science Driving the Future of Basic Life Support. Presented by: Dana Edelson, MD, MS, FAHA, FHM Medical Director of Rescue Care and Resiliency University of Chicago Medicine. Presenter Disclosure Information. Dana Edelson

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Science Driving the Future of Basic Life Support

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  1. Paris Hotel and Casino  Las Vegas, Nevada Science Driving the Future of Basic Life Support Presented by: Dana Edelson, MD, MS, FAHA, FHM Medical Director of Rescue Care and Resiliency University of Chicago Medicine

  2. Presenter Disclosure Information Dana Edelson Science Driving the Future of Basic Life Support FINANCIAL DISCLOSURE: • Employed by the University of Chicago • Grants from the National Institutes of Health, Philips Healthcare, American Heart Association, Laerdal Medical • Ownership interest in Quant HC and intellectual property for analytics related to predicting in-hospital cardiac arrest UNLABELED/UNAPPROVED USES DISCLOSURE: • None

  3. History of Resuscitation Liss. Ann Emerg Med 1986; 15:65-72. Rolling Method (1856) Bellows Method (1500s) Barrel Method (1700s) Side to side compression (1831) Prone compression (1903) 1500 1600 1700 1800 1900 QCPR & IHCA |

  4. Development of closed chest cardiac massage (1960) QCPR & IHCA |

  5. Introduction of CPR sensing defibrillators (2005) QCPR & IHCA | 5

  6. Resuscitation Eras QCPR & IHCA |

  7. January 19, 2005 • Baseline CPR Quality QCPR & IHCA |

  8. Abella, JAMA, 2005 • Baseline CPR quality by trained rescuers QCPR & IHCA |

  9. Previously by Kramer-Johanson J, 2006; Edelson DP, 2006; Stiell, 2012 • Vadeboncoeur, Resuscitation, 2014 • Chest compression: deeper seems better yet again Mean Compression Depth, mm QCPR & IHCA |

  10. A decrease in rate (Vadeboncoeur, 2014) • An increase in leaning (Robertson-Dick, 2010) • Caution: an increase in depth often comes with QCPR & IHCA |

  11. Idris, Circulation, 2012 • Fast but not too fast… QCPR & IHCA |

  12. -Edelson, 2006; Rea, 2006; Sell, 2010; Christensen, 2009; Cheskes, 2013 • Pauses in chest compression are bad Shock Success, Percent n=17 n=18 n=10 n=8 Pre-Shock Pause, Seconds QCPR & IHCA |

  13. Worsen hemodynamics • Associated with poor outcomes • Clinical data sparse • Aufderheide, 2004 • Niles, 2011 • Hyperventilation and leaning are detrimental in animals QCPR & IHCA |

  14. Updates on feedback, debriefing and mechanical CPR for improving CPR quality and patient outcomes • Now that you can measure… QCPR & IHCA |

  15. Impact of feedback on compression depth Abella, Resus, 2007 Hostler, BMJ, 2011 IHCA OHCA QCPR & IHCA |

  16. Impact of feedback on compression rate Abella, Resus, 2007 Hostler, BMJ, 2011 IHCA OHCA QCPR & IHCA |

  17. Feedback + situational training Bobrow, Ann Emerg Med, 2013 QCPR & IHCA |

  18. Debriefing QCPR & IHCA |

  19. QCPR & IHCA |

  20. Results: CPR at goal over time Abella, Resuscitaton, 2007 Edelson, Arch Int Med, 2008 Feedback + debriefing QCPR & IHCA |

  21. Results: Return of circulation Edelson, Arch Int Med, 2008 p=0.03 QCPR & IHCA |

  22. Pediatric Debriefing Data • Wolfe, Crit Care Med, 2014 QCPR & IHCA |

  23. Pediatric Debriefing Outcomes • Wolfe, Crit Care Med, 2014 QCPR & IHCA |

  24. Integrated Automated Load Band Distributing CPR QCPR & IHCA |

  25. June 14, 2006 Hallstrom et al. Multicenter, randomized Early discontinuation ↓ survival to discharge: 9.9%5.8% (p=0.06) ↓ neurologically intact survival: 7.5%3.1% (p=0.006) Ong et al. Richmond, VA. historical control ↑ROSC: 20.2%34.5%* ↑Survival to discharge: 2.9%9.7%* *p<0.05 QCPR & IHCA | 25

  26. QCPR & IHCA | 26

  27. Circ Trial Outcomes – no difference Compression fraction 0.80 in both groups!!! QCPR & IHCA |

  28. QCPR & IHCA | 28

  29. High-quality CPR should be recognized as the foundation on which all other resuscitative efforts are built • Continually adjust resuscitative efforts based on the patient’s physiological response • Capture CPR performance data in every cardiac arrest and use an ongoing CPR CQI program to optimize future resuscitative efforts • Final Consensus Recommendations • Meaney et al, Circulation, 2013 QCPR & IHCA |

  30. Recommendations (cont) Meaney et al, Circulation, 2013 • Target CPR performance metrics: • CCF >80% • Compression rate of 100–120/min • Compression depth of ≥50 mm in adults with no residual leaning • (At least one third the anterior-posterior dimension of the chest in infants and children) • Avoid excessive ventilation •  (Only minimal chest rise and a rate of <12 breaths/min) QCPR & IHCA | 30

  31. New data supports import of high quality CPR • Compression rate recommendations should likely include an upper limit • Data in support of real-time feedback is strengthened, though still no outcome benefit • Data in support of debriefing now includes a possible pediatric survival benefit • High quality manual CPR is equivalent to integrated automatic load-distributing band CPR • Conclusions QCPR & IHCA |

  32. Thank you QCPR & IHCA | 32

  33. Acknowledgements • Ben Abella, MD, MPhil • Lance Becker, MD • Trevor Yuen • Brian Robertson-Dick, MD • Meredith Borak, RN, MSN • Matt Churpek, MD, MPH, PhD • Frank Zadravecz, MPH • Nicole Twu, MS

  34. Questions?

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