Skip to main content

CPR quality...this what matters

There are many studies that address the quality of CPR.  Here, we discuss a multicenter, observational study of in-hospital and out-of-hospital cardiac arrests.  While we prefer randomized trial data, it would not have been ethical to conduct the following study as a trial.
Edelson et al. analyzed 60 VF arrests to identify predictors of successful shocks.  A shock was deemed successful if VF was terminated for at least 5 seconds (a common definition in the literature).
Using logistic regression, the study reported that successful defibrillation was associated with deeper compressions and shorter pre-shock pauses.  Each 5 mm increase in compression depth and each 5 second decrease in pre-shock pause was associated with an approximate two-fold increase in the likelihood of shock success. Note, however, that the study was not powered to predict “harder” outcomes, such as survival or neurological recovery.
Predictors of successful shocks
Below is another way to look at the data. After only 10 seconds of pausing compressions, the likelihood of a successful shock dropped by 22%.  That’s a big drop. While the sample size was small and no error bars were reported, the trend was statistically significant.
Predictors of successful shocks chart 2
In the figure below, compression depth is categorized in 0.5 inch or 11 mm intervals. The trend was that the deeper the compressions, the better the shock success. Although the sample size was small (n=5), the shock success rate was 100% with 5 cm of compression. Based on this data, guidelines for compressions for adults have changed from 3.8-5 cm (1.5-2 inches) to > 5 cm (2 inches). A remaining question is whether or not an even greater compression depth would be better.
Predictors of successful shocks chart 3
Below is an example of a successful shock preceded by an 8 second pre-shock pause and deep compressions.
Successful shock diagram
Below is an example of an unsuccessful shock preceded by a 16 second pre-shock pause and shallow compressions.
Unsuccessful shock diagram

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more