2006 Resuscitation Guidelines

Started by militarymd
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militarymd

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I just looked at the new updates on ventilation and chest compression. They now say it is OK to perform mask ventilation asynchronously to chest compression.

What does everyone think of this?
 
militarymd said:
I just looked at the new updates on ventilation and chest compression. They now say it is OK to perform mask ventilation asynchronously to chest compression.

What does everyone think of this?
Click to expand...

Counterintuitive to say the least, Mil, is all the emerging data on immediate CPR intervention reducing the significance of airway management...in other words the compressions is where the money is...pre-hospital intubation of critical patients by paramedics in the field has also shown no change in patient outcome...
 
Based on data, I will agree that not ventilating at all can be argued for....but MASK ventilating while actively doing chest compressions without pausing ...even for 1 second?
 
militarymd said:
Based on data, I will agree that not ventilating at all can be argued for....but MASK ventilating while actively doing chest compressions without pausing ...even for 1 second?
Click to expand...

I've actually never seen it any other way (only asynchronously, that is)...but then again my first code was last year on my IM rotation.
 
The chest compressions are effectively doing the breathing for the pt as they compress the air out of the lungs with each compression. So why even bother masking the pt. Of course I am kidding somewhat. 😎
 
The new ACLS/BLS guidelines are really trying to minimize the importance of rescue breathing. The studies are showing that people are really really bad at giving people breaths. The biggest problem is that the ineffective at best breaths cause a pause in the ALL IMPORTANT chest compressions. That's what the literature is showing. Chest compressions are now recommended BEFORE defibrillation for 2 minutes if the patient has been down longer than 5 minutes. It improves success of defibrillation.

No more stacked shocks of 3 either. One shock at 360J. The more CPR. Then one more shock at 360.

Apparently, the data shows CPR increases the effectiveness of defibrillation and pausing to breath is not very helpful.

It was actually posed that there be NO rescue breathing during CPR, but it was decided that there may be a few hypoxic causes of cardiac arrest that giving breaths to a person may perhaps help. so they compromised and teach people to give some.

I'm just talking about lay person response. Of course if you tube the person you're going to bag them through the compressions.

later
 
Yes, I know about all the theory....etc.


I'm asking about what everyone thinks of giving a Mask breath at the same time that the chest is being compressed.
 
militarymd said:
Yes, I know about all the theory....etc.


I'm asking about what everyone thinks of giving a Mask breath at the same time that the chest is being compressed.
Click to expand...


I'm sure you do know........I guess the point is it doesn't matter if and when you give a mask breath. they aren't really helping that much. Thus the reason they are being minimized so much.

just tube 'em.

later
 
12R34Y said:
they aren't really helping that much. Thus the reason they are being minimized so much.

just tube 'em.

later
Click to expand...

In my 5 years of attending in the ICU and running countless codes in various parts of a teaching hospital, the only time that MASK ventilation is not effective is when non-anesthesia providers are doing it.....
 
militarymd said:
In my 5 years of attending in the ICU and running countless codes in various parts of a teaching hospital, the only time that MASK ventilation is not effective is when non-anesthesia providers are doing it.....
Click to expand...


I guess I'm confused by your question.

I'm not saying that you (anesthesia) are ineffective at giving bag valve mask ventilations. They're probably quite nice.

What I'm saying is that they don't mean anything to survival in a cardiac arrest setting.

compressions are the key as is stopping the inciting reason (v-fib etc...).

So my answer is still give your mask ventilations whenver you want. As far as code blues go compressions are the new "gold".

Pausing to give breaths lets say every 5 compressions or every 15 compressions causes a delay in compressions (ie a bad thing according to the new data).

later
 
I think you are not getting my question.

I think giving breaths at the same time that compressions are made is relatively unsafe.......aspiration, gastric insufflation, etc.

I'm asking if anyone else feels the same way......and I'm asking other people experienced in airway management....ie...anesthesia attendings, senior residents.

Compressions ARE the gold standard....I would agree with compressions alone without MASK breaths at all.....I'm questioning wasting time with MASK breaths while doing compressions...which CAN be deleterious for the patient.
 
My feeling is that if you are an effective mask ventilator (ie: anesthesia provider) then give the breaths but not during compressions assuming someone else is doing compressions. A well trained anesthesia person can give some breaths b/w compressions without hampering the compression process. Compressions should be around 80-100/min and there is time to give at least 4 breaths during that minute. However, poorly timed breaths will just insufflate the the stomach leading to other complications.

So as I stated earlier. The compressions can effectively achieve gas exchange through the lungs assuming there is no obstruction to outflow.

I think this is what you are getting at, Mil.
 
militarymd said:
I think you are not getting my question.

I think giving breaths at the same time that compressions are made is relatively unsafe.......aspiration, gastric insufflation, etc.

I'm asking if anyone else feels the same way......and I'm asking other people experienced in airway management....ie...anesthesia attendings, senior residents.

Compressions ARE the gold standard....I would agree with compressions alone without MASK breaths at all.....I'm questioning wasting time with MASK breaths while doing compressions...which CAN be deleterious for the patient.
Click to expand...


I apologize. I didn't understand your question.

The last several codes I've responded to the interval from calling the code to tubing was so small that it didn't really matter (in the hospital setting). So, I'm one of those guys that is a proponent of NOT bagging altogether in the early 1 to 2 minutes of the code. I'd just set up equipment to tube and get the tube in. Realizing that compressions are more important in that early time frame.

I definately think this becomes more of an issue in the pre-hospital arena where typically I won't arrive on a call until at least 5-7 minutes after a code where BLS personnel have been bagging the patient prior to my arrival.

This will be a very big paradigm shift from previous with the 15:2 compression:breath ratio. It seems counterintuitive to tell BLS personnel to NOT bag and just beat on their chest 100/min until ALS arrives (of course pausing to use the AED).

later
 
militarymd said:
I think you are not getting my question.

I think giving breaths at the same time that compressions are made is relatively unsafe.......aspiration, gastric insufflation, etc.

I'm asking if anyone else feels the same way......and I'm asking other people experienced in airway management....ie...anesthesia attendings, senior residents.

Compressions ARE the gold standard....I would agree with compressions alone without MASK breaths at all.....I'm questioning wasting time with MASK breaths while doing compressions...which CAN be deleterious for the patient.
Click to expand...
hey MilMD

I think you are right about holding off on the mask vents. According to this article, http://www.asahq.org/Newsletters/2006/04-06/gabrielli04_06.html , it seems that there is a reduction to about 30% of nl in the blood flow to the lungs. Thus the dec need to ventilate in order to match perfusion.

Maybe this article has nothing to do with what you were talking about, but some reason when I was reading it, I remembered this thread :idea:
 
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