New ACLS/BLS guidelines came out today

[12R34Y]

Did you guys check these new guidelines out? Some pretty big changes i thought.

BLS now has the compression/ventilation ratio of 30:2 for infant, child and adult.

Also it says that if a patient has a secured airway the ventilations should be 8-10 for adult (duh), and CHILD/INFANT. that's a big change.

ACLS is emphasizing the use of hypothermia for post VF cardiac arrest.
Also more use of vasopressin for codes.

Some other cool stuff too.

Any thoughts?

you can get this stuff on AHA's website. I don't remember it.

later

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[leviathan]

Did you guys check these new guidelines out? Some pretty big changes i thought.

BLS now has the compression/ventilation ratio of 30:2 for infant, child and adult.

Also it says that if a patient has a secured airway the ventilations should be 8-10 for adult (duh), and CHILD/INFANT. that's a big change.

ACLS is emphasizing the use of hypothermia for post VF cardiac arrest.
Also more use of vasopressin for codes.

Some other cool stuff too.

Any thoughts?

you can get this stuff on AHA's website. I don't remember it.

later

I heard rumours that the Canadian H&S foundation was going to remove ventilations entirely from CPR...do Canadian & American associations follow the same protocol, or is it possible this will still happen?

 

[corpsmanUP]

I heard rumours that the Canadian H&S foundation was going to remove ventilations entirely from CPR...do Canadian & American associations follow the same protocol, or is it possible this will still happen?

The AHA was rumored for years to be considering the same thing in layperson CPR because of the relative ineffectiveness of ventilations by mouth. I have even heard it taught off the cuff to laypeople that if they don't feel comfortable doing vents, then at least do compressions. I have been around long enough to see probably 4-5 major updates to the ACLS and BLS guidelines. When I first took ACLS and started teaching it a year later, it had been common practice to push bicarb in the initial stages of an arrest. It was literally first line. Then I swear it seems that they change the ventilation to compression ration so often that anyone outside of EM would likely never remember the correct numbers. Get your hands on any of the old versions of the many exams that are floating around for AHA's BLS courses and you will laugh at the number of incorrect choices that are now correct related to ventilation/compressions ratios, and vice versa.

 

[Jeff698]

Then I swear it seems that they change the ventilation to compression ration so often that anyone outside of EM would likely never remember the correct numbers.

Outside of EM? Hell, I can't keep up with it either. I've been doing the ACLS thing for way too damn many years. I gave up keeping up with their ratios.

The one good thing I think is coming from this change is the focus on compressions as a means of creating and maintaining a pressure gradient. The key concept is that the gradient drops very fast with each pause in compressions.

I thought the days of the thumper were long gone. It looks like those days are coming back and a geezer squeezer will be on every corner before long. Deja vu all over again.

Take care,
Jeff

 

[NinerNiner999]

Then again, how many times in a code has anyone ever stopped to maintain compression ratios? "epi please, continue compressions, hold compressions, check rhythm, continue compressions - Dammit Jim - 10 to 1, 10 to 1!!!!"

 

[Siggy]

Well, once you get an advanced airway in place then the ratio becomes a moot point.

 

[12R34Y]

Well, once you get an advanced airway in place then the ratio becomes a moot point.

This has ALWAYS been true. technically once someone is intubated you just do continuous compressions NEVER pausing for ventilations, but this is RARELY if ever done in my personal experience. firefighters do it in the field and techs/nurses/docs do it in the ED and any unit i've rotated on. They all sseem to do the 5:1 or 15:2 even when they're tubed. it's a huge pet peeve of mine.

later

 

[leviathan]

Did you guys check these new guidelines out? Some pretty big changes i thought.

BLS now has the compression/ventilation ratio of 30:2 for infant, child and adult.

Also it says that if a patient has a secured airway the ventilations should be 8-10 for adult (duh), and CHILD/INFANT. that's a big change.

ACLS is emphasizing the use of hypothermia for post VF cardiac arrest.
Also more use of vasopressin for codes.

Some other cool stuff too.

Any thoughts?

you can get this stuff on AHA's website. I don't remember it.

later

Sounds like the Canadian protocol is the same. I don't know if it is the same down there, but it looks like our protocol is basically removing AR-only from protocol as well. In other words, if the patient isn't breathing, there is no longer a circulation check by lay-rescuers and they should start compressions right away. Also, 3 stacked shocks are removed and it is now 1 defib shock and then CPR.

 

[Emergency!]

I thought the days of the thumper were long gone. It looks like those days are coming back and a geezer squeezer will be on every corner before long. Deja vu all over again.

Jeff,

If you were referring to the automated CPR machines, they recently halted a study of their use after finding that there was a lower survival rate among patients who had the automated CPR vs traditional CPR. The article can be found here.

Even if something along these lines is not what was being referred to, it is at least somewhat relative to this thread.

Amy

 

[blotto geltaco]

I thought the days of the thumper were long gone. It looks like those days are coming back and a geezer squeezer will be on every corner before long. Deja vu all over again.

Take care,
Jeff

lol, I remember when I first started EMS all the trucks had thumpers except for a few that had this crazy contraption I can't even remember the name of. It was basically a CPR board that had a mini piston that strapped onto the chest. I can remember riding codes in by myself in the back of the meat wagon with the thumper going, sometimes for extended periods (20-30 minutes) if we were coming in from an outlying area. My personal observation of the save rate with thumpers was 0%.

 

[bartleby]

I'm not surprised given the 20-30 minute transport times you're talking about, with or without the "thumper". Once you get to 5-8 minutes of arrest, the battle's already lost.

My personal observation of the save rate with thumpers was 0%.

 

[quideam]

In Israel, the EMS people use this crazy suction-pump-like device (think small plunger). You manually press on it (it's much harder to do physically than just regular compressions), and it supposedly helps increase circulation to the heart (??). Anyway, thought i'd chime in

Q

 

[12R34Y]

Still using the thumper at my service. been using it at least since 1995. so not everyone has stopped doing it yet. We're a pretty large surburban system that runs over 27,000 call/year.

i personally HATE the thumper just because i think it is easier and faster to load and go and play on the way.

later

 

[Siggy]

This has ALWAYS been true. technically once someone is intubated you just do continuous compressions NEVER pausing for ventilations, but this is RARELY if ever done in my personal experience. firefighters do it in the field and techs/nurses/docs do it in the ED and any unit i've rotated on. They all sseem to do the 5:1 or 15:2 even when they're tubed. it's a huge pet peeve of mine.

later

I've had the exact opposite, even if it is limited experience. I've seen 4 codes (I work for an IFT ambulance company. All the codes have been either during my ER clinical for my EMT, or while volunteering in a different local hospital). At both hospitals it was a "Don't stop till the MD tells you to for a pulse/EKG check."

What was really interesting was one of the ER techs showed me the difference in sizes in the EKG wave caused by the CPR between when I started and when someone else took over.

 

[Hercules]

I've had the exact opposite, even if it is limited experience. I've seen 4 codes (I work for an IFT ambulance company. All the codes have been either during my ER clinical for my EMT, or while volunteering in a different local hospital). At both hospitals it was a "Don't stop till the MD tells you to for a pulse/EKG check."

What was really interesting was one of the ER techs showed me the difference in sizes in the EKG wave caused by the CPR between when I started and when someone else took over.

Same here. I've never been in a code that worried about the ratios either.

 

[corpsmanUP]

Jeff,

If you were referring to the automated CPR machines, they recently halted a study of their use after finding that there was a lower survival rate among patients who had the automated CPR vs traditional CPR. The article can be found here.

Even if something along these lines is not what was being referred to, it is at least somewhat relative to this thread.

Amy

Hey Amy,

Not to pick on you, but it actually was called the "Thumper". You may not know this but Jeff is arguably the most seasoned EMS guru's on this forum. He is a former paramedic, paramedic instuctor, and EMS education director at a college. You might want to check and see who wrote that paper because it might have been him for all you know

 

[Emergency!]

Not to pick on you, but it actually was called the "Thumper". You may not know this but Jeff is arguably the most seasoned EMS guru's on this forum. He is a former paramedic, paramedic instuctor, and EMS education director at a college. You might want to check and see who wrote that paper because it might have been him for all you know

No offense taken. I hope no one thought that I was trying claim a level of expertise anywhere close to Jeff's (or of anyone else on this forum, for that matter). Jeff's comments simply brought to mind the recent halting of the autopulse study and I thought it might stimulate discussion on either the study and/or the effectiveness of human and automated compressions.

I have been following the autopulse study since the lead investigator is here at Ohio State and the press releases tend to get quite a bit of media play both in the university and city media.

 

[FoughtFyr]

No offense taken. I hope no one thought that I was trying claim a level of expertise anywhere close to Jeff's (or of anyone else on this forum, for that matter). Jeff's comments simply brought to mind the recent halting of the autopulse study and I thought it might stimulate discussion on either the study and/or the effectiveness of human and automated compressions.

I have been following the autopulse study since the lead investigator is here at Ohio State and the press releases tend to get quite a bit of media play both in the university and city media.

Amy,

Dr. Sayre is certainly a well respected member of the EM community, but the paper in question was small and yes, it was terminated because of death, but it really didn't reach that definate answer to comression devices that would cause a huge nation-wide change in practice. "Thumpers" and their ilk, have been, and will be, with us for a long time. As compressions become more and more the centerpiece of resus, I'd expect to see them more and more.

Has anyone else played with the Res-Q? Now here is a weird theory device to "assist" with ventilation - pocket PEEP, coming soon to an ambo near you...

- H

 

[kbrown]

In Israel, the EMS people use this crazy suction-pump-like device (think small plunger). You manually press on it (it's much harder to do physically than just regular compressions), and it supposedly helps increase circulation to the heart (??). Anyway, thought i'd chime in

Q

Quideam,

I was just recently at Hennepin and they are part of a trial that is training EMS/FireFght to use this device. Their protocol demands that the device be used on pts in the field and for at least thrity minutes after arrival to the ED. The only downside is that the only people that are trained on this device are the EMS and Fire Fght, so upon arrival to the ED they (and only them) must continue to perform compressions. The study calls for at least thirty minutes of use, but if if is obvious that the effort is futile, CPR with this device can be ceased.

They state that several trials in other countries have demonstrated that it increases not only survival, but outcomes. As we all know, CPR can save a life, but rarely preserves quality of life in the majority of pts we use it on. They claim that it does so by increasing cerebral perfusion as well as cardiovascular circulation.

 

[southerndoc]

When I was in the UK, the paramedics and physicians were using this to perform CPR. The theory is that on the upstroke, it creates negative intrathoracic pressure that helps fill the ventricles and allow more preload. As we all know from the Frank-Starling theory, increased preload results in an increased stroke volume. An increased stroke volume leads to better perfusion.

There were studies underway in the US several years ago. Ambu was sponsoring them since they hold the patent on the device. The studies were terminated because they were not getting patient consent to be enrolled in the study. The consent issue was finally settled when studies on patients in extremis could be completed after proper public notification processes were completed (newspapers, town hall meetings, etc.).

This is the first I've heard of the Cardiopump studies resuming in the US. Can't wait to see the results of the study. The Brits swore by them!