Update from ECCU 2014: Road to the 2015 Resuscitation GuidelinesBy Mike Bowen

June 24, 2014

AHA Update 2015In early June I was fortunate enough to attend the ECCU 2014: Road to the 2015 Resuscitation Guidelines. The conference was exceedingly informational and presented by the people behind the research, mostly physicians. The intention of the conference was to present the new and emerging science that is the driving force behind the expected changes in 2015 resuscitation guidelines.  Although this was not an official release from the American Heart Association (AHA), it was a good insight into the ongoing research and outlines the of projected changes.

Throughout the three days several topics were reiterated. High-quality chest compressions are still essential. The researchers stated that they’ve found a “sweet spot” for chest compression rates: 100-120 per minute at depth of two inches or 50 mm. Anything slower and the myocardium (heart muscle) is not being perfused well; anything faster, and chest compressions become less effective. If chest compressions are performed too fast the provider may be in poor form and make errors such as leaning off the breast bone, inhibiting chest recoil, or shallow compression depth.

The researchers did not endorse any specific automated chest compression device but did reflect on how beneficial these products may be if applied with minimal interruption to CPR and at the appropriate time. The benefits of an automated device are consistent high-quality chest compressions and slightly negative upstroke with each compression that increases preload and decreases the duration of interruptions. They also discussed the importance of intrathoracic pressure and the increase of survival rates with the application of an impedance threshold device (ITD). This was a reversal of their initial recommendations because they did not originally look at compression depth.

Now that researchers feel confident about the correct depth and rate of compressions they are more interested in evaluating the efficacy of antiarrhythmics, which is the purpose of the Amiodarone, Lidocaine, Placebo Study (ALPS). This double-blinded study is designed to investigate which antiarrhythmic is most beneficial and which may not be beneficial at all. While earlier research has investigated these medications, researchers are interested in examining them in conjunction with current compression depth recommendations. However, the researchers cautioned that they may not have results available in time for the next update of Advanced Cardiac Life Support (ACLS).

Another extremely interesting discussion surrounded ways to improve care for an unwitnessed cardiac arrest. Implantable cardioverter-defibrillators work well for cardioversion or defibrillation, but these devices are like a fire extinguisher. What the unwitnessed cardiac arrest needs is a smoke alarm. Imagine a watch-type device that could be worn around the wrist to monitor peripheral perfusion and would sound an alarm or call EMS if a pulse or blood flow ceased. This technology would help notify bystanders, family members, or coworkers in the event of an unwitnessed cardiac arrest.

Other notable presentations revolved around the benefits of Pit Crew CPR with real-time feedback, and what to do with a return of spontaneous circulation (ROSC). The philosophy behind Pit Crew CPR is delegating specific tasks to individuals while the equipment provides real-time feedback on the quality of the skill being performed. A device can be placed in the middle of the patient’s chest to monitor the depth of chest compressions, and the device will notify the provider to make mid-resuscitation corrections. Now that resuscitation efforts are more successful, plans and protocols need to be implemented about continuation and transfer of care once ROSC has been achieved. These protocols should include appropriate sedatives and definitive care facilities.

If you’re an EMS educator and have not been to an Emergency Cardiovascular Care Update (ECCU) before, I highly suggest it.  If you would like to hear more about my experience at the conference, you can reach me at mbowen [at] fisdap [dot] net.

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Rajasekharan Nair says CPR is very effective for Cardiac Arrest Patients (No Pulse and No Respiration) earlist.      

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