[Consensus] Virtual Podcast 1: Cardiac Arrest Update

 

 

The Bottom Line

Thanks for participating! Here you can find our consensus from our discussion during our first virtual podcast club.

  • Goals in cardiac arrest
    • Restore coronary perfusion pressure
    • #1 goal should be hands on chest. Any intervention that interferes with this should be abandoned or modified
  • Dual sequential defibrillation
    • Situationally appropriate (refractory to amio/lido, multiple shocks), probably logistically difficult (getting 2x Zolls).
    • Probably worth a shot if indicated and agreed upon
  • Esmolol
    • Situationally appropriate (VF refractory to shock)
    • 500mcg/kg push +/- drip at 50 mcg/kg/min
  • Profound vasoplegia
    • Low diastolic drags down perfusion pressure and prevents ROSC.
    • Consider high dose epi (?unclear specific dose above 1mg q 3-5 min)
    • Consider methylene blue (2mg/kg) – avoid in pt on SSRI 2/2 serotonin syndrome
  • Ultrasound in cardiac arrest
    • Valuable. Profound difference in treatment strategies for PREM (pulseless rhythm echocardiographic motion) vs PRES (pulseless rhythm echocardiographic standstill).
    • We should talk more about these physiologic states as a group
    • Do not use US if obtaining views prolongs time off chest
    • We should probably improve our ultrasound skills out of arrest prior to attempting intra-arrest
  • Deviating from 1mg Epi q 3-5 min
    • Good argument against utilizing high dose epi in PREM
    • Not ready to abandon AHA recommendations yet
  • ETCO2      
    • Standard now. Needs to be used.
    • Feedback on CPR quality, guides termination of resuscitative efforts
  • Intra-arreset ABG
    • Can use VBG if easier to obtain
    • pH (of ABG or VBG) probably limited utility
    • G8 (lytes, blood count) of great utility
  • Nurse-run codes
    • Seems we all agree that this would be highly valuable
    • Could also consider utilizing this model when multiple providers available
    • Nurse-run codes would take some education and select RNs
  • Pre-shock pause
    • Get rid of it. Pre charge your defibrillator at 1 min 30s. This should be standard.
    • Not quite ready to shock with hands on the patient yet.
  • Mechanical CPR
    • No benefit in literature, but clear benefit in organizing and calming room
    • Need to operationalize placing LUCAS device faster
    • Ensure proper placement
  • Consciousness during CPR
    • Ketamine seems to be a good option. 20mg aliquots until dissociated.
Jeremy AmayoComment