[Consensus] Virtual Podcast Club 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.