EMS World

AUG 2016

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 12 of 61

NEWS NETWORK pected, especially with a small prehospi- tal crew. Because these pauses are often unavoidable and unexpected during CPR in the field, it fundamentally makes sense to continue compressions whenever possible and only stop for unpreventable obstacles. Continuous compressions minimize the avoidable pauses, thereby mitigating the negative effects the unavoidable pauses would have on compression rate and com- pression fraction. Mitigating these pauses is one mechanism explaining why inter- ventions like minimally interrupted car- diac resuscitation (MICR), which includes continuous compressions, single shocks, immediate post-shock compressions and delayed intubation, have previously shown survival benefit in OHCA. 2 Lastly, as seen in Table S1 of the Supple- mentary Appendix, the Nichol, et al. study selected cardiac arrests with high mean compression fractions in both groups: >80% in the continuous compression group and between 60%–80% in the interrupted compression group. This cre- ated some selection bias in the sample population against cardiac arrests with lengthy pauses in compressions, which is the subgroup of cardiac arrests that would likely benefit most from continuous compressions. 1 Potential Pitfalls There are some pitfalls to avoid when per- forming continuous compressions: » Although the Nichol, et al. study did not address ventilation rates or tidal volume, continuous compressions can facilitate hyperventilation. Maintaining an appropriate ventilation rate utilizing the 1 breath every 6 seconds method is difficult and multiple studies have shown that hyperventilation with this method is common and detrimental. 15–19 However, several commonly used adjuncts are avail- able to mitigate hyperventilation, including compression-adjusted ventilations, metro- nomes and CPR feedback devices. 20 » Compression-only CPR may facilitate a compression rate that is too fast. Aha- med Idris, MD, et al. found that in about 1/3 of CPR cases compression rates exceeded 120/min, while in 7% of cases they exceed- ed 140/min. They also found that the like- lihood of ROSC peaked at about 125/min and declined at greater rates. 7,12 » Excessive compression rates have been associated with inadequate com- pression depths, potentially explaining negative outcomes with elevated rates. 12,21 Conclusion High-quality resuscitation trials through research networks such as ROC have helped to deeper our understanding of the impact each intervention we provide dur- ing CPR may have on patients. Regardless of the CPR technique employed (continu- ous or briefly interrupted), lengthy breaks in CPR for other aspects of resuscitation may be detrimental and should be avoid- ed. The Nichol et al. study reinforces that good quality CPR with adequate com- pression rates, compression fraction, compression depth and minimal pauses $14 PEOPLE C ARE IS BACK JUST IN TIME FOR SCHOOL! Online shopping made ea sy at EMSWorld.com /store Order today! RegisteR Now: Building an effective stroke system of Care when: Wednesday, August 31 at 11 A.M. PT/2 P.M. ET what: Recent advances in the management of acute strokes caused by blockages of major blood vessels have placed renewed emphasis on the importance of rapid identification and treatment. EMS can play a critical role in the chain of care for these patients by identifying symptoms, notifying the stroke team and transporting patients to the most appropriate hospital. At Memorial Healthcare System in southern Florida, physicians, EMS professionals and other members of the healthcare system collaborated to transform stroke care, reducing the median door-to-needle time for the administration of IV tPA by more than half. Join Peter Antevy, MD, Brijesh P. Mehta, MD, and Chief Mark Ellis to hear about their experience and learn how you can provide optimal stroke care in your community. sponsored by V i s i t E M S Wo r l d . c o m / w e b c a s t s t o r e g i s t e r 12 AUGUST 2016 | EMSWORLD.com

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