Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest

Ewy, Gordon A.; Kellum, Michael J.

doi:10.1017/cbo9780511544828.042

Cited by 1 publication

(5 citation statements)

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“…In cardiac arrest, the prompt reestablishment of cardiac and cerebral perfusion is of paramount importance. The sternum should be compressed at least 2 inches at a rate of 100 times per minute [ 28 , 29 ]. Each chest compression must be followed by full chest wall recoil [ 30 ].…”

Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%

“…Each chest compression must be followed by full chest wall recoil [ 30 ]. Therefore, if good bystander chest compressions are not underway, the first EMS intervention is the prompt initiation of 200 uninterrupted chest compressions at an optimal rate, depth, and recoil (Figure 4 ) [ 9 , 29 , 31 ].…”

Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%

“…Interruptions of chest compressions for these durations during cardiac arrest are usually lethal. Eliminating the need for early ETI also frees up that EMS person to quickly apply the defibrillator pads, to turn on the defibrillator, and to perform other essential duties such as relieving the person doing chest compressions or providing the early administration of epinephrine (Figure 4 ) [ 29 ]. Intubation is usually performed following ROSC to stabilize the patient’s airway during transportation.…”

Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%

“…Following each defibrillation shock, EMS personnel are prohibited from looking at the electrocardiogram (EKG) or palpating for an arterial pulse (Figure 4 ) [ 29 ]. The reason for this is that following prolonged untreated VF, a direct current shock will usually terminate the VF but will result in pulseless electrical activity (PEA) [ 39 ].…”

Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%

“…In patients with VF arrest, after three cycles of “200 CCC, rhythm analysis, plus shock are completed,” if the patients is not gasping, ventilation is no doubt indicated (Figure 4 ) [ 29 ].…”

Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%

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The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest

Ewy

2012

Scand J Trauma Resusc Emerg Med

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Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

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Section: The Ems Component Of Cardiocerebral Resuscitationmentioning

confidence: 99%