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Systole

Diastole
DEATH
BY HYPERVENTILATION
A COMMON EXPERIENCE
IN CARDIAC ARREST
THE PAINFUL TRUTH
•Perceived performance does not always match observed performance.

•Aufderheide et al. showed that duty cycle, chest compression depth and
complete recoil were performed significantly less well when directly observed
than EMT perceptions of their performance.

•Wik et al. showed that chest compression rate and depth were both
significantly below AHA guidelines by trained EMS providers, and no flow time
(when there was neither a pulse nor CPR being given) was almost 50% in
directly observed performance evaluations.

•The likelihood of ROSC increases significantly with higher mean chest


compression rate (in a hospital study 75% of patients achieved ROSC with 90
or more chest compressions/minute compared to only 42% with 72 or fewer
chest compressions/minute).
COMPRESSIONS……..C

VENTILATIONS………..
C

DATA
COLLECTION…..D
Fatigue and poor crew resource management (CRM)

contributed to the accident.

EA 401 gradually lost altitude while the flight crew was

preoccupied and eventually crashed.

The effect of this crash on the airline industry continues

today and has resulted in the development of Crew

Resource Management (CRM). CRM is a technique that

requires air crews to divide the work in the cockpit


“Quality CPR is a means to improve survival from
cardiac arrest. Scientific studies demonstrate
when CPR is performed according to
guidelines, the chances of successful resuscitation
increase substantially. Minimal breaks in
compressions, full chest recoil, adequate
compression depth, and adequate compression
rate are all components of CPR that can increase
survival from cardiac arrest. Together, these
components combine to create high performance
CPR (HP CPR)”
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
Improved
survival

Paramedic
Intubation IV Advanced Life
placement
Support

Rapid
rhythm Minimize Administer
analysis pauses drugs

Prioritize
Switch compressions
compressor C-A-B
s every 2 Hover hands
min.

Rate between
Compress Minimize Full recoil 100 and
interruptions 120/min
> 2 inches

EMT CPR Foundation


BLS Continuous BLS 30:2

Compression/ventilation ratio 10:1 30:2

Stop for ventilations no yes

Rhythm assessment every 2 minutes every 2 minutes*

Compressions prior to rhythm 2 minutes or 200


variable*
assessment compressions
•EMTs own CPR
•Minimize interruptions in CPR at all times
•Ensure proper depth of compressions (>2 inches)
•Ensure full chest recoil/decompression
•Ensure proper chest compression rate (100-120/min)
•Rotate compressors every 2 minutes
•Hover hands over chest during shock administration
and be ready to compress as soon as patient is cleared
•Intubate or place advanced airway with ongoing CPR
•Place IV or IO with ongoing CPR
•Coordination and teamwork between EMTs and paramedics
•C-A-B
•Minimize interruptions in compressions
•Compress at least 100/min
•Allow complete chest wall recoil/decompression between
compressions
•Rhythm assessment every 2 minutes
•Rotate compressors every 2 minutes
•Hover over patient with hands ready during defibrillation so
compressions can start immediately after the shock (or
analysis) has occurred
1
2
3
4
5
6
CPR 1
AIRWAY
VENTILATION

4 BOSS

2
1
6 5 3
AIRWAY
ASSISTANT CPR 2 ACCESS
MEDS
MONITOR
Compressions

Ventilations

Shock 1 Delivered Medics on scene: no Analysis 2: no shock


break in CPR advised
Are you interested in high quality
resuscitation related news, discussion topics
and other associated interests?

HEARTSafe Community and


American Heart Association-
Public Safety

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