Minimally Interrupted CPR

There is another new study out (published in the March 12 Journal of the American Medical Association that may change the way we do CPR, continuing the emphasis on “Minimally Interrupted CPR.”

Minimally Interrupted Cardiac Resuscitation for Out-of-Hospital Cardiac Arrest

Here the jist of the protocol:

This novel approach, aimed at maximizing cerebral perfusion, involves:

an initial series of 200 uninterrupted chest compressions;
rhythm analysis, with a single defibrillator shock if indicated;
200 immediate post-shock chest compressions before pulse check or rhythm reanalysis;
administration of epinephrine as soon as possible, repeated with each cycle of compressions and rhythm analysis;
delay of intubation until after three cycles of chest compression and rhythm analysis.

I haven’t read the full research article, here is the abstract:

Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest

The article suggests the study needs to be validated by a randomized study.

What I find interesting is the high profile of epi, which has not performed well in the past. One physician told me that the reason epi may not have made a difference in the past is because the CPR was too poor. By improving the CPR we change the entire dynamics of all the other elements.

What I love about medicine is it is never stagnant, always changing, and hopefully get closer to, not farther from, the best course for the patient.

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As a side note, I wish there was a way to better(quicker) communicate at least the new CPR’s emphasis on compressions to other health personnel. I did another code this morning (I have had quite a rash of them this year) and again arrived to find two nursing home personnel trying to figure out how to bag properly) and no one doing CPR. I have also seen this with sanctioned first responders. While I can’t find it in the abstract — it may be in the text of the article, I believe either this study or another protocol somewhere calls for the application of a non-rebreather on the apneic patient until time for intubation. I know one the commentators on a recent post mentioned doing that.

3 Comments

  • NJ EMS says:

    My wife’s sister is the only nurse on her floor that was an E.M.T before she became a nurse.Guess who they call on a floor code?

  • Gary says:

    It’s hard enough to get EMS personnel to do two minutes of CPR before defibrillating, never mind nursing home, clinic, or health center staff. There has been some talk of treating them as non health care providers when it comes to CPR training. That is, teach them compression only CPR and defib. Considering that some studies show that oxygen reserves in arterial blood are much higher than we’ve previously thought, it might have some merit. More and more it appears that the only two things that consistently work for V-Fib are CPR and electricity. I think in the near future we’re going to see the AHA call for Asystole, absent one of those H’s or T’s, to be called without any resuscitation. Gary

  • Dawson says:

    I heard that Arizona is doing a pilot study in either Phoenix or Tucson with the new CPR protocol and getting amazing results.

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