I don’t have guest posts as a matter of course, but Andrew Randazzo,a paramedic from Knoxville, Tennesse offered to do one on the updates to the 2015 AHA guidelines, which we are all anxious to learn about, so I happily agreed. Take it away, Andrew
Back in January, Peter highlighted some of the upcoming guidelines for AHA. Today, Peter is letting me follow up with a post that will take a look at a few more changes and trends coming down the pike.
No More Vasopressin
This probably does not come as a shock to most of you. I donâ€™t even remember the last time I used vasopressin. I think the only reason Iâ€™ve used it in a code is to say that I used it. Aside from the affects of the drug itself, it is very impractical. Typically you have to draw up 2 vials in order to get your 40 units, and itâ€™s more time consuming than popping the caps on an amp of Epi and pushing them together.
Looking at the pharmacological effects of Vasopressin, statistics show that there is no superior benefit during cardiac arrest over using Epinephrine. Therefore, they are eliminating a drug to simplify and streamline the ACLS algorithm.
We have seen a similar occurrence in the 2010 guidelines when they removed Atropine from the Asystole and PEA algorithm. Again, it was a drug that showed no added benefit and therefore was eliminated.
Chest Compressions Only
You may be wondering why I placed this as a new guideline. The concept of hands-only CPR has been around for several years now. Iâ€™ve even written in the past about why in some instances breaths are no longer included in CPR. However, up until now, we have associated CC Only with lay person CPR. Not anymore.
AHA strongly believes that the 2 most important aspects of working a cardiac arrest are high quality compressions with limited interruptions and early/immediate defibrillation. To that end, they are recommending that rescuers of all training levels perform 3 cycles (2 minutes each) of CC Only with defibrillation before initiating ventilation of our patients.
That may come as a shock, but there are services such as the Kansas City EMS who have been following this protocol as early as 2010. As a side note, they were also one of the first to do away with backboards before it was ever a trending topic.
Use of ACD + ITD
The acronyms above may be foreign to some and familiar to others. ACD stands for Active Compression Decompression, and ITD stands for Impedance Threshold Device. The use and combination of ACD + ITD during cardiac arrest has shown the most profound impact on survival rates since incorporating AEDs.
The most common ACD is the Lucas device which Iâ€™ve demonstrated before, and the only ITD out there is the ResQPod which just received FDA pre-approval. Both work to create negative intra-thoracic pressures. Negative pressure in the heart and lungs creates a vacuum that in turn creates significantly better perfusion and neurological viability.
One of the classic examples is of a pig that was placed in v-fib and left for 12 minutes. After 12 minutes, chest compressions with an automated device and an ITD were used. The pig was resuscitated shortly thereafter with no neurological deficits.
As you can see, there are some large and exciting new changes coming this October from the American Heart Association. I believe there are 2 important takeaways. First, we must strive to keep up with the ever evolving field that we practice in. Second, we must embrace these changes and be willing to let go of â€œhow weâ€™ve always done itâ€.
What do you think about these changes? Do you hope or wonder if anything else will change? Share your thoughts below!
Andrew is the Director of Prime Medical Training. He is also a Nationally Registered Paramedic and Level 1 EMS Instructor. Andrew is passionate about continuing medical education, and it is his goal to see the bar of excellence raised among educators and healthcare professionals.
Note: (Andrew sent me a note that the people at ResQCPR had a couple clarifications he wanted to add to his post.
ACD-CPR is only cleared by the FDA with the ResQCPR system, formerly from Advanced Circulatory, Roseville, Minnesota, and now owned by ZOLL Medical.
ResQCPR is the only device that actively lifts the chest past neutral with a force of 10KG (~20 lbs.). The LUCAS does provide a minor assist in lifting the chest to the neutral position (1-3 Lbs.), but this is not active decompression as mentioned in all the ACD-CPR research. The confusion comes from a modified version of the suction cup technology deployed in the research labs. (As a side note: the suction cup is also owned by Advanced Circulatory, licensed to use by Physio for their LUCAS device.)