Tag Archive for: Resuscitation

REBEL Cast Ep57 – Cardiac Arrest Sonographic Assessment (CASA) with Lead Author Kevin Gardner, MD

25 Jul
July 25, 2018

Background: In the ED, POCUS has become one of the most important tools in discovering both the diagnosis and in the management of critically ill patients.  cardiac arrest, is ultimately as sick as a person can get in the spectrum of critical illness.  I mean how can someone be deader than dead, right?  There has been a slew of literature evaluating the use of POCUS in cardiac arrest and many providers have started to incorporate its use into their practice.  Newer literature, however indicates that the use of POCUS prolongs CPR pauses which ultimately impacts good neurological survival.  POCUS protocols may help decrease cognitive load, but many are too cumbersome and complicated.  Enter the Cardiac Arrest Sonographic Assessment (CASA) exam. Read more →

REBEL Cast Ep56 – PARAMEDIC-2: Time to Abandon Epinephrine in OHCA?

20 Jul
July 20, 2018

Background: Epinephrine(adrenaline) has been used in advanced life support in cardiac arrest since the early 1960s. Despite the routine recommendation for its use, evidence to support administration is less than ideal.  Although it is clear from multiple observational studies that epinephrine improves return of spontaneous circulation (ROSC) and short-term survival, most evidence suggests an absence of improvements in survival with good neurologic outcomes.  In cardiac arrest we want to take advantage of the alpha effects of epinephrine, including peripheral vasoconstriction, and therefore increasing aortic diastolic pressure, which in turn helps augment coronary and cerebral blood flow.  On the other hand, we want to avoid the potentially detrimental beta effects including dysrhythmias, decreased microcirculation, and increased myocardial oxygen demand all of which increase the chances of recurrent cardiac arrest and decreased neurologic recovery.  The only two interventions in cardiac arrest that have shown improve survival with good neurologic outcomes continue to be high-quality CPR and early defibrillation. The debate over the utility of epinephrine in OHCA has been ongoing for several years now and many providers have been awaiting the results of the PARAMEDIC-2 trial that was just published in the NEJM 2018.  Read more →

Topics in Post-ROSC Care

29 Jan
January 29, 2018

Background: Post-cardiac arrest patients are among the sickest groups of patients seen in the Emergency Department. They are difficult to study, which leads to endless questions about how to best care for them. Below we address the available evidence on four of these controversies: oxygen therapy, hemodynamic management, cardiac catheterization and head CT. We recognize the limitations to the available data and attempt to offer the best recommendations we can. Read more →

REBEL Cast Episode 41: Research From the Past Year – Resuscitation

26 Oct
October 26, 2017

Welcome back to Episode 41 of REBEL Cast. In this episode, we will be discussing some studies from the past year that caught our attention in the area of resuscitation. Again, this 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice. Read more →

Can We Agree on Cardiac Standstill?

18 Sep
September 18, 2017

Background: Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an important role in determining the etiology of arrest as well as being used to determine the presence or absence of mechanical activity. The REASON study demonstrated that patients with PEA or asystole without cardiac activity on POCUS are extremely unlikely to survive to hospital discharge though this study did not investigate the more important question of a survival with a good neurologic outcome. (Gaspari 2016). In light of this as well as other evidence, some have proposed that the absence of cardiac activity may be adequate to declare resuscitation futility and stop resuscitative efforts. However, there is a lack of agreement on what defines cardiac activity (see table 1). Due to this, and other factors, the level of agreement between physicians in interpretation of cardiac standstill is unknown. Read more →