May 1, 2021

Background: Head up (HUP) CPR is an emerging concept.  The theory behind HUP is it allows for venous blood to drain from the brain to the heart thereby decreasing intracranial pressure and lowering the arterial/venous pressure waves which concuss the brain with each compression.  Additionally, conventional CPR increases vascular pressure in both the venous and arterial sides of the heart simultaneously which in turn increases intrathoracic and intracranial pressure which can impede cerebral blood flow and compromise coronary circulation.  All of these theories were evaluated and confirmed in animal models with very limited human trials. In order for HUP to work however, we have to be able to effectively pump blood up to the brain which is not typically achieved with conventional CPR (C-CPR). Active Compression Decompression with Impedance Threshold Devices (ACD-ITD) are one way to improve C-CPR.  They can theoretically help by reducing intracranial pressure (ICP), reduce the potential for concussion with every compression, increase cerebral perfusion pressure (CerPP) and coronary perfusion pressure (CorPP). However, with any new approach, we should always temper enthusiasm, as the realities of implementing them may actually not be helpful, and maybe even harmful.

March 20, 2021

Background: A major challenge during the COVID pandemic is balancing personal protection and communication. Being heard while wearing a surgical mask or N95 isn't too much of a challenge, communication can be significantly impaired while wearing a respirator mask. There are a number of fixes to this problem. Here, we share one simple, inexpensive option via Whit Fisher, MD (

March 4, 2021

Background:  Despite medical advances, survival after out of hospital cardiac arrest (OHCA) is still largely dependent on high-quality CPR. Many of these events are due to a primary cardiac event, likely coronary artery occlusion. Current guidelines recommend reperfusion therapy following cardiac arrest with signs of acute coronary occlusion on EKG. But this only applies when return of spontaneous circulation (ROSC) is achieved. What about those in refractory arrest? Is there a way to increase survival in those patients? Keeping in mind that achieving ROSC may be impossible without reperfusion and reperfusion will likely not occur without ROSC.

January 14, 2021

Background Information: Out-of-hospital cardiac arrest (OHCA) remains a diagnostic challenge to providers and a significant burden on healthcare systems globally. Despite the advancement of invasive medical therapies such as percutaneous coronary intervention (PCI) and extracorporeal membranous oxygenation (ECMO) at designated cardiac catherization centers, the majority of these patients sustain poor outcomes due to hypoxic brain injury. Clinical features of neurologic injury are typically delayed until 72 hours after admission. As a result, many neuro-prognostication tools have been developed to assist with clinical decision making as well as reduce expensive futile interventions.1 Some of these neuroprognostication tools include the Cardiac Arrest Hospital Prognosis (CAHP), OHCA and Targeted Temperature Management (TTM) risk tools. Unfortunately, these are complex and time consuming, thus limiting their use in the emergency department (ED). The authors of the following study sought out to develop and validate a point-based risk score to support clinical decision making and predict neurologic outcomes using the cerebral performance category (CPC) scale (Figure 1)

December 31, 2020

Introduction: Respiratory failure is an uncommon but important complication in pregnancy and the postpartum period, occurring 1 in 500 pregnancies.1 Respiratory failure can result from pregnancy-related conditions, conditions exacerbated by pregnancy, or pathologies common to the general population (Table 1). Understanding of respiratory failure and mechanical ventilation in pregnant patients is limited by the relative rarity of the condition as well as the exclusion or underrepresentation of pregnant patients in the majority of the trials that have informed our understanding of respiratory failure. As such, respiratory failure in this vulnerable population is a stressful emergency that requires understanding of the anatomical and physiological changes of gestation as well as meticulous preparation for a difficult airway.