March 30, 2020

The American Heart Association (AHA) released a focused update in 2019, for advanced cardiovascular life support (ACLS) guidelines, to addend those published in 2017 and 2018 for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care.  These recommendations were based on evidence identified by the 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) from the International Liaison Committee on Resuscitation (ILCOR).  This ACLS Update addresses three main concerns:
  1. Advanced Airway management
  2. Vasopressors in cardiac arrest
  3. Extracorporeal CPR (ECPR) during cardiac arrest

January 14, 2016

 

The Ontario Prehospital Advanced Life Support (OPALS) Study

Background: Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are OHCA and the survival rate is pretty poor. The most recent survival estimates put it at 7 – 9.5% in most communities. About 10-12 years ago, the American Heart Association built the 4-step “chain-of-survival.”
  • Step One - Early access to emergency care
  • Step Two - Early CPR
  • Step Three – Early defibrillation
There is little debate about these three steps as the sum of the data supports that they lead to better outcomes. The 4th step in the chain, however, is slightly more controversial; early advanced care. This basically means rapid access to ACLS type resuscitation skills (intubation and intravenous drug therapy). Despite it being the 4th step, ACLS has little evidence to defend it. 

July 16, 2015

Background: Out-of-hospital cardiac arrest (OHCA) occurs in the United States at a rate of nearly 300,000 individuals per year. Even more concerning is the high mortality rate which is associated with this. The majority of OHCA is due to cardiac etiology with the most common initial rhythm being ventricular fibrillation (VF). What we all know is that high-quality, limited interruption cardiopulmonary resuscitation (CPR) and early defibrillation are the hallmarks of successful neurologic outcomes in OHCA. For many who have heard me speak about ACLS, you have heard me say that these guidelines are created for the providers who do not perform resuscitation as part of their daily routine. For those of us in the trenches of the emergency department, we have to think beyond ACLS at times. Although VF typically responds very well to the standard energies of defibrillation, maybe in patients with higher body mass index or morbid obesity we need higher energies to achieve successful defibrillation.

May 18, 2015

Patients with pulseless electrical activity (PEA) account for almost 1/3 of cardiac arrest and even more troublesome is that the survival rate is significantly worse than patients with shockable rhythms. Both the European and American ACLS guidelines stress the importance of quickly finding and addressing the cause of PEA. This is traditionally done with recalling the 5 to 6 H’s and T’s, but during cardiopulmonary resuscitation it is difficult to recall all 13 causes of PEA by trying to recall this list. In 2014 a review article was published that was developed by several departments from the Carolinas Medical Center in Charlotte, NC that tried to simplify the diagnostic approach to PEA.

April 6, 2015

Welcome to the REBEL Cast Episode 7, where Swami, Matt, and I are going to tackle a couple of articles just published this year. Today we are going to specifically tackle:
  • Topic #1: Basic Life Support (BLS) vs Advanced Cardiac Life Support (ACLS) in Out of Hospital Cardiac Arrest (OHCA)
  • Topic #2: PROMISE Trial - Anatomic vs Functional Testing for Coronary Artery Disease (CAD)
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