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.

November 12, 2018

In October 2016, I was exposed to the vast world of Free Open Access Medical Education and MedTwitter. I was astounded and inspired by the different educators who were trying to make learning easier. The Knowledge Translation (KT) gap was being vastly shortened by some very smart people who took to social media to educate the rest of the world. Although there were knowledge bombs in all areas of medicine, I was particularly drawn to the ones most relevant to emergency medicine and critical care.

Each day in 2017, I used Twitter to share a few pearls with the world as my contribution to #FOAMed. I included the hashtag #TodayILearned (Today I Learned) so I could keep track of them to use for future projects. Here are just a few of those pearls:

March 24, 2016

Post Written By: Sam Ghali (Twitter: @EM_RESUS)

In cardiac arrest care there has been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad [1,2]. One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival [3,4].

January 21, 2016

One of the major reasons contributing to dismal survival rates in out-of-hospital cardiac arrest (OHCA) is the lack of bystander initiated cardiopulmonary resuscitation (CPR). Even though the majority of OHCA is witnessed, only 1 in 5 patients will receive bystander initiated CPR [1].  Survey studies have shown that bystanders are not wanting to do mouth-to-mouth resuscitation on strangers. Outside of early defibrillation, only early bystander initiated CPR has consistently been shown to improve neurologically intact survival in OHCA. So what about  Cardiocerebral Resuscitation, also known as "Hands-Only" CPR?

December 10, 2015

Welcome to the December 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Cardiology and Critical Care. First of all, we all know that the optimal treatment for STEMI is getting the patient to the cardiac catheterization lab, and time is muscle, but does it help to get patients to the catheterization lab even faster than 90 minutes? Or does speeding up the time have bad outcomes? Secondly, it has been drilled into our heads that high-quality CPR with minimal to no interruptions is key in OHCA.  This gives our patients the best chance of neurologically intact survival.  But a new study just published might beg to differ. So with that introduction today we are going to specifically tackle:

Topic #1: Reducing Door to Balloon (D2B) Times to <90 Minutes in STEMI Topic #2: Continuous vs Interrupted CPR in OHCA

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