b-card symposium - ilcor protocols & continuous o2 insufflation in cardiac arrest
TRANSCRIPT
b-card symposium
ILCOR 2015 & CPR-Ventilation Continuous 02 Insufflation in Cardiac Arrest
TuesdayMarch 7th
2017
Nicolas PESCHANSKI, MD, PhD
Acknowledgments
Salim R. Rezaie, MD@srrezaie
Justin L. Benoit, MD@justinleebenoit
ILCOR Cardiac Arrest Ventilation
Callaway CW et al. Circulation 2015
Chain-Of-Survival
Soar J et al. Resuscitation 2015
Missing Link
or
Weak Link?
ILCOR2015
CPR-Ventilation
Ewy GA et al. JACC 2009
Chain-Of-SurvivalILCOR2015
ILCOR2015
Give
O2
Callaway CW et al. Circulation 2015
ILCOR2015 Advanced Airway
10”
Deakin CD et al. Resuscitation 2010
EtCO2
ILCOR2015
Ahrens T et al. Am J Crit Care 2001
20’
Negative Factors
Rhythm <100/min
Interruptions
Depth <2’
Hyperventilation
ILCOR2015
Travers AH et al. Circulation 2010
RealLife
Hyper
Ventilation
Aufderheide TP et al. Circulation 2004
Do we hyperventilate?
RealLife
Pressure
O’Neill JF et al. Resuscitation 2007
Bag-Valve-Mask
Inflation Rate
Airway
Mean
➘PerfusionPressure
ILCOR2015
➘CoronaryPerfusion
➚Vent’
Berg RA et al. Circulation 2010
➚Chest Comp’Interruptions
ILCOR2015
“Everything should be made
as simple as possible,
but not simpler”
Hands-Only
CPR
Rea TD et al. NEJM 2010Bobrow BJ et al. JAMA 2010
RealLife
Passive Oxygen Delivery
Bobrow BJ et al. Annals Emerg Med 2009
Passive Oxygen Delivery
Saissy JM et al. Anesthesiology 2000
Passive Oxygen Delivery
Recommendations Grade IIb LOE C
Boussignac©
Cardiac
Arrest Tube
Continuous O2 INSUFFLATION
Bertrand C et al. Intens Care Med 2006
Concept
CardiacArrestTube
Steen S et al. Resuscitation 2004
Results
AnimalStudy
CIO vs. PPV
➚ROSC
Steen S et al. Resuscitation 2004
AnimalStudy
➚Coronary Perfusion
CIO vs. PPV
RealLife
MICU
No➚Vent’
ILCOR2015
First Responders / EMT
No CIO!
ILCOR2020
Is There A
Next Step?
Maybe…
ILCOR2020
Virtual valve
15 L/min
Same Concept
Same Concept
Lab Tests
Negative Pressure
Cadavers’ Study
Segal N et al. Resuscitation 2015
CPR-Induced Gastric Air➘
COIEffects
New RecommendationsIn Cardiac Arrest
Oxygenation?
Bag-Valve-Mask Can Be Bad
for CPR-Ventilation
Advanced-Airway Can Be Bad
for CPR-Ventilation
CPR-Ventilation
Is Compulsory!
CPR-Ventilation=
CPR-Designed Devices!
b-card symposium
Thank You for Your AttentionQ & A
TuesdayMarch 7th
2017
Nicolas PESCHANSKI, MD, PhD