Ep87 - Those CPR Pauses, Though...

The EMS Lighthouse Project

Train the Best. Change EMS.
Howdy, y'all, I'm Dr Jeff Jarvis, and I'm the host of the EMS lighthouse project podcast, but I'm also the medical director for the new EMS system we're building in Fort Worth Texas. We are looking for an experienced critical care paramedic who is an effective and inspiring educator to lead the initial and continuing training and credentialing of a new team of Critical Care Paramedics who will be responding to our highest acuity calls. The salary is negotiable but starts between $65,000 and $80,000 a year for this office position. Whether y'all wear cowboy boots or Birkenstocks, Fort Worth can be a great place to live and work. So if you're ready to create a world-class EMS system and change the EMS world with us, give us a call at 817-953-3083, take care y'all.

Remember when we learned interruptions in compressions take a long time to recover blood pressure from? And how, to avoid these, we should do continuous compressions to avoid them. And ventilations aren’t all that important. Right? Right? Well, about that. Maybe the stories of the importance of continuous compressions were greatly exaggerated. Join Dr. Jarvis as he discusses the literature that led us to this point and some evidence that has led him to reconsider how his system approaches cardiac arrest. He’ll eventually get around to discussion a recent paper by Dr. Rose Yin that analyzes arterial pressures during cardiac arrest that was a catalyst for him to make changes in his arrest protocols.

Citations:

1. Yin RT, Berve PO, Skaalhegg T, et al. Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest. Resuscitation. 2024;201:110311. doi:10.1016/j.resuscitation.2024.110311

2. Azcarate I, Urigüen JA, Leturiondo M, et al. The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation. JCM. 2023;12(21):6918. doi:10.3390/jcm12216918

3. Berg RA, Sanders AB, Kern KB, et al. Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest. Circulation. 2001;104(20):2465-2470. doi:10.1161/hc4501.098926

4.Kern KB, Hilwig RonaldW, Berg RA, Ewy GA. Efficacy of chest compression-only BLS CPR in the presence of an occluded airway. Resuscitation. 1998;39(3):179-188. doi:10.1016/S0300-9572(98)00141-5

5. Bobrow BJ, Clark LL, Ewy GA, et al. Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest. JAMA. 2008;299(10):1158-1165.

6. Idris AH, Aramendi Ecenarro E, Leroux B, et al. Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023;148(23):1847-1856. doi:10.1161/CIRCULATIONAHA.123.065561

7. Nichol G, Leroux B, Wang H, et al. Trial of Continuous or Interrupted Chest Compressions during CPR. N Engl J Med. 2015;373(23):2203-2214. doi:10.1056/NEJMoa1509139

8. Schmicker RH, Nichol G, Kudenchuk P, et al. CPR compression strategy 30:2 is difficult to adhere to, but has better survival than continuous chest compressions when done correctly. Resuscitation. 2021;165:31-37. doi:10.1016/j.resuscitation.2021.05.027

9. Zhan L, Yang LJ, Huang Y, He Q, Liu GJ. Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Anaesthesia C and ECG, ed. Cochrane Database of Systematic Reviews. Published online 2017. doi:10.1002/14651858.cd010134.pub2

10. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109(16):1960-1965. doi:10.1161/01.CIR.0000126594.79136.61