American Heart Association website
This is a little off the topic of “advanced resuscitation”, but equally as important. Today I was walking into our local grocery store here in San Diego, California and found a team of firefighters teaching “Hands-only CPR” to anyone walking by who would listen. Lots of folks stopped and practiced chest compressions on the mannequins. I heard comments like, “wow, you really have to push harder than I imagined.” Yep! Hard and fast baby! In fact, nurses, EMT’s, and other health care professionals also require CPR class. CPR Training in Charlotte is an advanced level of BLS CPR/AED certification.
Being at the receiving end of this very important part of the chain of survival, I really appreciate that we are taking strides at getting the word out, always remember to sy in shape, you can use the Joy ON for healthier lifestyle and be more stress free to avoid this accidents.
Now In plain words, this is our chain of survival when ECMO is an option:
- The only way we can get a patient, with a fixable coronary lesion and an intact brain, who is in refractory VF to the cath lab is on ECMO.
- The only way to get them on ECMO, in time, is to run a good code. (see our discussion on the Tactical Approach to the Cardiac Arrest)
- The only way to get to the point of running a code well is for medics to transport the patient with good quality CPR, and mechanical chest compression devices are the wave of the future.
- The only way to get keep a patient’s brain perfusing until medics arrive is “Hands Only CPR.” The AHA has come a long way in now promoting this recommendation.
So lets all do our part in getting the good word out there: If someone collapses in front of you:
- Call 9-1-1
- Push HARD & FAST in the center of their chest.
We are the very last link in the chain of survival. And since a chain is only as strong as its weakest link, lets get that first link as strong as possible. Remember that our inclusion/exclusion criteria for considering ECMO, the last bridge to a curative intervention, includes all components of this chain of survival, and the first (your chest compressions) are one of the most important. If paramedics bring us an arresting patient in extremis and the history includes a delay until chest compressions are started, crappy CPR, or any other mitigating factor, we may decide that ECMO is not appropriate.
Great post and totally agree! I have the same take on hands only cpr. Unless bystanders in the field get hands on the chest asap, we can’t use any of our high tech stuff to get the big saves. That’s why we run a weekly hands only cpr course in our institution (new york presbyterian weill cornell medical center) and partner with the AHA to teach people in the community. In the past week, I’ve helped run two events, one in lower manhattan for cpr week and one yesterday in brooklyn at northside festival.
James, Keep fighting the good fight!!! Great thoughts and thanks for your comments. The first link in the chain is likely the most important. Ben Bobrow, in Arizona, had it right with PSA’s. Indeed we have SO MUCH to offer if we can just get those patients to us with reasonable exogenous perfusion. I love to talk ECMO, circuits, pressures, cannulation, etc, etc…but all that isn’t worth S*** if we can’t get salvagable patients to us.
I can tell you that in our community we’ve heightened the intensity and excitement of pre-hospital CPR efforts in advertising what we can do if they bring us patients with vigor!
But the message is still not broadcasted loud enough! How do we get the “hands only CPR” message out to everyone?? And how do we pay for that?
Paramedic Andrew Meakin sent us the following:
“I have just found your site after watching a great talk by Dr Cliff Reid about when not to stop CPR.
I am a lowly paramedic and during my training I observed a CABG surgery and thought to myself “If a perfusionist can keep a patient alive while his heart is stopped, why can’t we do that for someone in cardiac arrest?”. Colleagues told me it wasn’t possible. I’m glad that some dedicated doctors found a way to make it work!
Kudos to everyone involved. I hope I get to see it first hand one day.”
My response (~Joe):
Andrew, thanks for the comments and thanks for following us! But you should have learned from Cliff’s talk that there is no such thing as a “Lowly paramedic.” You are the first link in the chain my man! Unfortunately that link can sometimes be the weakest one. But its the most important one. YOU get to decide whether you think the patient is salvageable, perform heroic chest compressions and bring them to a place that can put them on ECMO and get them to the cath lab. You are the most important link in the whole chain. Thanks for doing what you guys do!
Viva LA Foam- Today in New Zealand during an ” Airway Day” ED training I was running one of my ED registrars ( Residents)also quoted Cliff Reid from his when (not) to stop CPR, and we ended up discussing ED ECMO, and ECMO in general. . .Hard act to follow. . but Scotts’ ” How to stop using the laryngoscope as a Murder Weapon” Video podcast was still on the agenda.so we forged on. We are still waiting for the opportunity for our patients to benefit from ED ECMO here. What if anything can be done to make this more accessible- any mini-fellowships or sabbaticals available in this????
Renee, we get this question a lot. In reality I really don’t think you need to do a sabbatical or fellowship, in my opinion. If you have the infrastructure: ECMO/ECLS established at your hospital to support your CT surg team then you are 90% there. Cannulation is a skill that is essentially an extension of everything you already know about central line placement – just a lot bigger. My hope is that this website will help provide the background, foundation, and knowledge you will need.