Cardiac Arrest Management 101

One of the direst calls we respond to in the EMS world is the patient who is not breathing and is without a pulse. During the management of the call, it is imperative that first responders remain in control both internally and externally to defeat the opponent, in this case death.  During a cardiac arrest, a tempo or pace is dictated by the condition of the patient and the reaction of the resuscitation team.  Tempo can be described both as positive and negative in nature.  Negative tempo is demonstrated by the pulseless patient as in length of downtime, a lack of bystander CPR, the buildup of lactic acid, and the deoxygenation of primary organ systems.  Positive tempo is demonstrated in early chest compressions and/or defibrillation, the establishment of a formal CPR team approach, a solid foundation of BLS followed by solid ALS care.   

What does tempo look like during an arrest?  If we were honest with ourselves, we have all participated in the cardiac arrest where CPR may have been inefficient, drugs may have been late, and skills may have not been performed in a timely manner for a plethora of reasons.  In this case a negative tempo was created and allowed to infiltrate the entire response effort.  In contrast we have participated in resuscitations where we set ourselves and the patient up for success with our training, experience, teamwork, poise, and time management to overcome death.  Regardless of the outcome of the patient, we knew we had provided the best care possible giving the patient every chance of survival.  

What are the factors that separate a good resuscitation from a less than stellar attempt?  Our success during a cardiac arrest is not happenstance, but is the byproduct of good team management, communication, knowledge, and training.  Ever notice there is never time to do something initially, so you cut a corner only to realize there is always time to go back to fix things?  A good team leader is poised, efficient, and methodical while keeping their emotions in check, sometimes defined as emotional intelligence.  A good team leader can recognize when a code is headed south and stop the “snowball from running downhill.”  During an emergency time will compress or in some instances even stretch.  Efficient team management includes the following:

• ·       Early and effective CPR and or defibrillation
• ·       Use of a metronome, chest compressions rate of 100-120 beats per minute (per AHA)
• ·       No interruption of chest compressions greater than 10 seconds
• ·       Ensuring slow and methodical ventilations without hyperventilation
• ·       Switching chest compressors every 2 minutes
• ·       Good treatment communication with all team members
• ·       Successful IV and advanced airways to include capnography
• ·       Timely and appropriate medication administration
• ·       Time management
• ·       Appropriate post resuscitation care

Each member of a resuscitation team is responsible for their contribution, creating a positive tempo during the management of the patient.  During resuscitation it is imperative each member remains calm and poised to stay on point with the care being provided.  Calmly speaking and relying on our cumulative experiences, knowledge and training begins long before you arrive at the patient’s side.  It is everyone’s duty to provide the most efficient resuscitation attempt and to ensure best practices in cardiac resuscitation.  By following these simple steps, you will give each patient the best chance of survival each and every time.

- Brian Davis
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com