Introduction - Patient Care - @


Advances in cardiac & resuscitation call for new EMS field practices


By A.J. Heightman, MPA, EMT-P, & Paul E. Pepe, MD, MPH | From the EMS State of the Science 2012 Issue

Cardiac, respiratory and resuscitation medicine is rapidly changing with new protocols, procedures, thought processes, treatment devices, training and operations. More importantly, research and resuscitation outcomes are validating new approaches to care and driving new approaches to resuscitation. Consequently, care in the field must adapt.

This EMS State of the Science supplement, developed in cooperation with the U.S. Metropolitan Municipalities EMS Medical Directors Consortium and our sponsors, features articles that address key resuscitation issues.

In “The Sweet Spot,” Ahamed H. Idris, MD, director of the Dallas Fort-Worth Center for Resuscitation Research at UT Southwestern Medical Center, demonstrates that the delivery of uninterrupted, quality compressions is crucial to patient resuscitation, but also that the likelihood of ROSC after out-of-hospital cardiac arrest is greatest with chest compression rates between 100–120 compressions/minute and that ROSC declines when compressions exceed 125 compressions/minute.

The current state-of-the-science in cardiac care is presented in “Trends & Changes in Cardiac Care,” authored by Vanderbilt University’s Corey Slovis, MD, FACEP; Jared McKinney MD; and Jeremy Brywczynski MD, FAAEM. Areas discussed include the importance of first responder AED use; optimal CPR and new perspectives on ventilations and compressions; metronomes; mechanical CPR devices; the impedance threshold device; and transportation of ROSC patients to resuscitation centers.

“Q&A with Joan Mellor” is an informative interview with the program manager for the Medtronic Foundation’s HeartRescue Project, which is working to improve cardiac arrest survival by 50% over five years. The interview details how they plan to develop and expand their SCA response systems by coordinating measurement, education and training among the general public, first responders, EMS and hospitals.

David P. Keseg, MD, FACEP, medical director for the Columbus (Ohio) Division of Fire, tackles CPR delivery methods in “The Merits of Mechanical CPR.” Although some controlled trials and studies have reported insufficient evidence to draw conclusions about the benefit of mechanical chest compressions during CPR, Dr. Keseg points out that many EMS systems are having positive results and increased ROSC using these devices in conjunction with updated and regimented resuscitation processes.

Finally, in “Depth Perception,” author Kathleen Klein points out that compression depth is one of the main determinants of coronary perfusion pressure, which in turn is a primary predictor of patient survival. She then introduces us to triaxial field induction (TFI) technology, which will assist crews in compressing patients to the appropriate depth by measuring and displaying the relative distance via a chest sensor and a reference pad placed under the patient.

As with all JEMS editorial supplements, this EMS State of the Science supplement presents the latest information by outstanding authors, and also backs up the information with the more than 140 footnoted references for the most current research in each area. Read each article carefully and share this important information with your staff.

Paul Pepe, MD, MPH, is coordinator of the U.S. Metropolitan Municipalities EMS Medical Directors and A.J. Heightman, MPA, EMT-P, is editor-in-chief of JEMS.

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Related Topics: Patient Care, Cardiac and Circulation, David P. Keseg, Joan Mellor, FAAEM, FACEP; Jared McKinney MD; and Jeremy Brywczynski MD, MD, Corey Slovis, Ahamed H. Idris, EMS State of the Science, Kathleen Klein

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