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Proper Use of the Pump is Key to Cardiac Arrest

All-about-the-pump

At a conference I participated in recently, Jason McMullan, MD, associate medical director for the Cincinnati Fire Department, made a statement during a lecture that I want to pass along because it illustrates the critical importance of consistent, uninterrupted compressions and care delivery to cardiac arrest patients.

He pointed out that if his heart were interrupted in its pumping functions for even a few precious seconds, he would experience an interruption in oxygenated blood flow and pass out.

He also noted that the longer the heart was allowed to be dormant, the longer the risk was for bad things to occur and the more difficult it would become to return the heart to its essential pumping efficiency and sustain life. So resuscitation is really all about the pump: timing, efficiency
and consistency.

I think back to my early days as a paramedic and the infrequent cardiac arrest “saves” I had. In almost all my successful resuscitations, someone was performing effective CPR early, a shockable rhythm was present, and I was able to rapidly draw the paddles from my defibrillator and shock the rhythm while it was primed, well oxygenated and “ripe.”

In the wild, wild West days, if a gunfighter delayed in getting his gun into action, his chances of winning the battle were less than 50%. The same is true in cardiac arrest resuscitation. You can chuckle about me using those old-fashioned paddles to shock v fib, but I bet I can still get my paddles on a patient’s chest faster than you can dig out, unpackage and deploy your pre-packaged defibrillator pads. The point: Technology can sometimes present delays in care delivery if not performed rapidly and in a consistent, systematic manner.

The September issue of JEMS focuses on cardiac issues, from our regular content to the special 32-page EMS State of the Science editorial supplement developed and presented to you and attendees at the bi-annual Emergency Cardiac Care Update (ECCU) Conference in Orlando, Fla.—where the latest information on cardiac care and resuscitation will be discussed.

In the supplement, developed in cooperation with the U.S. Metropolitan Municipalities EMS Medical Directors Consortium and multiple sponsors, we feature a host of key articles, backed up by 150 pieces of research, that demonstrate why delivery of resuscitation processes in the field needs to be quickly administered and, most importantly, consistently delivered.

In addition to the supplement articles, each of the JEMS articles in this issue presents significant messages that are important for you to read, digest and discuss with your medical director, management team, supervisors, training staff and field crews. Each also emphasizes important processes or procedures that can increase your efficiency and effectiveness in the field, particularly in the resuscitation of cardiac arrest patients and improvements in return of spontaneous circulation (ROSC).

In “Attacking Cardiac Arrest,” pp. 34–39, we focus on a systematic approach to resuscitation in the Tulsa and Oklahoma EMS systems. In “Check the Rhythm,” pp. 40–45, we discuss the correct and effective use of adenosine, the drug of choice for paroxysmal supraventricular tachycardia (PSVT) and for differentiating PSVT with aberrancy from v tach in patients with monomorphic wide complex tachycardias.

Like many other potent medications designed for a specific effect on the heart, adenosine, if used inappropriately or for the wrong arrhythmia, can prove fatal.

A thought-provoking question-and-answer session by EMS blogger and writer Brandon Oto, “Survive and Thrive,” pp. 58–59, rounds out the issue by presenting multiple important procedures that we currently deploy in the field, or may deploy in the future.

You’ll read several common elements of cardiac resuscitation in both September JEMS and the editorial supplement. But the real take-home message is that the keys to resuscitation are early initiation of each procedure, limited interruption of compressions and a pre-planned, systematic approach to everything you do on these critical cardiac resuscitation calls. And remember, success is all about the effective use of the pump. JEMS

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