Back to Course

La nuova frontiera della gestione di un arresto cardiaco extra ospedaliero

0% Complete
0/0 Steps
Lesson 1 of 1
In Progress

Una nuova frontiera nella gestione dell’arresto cardiaco

Questo video è stato registrato durante la sessione EMU 365 del 2019 e tratta le novità relative alla gestione dell’arresto cardiaco extra-ospedaliero.

Autore dell’intervento è il dr. Salim Rezaie, ordinario al Greater San Antonio Emergency Physicians, dove dirige la sezione di educazione clinica. E’ anche il fondatore del progetto REBEL EM e del progetto REBEL Cast. Zezaie si è laureato alla Texas A&M Health Science Center e svolge anche attività educativa come medico di emergenza-urgenza alla East Carolina University.

In questo video EMU365 Rezaie ha approfondito le ultime evidenze cliniche nella gestione delle vie aeree e nell’utilizzo dell’epinefrina come farmaco gestionale dell’arresto cardiaco extra-ospedaliero. Nella gestione delle vie aeree presenta alcuni device da utilizzare per ottimizzare la perfusione, analizza alcune controversie sull’uso dell’epinefrina per tempi e dosi, così come rispetto alla somministrazione emodinamica diretta durante gli arresti cardiaci.

Punto fondamentale di questo video è: salva una vita e il suo cervello!

Key messages: Save a life AND the brain

  1. High quality CPR & early defib
  2. Airway: SGA > BVM > ETT 
  3. Epinephrine: Hemodynamic guided epinephrine drip

Airway management in cardiac arrest

  • CAB instead of ABC. Our focus should be on high quality CPR with minimal interruptions and early defibrillation
  • No difference in neurologic outcomes in OHCA with use of supraglottic airway (SGA) vs. ETT (AIRWAYS 2)
  • Bottom line: SGA > BVM > ETT

Epinephrine in cardiac arrest

Problem: weak evidence for increased chances of ROSC and short-term survival at the expense of survival with an unfavourable neurological outcome (PARAMEDIC 2), with no increased long-term survival. The optimal dosing and frequency of epinephrine are unclear. 

Salim’s Approach: Hemodynamic-directed dosing of epinephrine for cardiac arrest 

Initial set up: Dirty Epi Drip – 1mg crash cart epinephrine in 1000mL of NS in with final concentration of 1mcg/mL. 

  • Option 1: Run this wide open under a pressure bag
  • Option 2: Quarter dose Epi Drip, running at 0.5mcg/kg/min. In a 100kg patient, this would be the equivalent of 250mcg over 5 minutes (ie. quarter dose)

Titration of epinephrine to (based on combination of animal studies, case reports and expert opinions)

  • Art line DBP >30 mmHg and/or
  • ETCO2 > 20 mmHg (surrogate marker of perfusion, can have false readings if V/Q mismatch)
  • If DBP < 30 or EtCO2 < 20 Optimize your CPR
  • Argument for Epi drip in OHCA: 1. Cognitive offload. 2. Supports Cerebral PP and coronary PP and 3. Avoids post ROSC hypotension

Speaker Bio

Dr. Salim Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University. Currently, Dr. Rezaie works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP), where he is the director of clinical education. He is also the creator and founder of REBEL EM and REBEL Cast.

All EMU 365 Videos

Visit emupdate.ca for more Emergency Medicine Update Conference content and registration