CCR - do you use it?

[jwraider]

JEMS recently had a great article on Cardiocerebral Resuscitation. It was great for me at least because my county has already implemented a protocol around it that made little sense before reading the article.

If you're wondering what CCR is it's basically CPR without ventilations early in the code. This practice is based on evidence that shows positive pressure ventilations actually decrease blood flow and the effectiveness of CPR.

JEMS: Cardiocerebral Resuscitation

Here is our sample protocol for initial resuscitation:

Sample Protocol

"passive insufflation" is an OPA with a NRB. Notice how many compressions are done before any interventions other than defibrillation. There is no ventilations until an ALS airway is inserted several minutes into the code.

Basically this technique (from what I can gather) is intended to increase perfusion and prolong the life of the brain and heart so that the problem can be solved quickly (defib / meds) and improve the PTs chances of a meaningful survival.

The article is also suggesting different approaches for cardiac arrest and respiratory arrest.

What do you guys think? Anyone run a code with this yet? I'm a newbie and awaiting my first code and will be running this protocol on top of that (yikes!).

[RomeViking09]

It looks odd but medical kinda works. I still would maybe push for early use of transport vent after inserting a combitube or ET Tube to control the rate and volume before removing any real airway support and oxygenation. I guess if they are gasping the airway is open (while not patient) and that high flow O2 could provide them the needed oxygen if they are getting good compressions.

JEMS recently had a great article on Cardiocerebral Resuscitation. It was great for me at least because my county has already implemented a protocol around it that made little sense before reading the article.

If you're wondering what CCR is it's basically CPR without ventilations early in the code. This practice is based on evidence that shows positive pressure ventilations actually decrease blood flow and the effectiveness of CPR.

JEMS: Cardiocerebral Resuscitation

Here is our sample protocol for initial resuscitation:

Sample Protocol

"passive insufflation" is an OPA with a NRB. Notice how many compressions are done before any interventions other than defibrillation. There is no ventilations until an ALS airway is inserted several minutes into the code.

Basically this technique (from what I can gather) is intended to increase perfusion and prolong the life of the brain and heart so that the problem can be solved quickly (defib / meds) and improve the PTs chances of a meaningful survival.

The article is also suggesting different approaches for cardiac arrest and respiratory arrest.

What do you guys think? Anyone run a code with this yet? I'm a newbie and awaiting my first code and will be running this protocol on top of that (yikes!).

[AnthonyM83]

AHA Guidelines 2010 . . . coming to a training center near you (late '09)

[Kiwiology]

I never really liked JEMS they make the research too "simple" and something you can read on the toilet in two minutes.

The full, scientific article as published by the AHA is here http://www.circ.ahajournals.org/cgi/content/full/111/16/2134

[Kaisu]

We implemented CCR protocols about a year ago. The roll out was less than sterling - some people didn't understand it was for pulseless Vtach/Vfib only and nurses in the ER would lose it when we brought in the patients with an OPA and non-rebreather instead of an ET tube. They eventually got on the same page with us.

[Tom B.]

AHA Guidelines 2010 . . . coming to a training center near you (late '09)

How can the 2010 guidelines come out in 2009?

Tom

We implemented CCR protocols about a year ago. The roll out was less than sterling - some people didn't understand it was for pulseless Vtach/Vfib only and nurses in the ER would lose it when we brought in the patients with an OPA and non-rebreather instead of an ET tube. They eventually got on the same page with us.

Why not capture the airway with a non-visualized airway like the King LT-D and deliver asynchronous ventilations with continuous chest compressions?

Tom

[Chief1C]

Prolly the same way you can buy a 2010 car... in 2009.. A new, projected, model.

Implement the training now, retrain everyone to the new protocol.. and Enact it in 2010. Sounds like a fairly normal approach.

[Tom B.]

Prolly the same way you can buy a 2010 car... in 2009.. A new, projected, model.

Implement the training now, retrain everyone to the new protocol.. and Enact it in 2010. Sounds like a fairly normal approach.

It might be, except that the ILCOR Conference doesn't meet until February 2010. If the AHA follows the pattern from 2005, the new guidelines will come out as a supplement to the November 2010 issue of the journal Circulation.

Tom

[cynical_as_hell]

we use CCR already in the area i work in. its a very simple concept and from my understanding with the base hospital, they are seeing more positive outcomes with this technique. It makes things a little easier when working a code because now you have another set of hands free to help out seems you are not "bagging" the patient. But as with anything else, only time will tell rather this is a good decision or a bad one.

[mobey]

Why not capture the airway with a non-visualized airway like the King LT-D and deliver asynchronous ventilations with continuous chest compressions?

Tom

My thoughts exactly!

If the pt is intubated you are not witholding compressions for respirations. Non-visualized or early ET intubation.

The answer may be thoracic pressures being increased by ventilations therby decreasing cardiac preload, but I doubt it.