Chest compression rate

[Robbyemt]

To get your panties in an uproar over the ER staff's rate of compressions is a moot point. If you delivered your pulseless/apnic pt to the ER, chances are they are already dead and nothing they or you do is going to change that. FACT: a human performing chest compressions is only about 20% effective at best. Secondly, even with the best compressions, you cannot create the negative pressure to effectively circulate oxygen to the brian. The bottom line is, if your doing manuel compressions for more than a half hour, you have a brain dead pt. (normal core temp) So if it makes you feel good, NICE JOB!! But you really are just going through the motions until someone has the brains to call it. The only good outcome would/could be some organs that have been perfused enough for transplant.

That being said, our entire fleet has these chest compression machines called the "Auto Pulse". It is a device that Zoll has bought the patent on and is available for about $17000 per unit. The compressions delivered by these units are second to only a strong healthy heartbeat. I have personally used the device on almost a dozen pts and had some code saves with no brain injury what-so-ever. Some of these arrests have been as long and longer than an hour. I am not going to toot my own horn as to how long I've been doing this or how great our company is because it just doesn't matter. Until these devices become standard of care, you will continue to bring dead bodies to the ER. So the next time some over zealous nurse jumps in and takes over compressions, just let them think they're dong a great job and leave it at that. You and everyone involved will all be better for it.

Rob

NYSEMT-P

[treaux]

Robby, you must have seen good CPR bring someone's pulses back before. In fact, that's the only thing I've seen really work on the majority of my codes. True, after a long time the chances of survival dwindle to an astonishing low number, but it doesn't mean the care providers should be slacking at their duties because of it.

I see poor CPR very often and don't have any qualms correcting it. The consensus is that quality compressions should be the focus of your attention when dealing with cardiac arrest and there's no reason anyone with a CPR or ACLS certification should not be capable of providing them. As usual, try to be polite about it and if you get a rude response, simply report it to someone of more authority (unfortunately that's how it works in the bureaucracy of EMS) and try to get it corrected.

I've noticed this is very prevalent with the "Respiratory Techs" or whomever it is who takes over the BVM ventilation when delivering patients in respiratory arrest to the ER as well. I will often see them take the bag and begin ventilating at a rate anywhere from 20-30 breaths per minute. I've even had one tell me I was "going too slow" as I walked in the door and grab it out of my hands to start squeezing it like they're priming a pump.

Fact is people need more practice and oversight to keep their skills in line (I of course include myself with everyone else in this profession).

[cardiacjumper]

Disagree completely. I often make suggestions to the ER staff of arrests I bring in, asking for deeper compression, slower vents, etc. Some take it well, others don't. But as long as my monitor is still hooked up and my partner is still ventilating I feel an ethical need to continue to advocate for my patient. I've never had a Dr. become offended because I attempted to keep CPR running 'my' way until I was completely clear of the pt.

I've delivered to a really busy ER, and even now, with a tiny ER, busy is still relative. It's very common that I review cases that I've delivered with the docs, and when it's slow often glove up and help with pts that I'm not responsible for. I think it's a great educational resource, as well as allowing the staff and I to get to know each other, our limits, expectations.

Walking away self satisfied is important for sure, but advocating for your patient is vital as well...todays pt, as well as tomorows.

Dwayne

Edit. Sorry, I got sidetracked. I also believe that the rate is secondary to adrenaline. I find that this is more of a problem with vents in head pts than with compressions. I sometimes have to argue to slow things down, despite allowing them to watch my ETCO2 with head injuries.

I agree. When I have questions (or doubts) about treatment in the ER, I usually wait until things calm down, then "politly" ask the nurses and Dr. what the rational was behind it...I have learned quite a bit that way....most of the time.

[Richard B the EMT]

I'll be presumptuous, that most of us using AHA or Red Cross CPR standards are mandated to renew our "cards" yearly, keeping us "up to date". On the same presumption, RNs and MDs are not so mandated, as they are already the supposed "higher medical authorities". Take that as a possible explanation as to why the ER staff would be, compared to our training, hyperventilating the patient with the BVM, or using a different compression rate, possibly with the Adrenalin fuel factor also being added to the equation.