EMCrit #235 – Cardiac Arrest Science with Zack Shinar - a podcast by Scott D. Weingart, MD FCCM

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Today, I get to speak with my buddy Zack Shinar about soem cardiac arrest science.



Questions Discussed



Is there a no-flow time past which there is no hope for survival?

If there is, how do we know the pt was actually fully no-flow--are we are conflating no-cpr for no flow?

What is the survival limit on low flow time?

VF survival is not linear across time. What happens to that number if you strip out all the 1-2 shock v-fib (real comparator for ecmo right?

Who are the few (5%) of non-ecpr patients who survive after 30 minutes of CC?

Effect of Transient ROSC on outcome data













Current Cardiac Arrest Assumptions – mantras needs changing



* Cardiac arrest rhythms have overlap but are very different disease

* Termination of Resuscitation (TOR) is outdated

* Pre-hospital prognostication needs an increase in sophistication



Some Literature on the Stuff Spoken About







* Asystole in patients with wearable ICDs are much better than historical1

* Shockable rhythm patients can have neurologically intact survival with CPR out to 47 minutes (mRS 0-3)2

* When Should EMS Transfer-Transport for ECPR should be considered between 8 to 24 minutes of professional on-scene resuscitation, with 16 minutes balancing the risks and benefits of early and later transport. Earlier transport within this window may be preferred if high quality CPR can be maintained during transport and for those with initial non-shockable rhythms.3 50%of ROSC would be captured at 8 minutes and 90% by 16 minutes.

* Reynolds et al. found similar data with 21 minutes being the 90% capture mark.4

* PEA should prob. not be an exclusion for ECMO, they can have a 23% neuro intact survival in this paper.5

* Wake County Data Packet

* Rate of Brain Death and organ donation, possibly another reason field termination in the field is a bad strategy in viable cohorts

* Adnet et al. on No-Flow and Low-Flow Durations



Other EMCrit Links of Interest



* Cardiac Arrest Update

* EMS Field Decisions in Cardiac Arrest with Howie Mell



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Now on to the Podcast...



References









1.

Liang J, Bianco N, Muser D, Enriquez A, Santangeli P, D’Souza B. Outcomes after asystole events occurring during wearable defibrillator-cardioverter use. World J Cardiol. 2018;10(4):21-25. [PubMed]









2.

Reynolds J, Grunau B, Rittenberger J, Sawyer K, Kurz M, Callaway C. Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating Resuscitation. Circulation. 2016;134(25):2084-2094. [PubMed]









3.

Grunau B, Reynolds J, Scheuermeyer F, et al. Relationship between Time-to-ROSC and Survival in Ou...

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