Podcast 191 – Cardiac Arrest Update - a podcast by Scott D. Weingart, MD FCCM

The team has done a bunch of stuff on cardiac arrest here on the EMCrit site:



* Podcast 125 - The New Intra-Arrest (Cardiac Arrest Management)

* EMNerd: The Tell-Tale Heart

* Hemodynamic-Directed Dosing of Epinephrine for Arrest

* The Future of CPR



There has been a lot of interesting stuff that has come out since my SMACCgold talk. This podcast will bring you up to date on the crap running though my mind. Beware: very little evidence lies here.

The Syndromes of Cardiac Arrest

Refractory Vfib/Vtach (Electrical Storm)



* Anti-Dysrhythmics

See EMNERD's ALPS Post

* Dual-Sequential Defib



Amazing session on EMRAP by Zack Shinar (membership required)

Study of Dual-Sequential shows early double better than single (Resuscitation. 2019 Jun;139:275-281)

* Esmolol

Driver et al. (Resuscitation. 2014 Oct;85(10):1337-41 PMID 25033747)

500 mcg/kg IVP, can add a drip starting at 50 mcg/kg/min

See this great EMPharmD Post

* Take them to the Lab

* ECMO anyone?



Vasoplegia

Note:  I (we) have probably been misunderstanding this Vasoplegia, it is imperative you read this post (choosing the correct DBP); you should also probably listen to that podcast.



* High-Dose Epi

* Methylene Blue

What's the dose? Who knows? I give 2 mg/kg (but not in pts on SSRIs)

* REBOA

* Junctional Tourniquet



PREM/PRES

We did an episode on this topic on the EDECMO podcast (ignore the ECG stratification stuff--since been debunked).



 

Monitoring



* ETCO2

* Cerebral ox

* Ultrasound (preferably TEE)



Time Zero Prognostication



* What can we use??

* This retrospective study from France indicates that if the pt has the following 3: 1. OHCA not witnessed by emergency medical services personnel, 2. nonshockable initial cardiac rhythm, and 3. no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine then there was no RONF and the pts should be put on the donation path. (Ann Intern Med. 2016 Dec 6;165(11):770-778. doi: 10.7326/M16-0402. Epub 2016 Sep 13.  Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation)



Blood Gases during Cardiac Arrest



* From the book Cardiac Arrest

* Study on Blood Gases during Arrest



Nurse-Run Codes

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM