Peter Antevy shares practical cardiac arrest techniques: deliver two large bag-valve-mask breaths on arrival, keep chest compression pauses under 5 seconds, maintain 100-110 bpm compressions ("Row, row, row your boat"), and use automated CPR devices without stopping compressions. Ventilate adults once every 10 seconds, children every 6 seconds.
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We're doing a really, really good job with cardiac arrest. And thank you to all of you for doing such an excellent job. We're already more than double the state average. We've had a tremendous rise in survival rates, but there are some things that we can now fine tune. So I think we've got the majority of the things out there. But there are a couple of tips and tricks I want to go over on this video to improve us even a little bit further. Move that bar a little further. So a couple of things I want to make sure you get is for adult primary cardiac arrest, the first step is still two big bag valve mass ventilations. I know we don't breathe for the first six minutes, but we still do. When you first arrive, whether it's bystander CPR or not, first step before you put that bag off to the side for six minutes is two big BVMs. The reason for this are a couple of fold. Number one, it fully expands the lungs and makes those lungs open with air spaces, so it makes our passive oxygenation better. Number two, a lot of times blood will pool into the back of the lungs if you're in cardiac arrest for a little while. And when you expand those lungs, it takes all that blood and sort of like squeezing a sponge out and pushes all that blood back into the central circulation. Number three, it ensures that we really are dealing with an open airway. So please do that. That's one of the tips I want to make sure that we're getting a little closer to 100% on the next tip I want to go over is not stopping chest compressions. All of these tips I'm about to go over are to maximize chest compressions and minimize pauses because pauses increase the mortality rate in cpr. So when we pause, we pause for a number of different things. We pause to check the rhythm, we pause to check the pulse, we pause to intubate, and we pause to put the Lucas device on. So it's important that we get rid of all those pauses. Charlie Coyle has already put out a really good video on how to put on the Lucas device without stopping cpr. If you have not seen this already, it is critical that you watch this. The reason is because every time you pause for more than 15 seconds, based on animal studies, it increases the mortality rate by 50%. Fifteen seconds goes really, really quick. We need to keep our pauses to five seconds or less. I know the protocol says 10, but I really want you to shoot towards five. So first step is learn how to put on the automated CPR machine. Without pausing cpr, we already have videos on that. I encourage you to watch that. Number two, these pauses at the end of each two minute cycle, you should pause for five seconds just to see whether it's shockable or non shockable. A rhythm. You should not repeat, not check for pulses at the end of the two minutes, unless one of two things has occurred during the two minute cycle. Number one is the patient showed signs of life. They're moving around, they're pushing you away. That's fine, you can pause obviously for that. But number two, during the two minutes preceding the pause, you had a sudden spike in your end tidal CO2. That's because our end tidal CO2 tells us if there should be a pulse back. So if you're humming along right at end tidal CO2 at 20, you don't have ROSC. If you go from 20 all of a sudden to 35, there's a good chance you do have ROSC. So let's not waste time checking for pulses when the end Tidal CO2 is telling us there's probably no pulse there. So limit your pause to five seconds simply to see if it's a shockable rhythm or a non shockable rhythm. So the sequence event should be Lucas device is on, you hit the pause button, you look at the monitor, five seconds, determine shock or not shock. You hit play if it was a shockable rhythm while the Lucas is going again, or in the case of manual cpr, while manual CPR is going again. You then will charge the monitor while compressions are occurring. And if its Lucas is on, you will shock while the Lucas is going. So that's important. Charge and shock while the Lucas is still going. Pause just to decide, yes, no shock. If it's manual cpr, you're going to pause, decide yes, no shock, and you're going to continue compressions until the monitor is ready to shock and, and you're going to hover over the, check the chest and pause, deliver the shock and go immediately back to compression. The next thing I want to go over is the proper chest compression rate. Now we know the Lucas device, or in the case of those that carry auto pulse, the auto pulse that handles the correct rate. But for manual cpr, those first few minutes where we were doing cpr, whenever I ask folks how fast you should be pushing, everybody accurately tells me between 100, 110. Then I ask them to tap that out. And I get and that's not 110, that's 160. And that's actually, what we're seeing on our code stats is that we know the rate in our head, how fast to push, but we don't have really good internal clock to give to give us that 110 rate. So I'm going to give you a couple of mental tips to use on this. And the first one is row your boat down the Mississippi. And you'll see why it's. Why it's that. So the first is to get to the rate. 110 is the song Row, row, row youw Boat. So if you just go to that beat, row, row, row your boat Row, row, row your boat, that puts you at 110. Now, why down the Mississippi? Well, this has to do with the breathing rate, because once you get to the point where you're breathing for them, which is after six minutes for our primary care, I mean, after six minutes for our primary arrests and immediately for our secondary or hypoxic arrests, you're going to breathe about one breath every 10 seconds. But when I look at the information, we're not breathing as slow as one every 10 seconds. What I'm seeing is people breathing much faster than that. So what I want you to do for the person who's doing the airway is do like this. Breathe 1 Mississippi, 2 Mississippi, 3 Mississippi, 4 Mississippi, all the way up to 10 Mississippi, and then breathe. So use those Mississippi. So you really are approximately 1 breath every 10 seconds. The rationale here is if you're not circulating a lot of blood, you're not metabolizing a lot, so you don't need a lot of oxygen. So let's not flood the engine with extra gas. Okay? The engine's running at idle. When you're in cpr, you don't need to flood it with extra gas every time you squeeze the bag. You decrease cardiac output during cpr. Feel free to hyperventilate. Once you get pulses back, before you get pulses back, you got to keep your breath to one every 10 seconds for adults, one every six seconds for the children because they need a little more oxygen. Okay, so after the six minutes marks, it's time to do the advanced airway. And then you've got your advanced airway in with your. With your rescue pod on. The patient should be on the Lucas and on the scoop stretcher. And. And at this point, you've been on the ground or whatever surface you're working on all up to that point when it's time to. Now get the patient on our stretcher, lift the patient up on the scoop, and bring them over to our stretcher. Once you place them on that stretcher try to lift the head of the stretcher up some. So now that you're in the you're at the point where you're getting ready to transport the patient. During transport it's important to lift the head up a little bit because that'll help the venous blood drain out of the head and that will improve arterial blood flow to the brain and improve neurological intact recovery rate at least according to animal models. So in the animal model they lifted the head all the way up to 30 degrees. It's difficult for us to get that high with our current equipment but every incremental degree is helpful. So 5 degrees is better than 0, 10 is better than 5 and so forth. So even if you can get them up to 10, 15 or even 20 degrees that would be great. So when at the point where you're actually transporting them try to get the head up some.
