Learn about the evolution of extracorporeal membrane oxygenation (ECMO) and emerging technologies using ECMO to revolutionize heart and lung failure care, organ preservation and care for extremely premature infants.. -- Extracorporeal membrane oxygenation (ECMO) does the work of a patient’s failing heart and lungs for a period of weeks, sometimes months. That’s often long enough for the heart and lungs to rest and recover, increasing the patient’s chance of survival.. The technology has spread worldwide, and has the extraordinary legacy of diminishing mortality in conditions where patients would otherwise have no chance of survival.. Robert Bartlett, MD, is credited as one of the founding fathers of ECMO. University of Michigan’s ECMO program was established in 1980 and has grown to supporting over 100 patients a year, including adults and pediatric patients. In addition, U-M’s ECMO lab has advanced a number of ECMO-related devices and technologies including artificial implantable lung development, mechanical support for organ preservation and transplantation, and artificial placenta support for severely premature infants.. Presented at the Joint Conference on Advances in Pediatric Cardiovascular Disease Management, hosted by the Congenital Heart Center at C.S. Mott Children’s Hospital.. C.S. Mott Children’s Hospital is consistently ranked among the top children’s heart programs in the nation.. Learn more at http://www.mottchildren.org
This video shows real cases of CPR-induced consciousness. It brings to life the current literature. And includes the expert panel discussion on how to manage CPRIC from SMACC. CPR-induced-consciousness (CPRIC) is defined as clinical signs such as breathing efforts, movements and eye opening that occur during CPR. “These signs can indicate ROSC and require verification by a rhythm and pulse check, but can also occur because CPR can generate a sufficient circulation to restore signs of life including consciousness”. (ERC, 2015, www.cprguidelines.eu Section 1 Executive summary). A 2015 systematic review could only identify 10 reported cases of CPRIC in the literature counting both in-hospital and out-of-hospital cardiac arrests (www.ncbi.nlm.nih.gov/pubmed/25447435). Subsequent retrospective observational reviews have shown the incidence of CPRIC in out-of-hospital cardiac arrests to be 1% and that it is increasing (www.ncbi.nlm.nih.gov/pubmed/28161214). In a survey of 100 clinicians, almost 90% (59 of 67) report that they had witnessed some level of CPRIC, occurring a median of 3 times (www.ncbi.nlm.nih.gov/pubmed/27478148 ).. Who gets CPRIC? CPRIC most commonly occurs in younger patients, with a cardiac aetiology of the arrest, where the initial rhythm is VF/VT, and they have a short down time (www.ncbi.nlm.nih.gov/pubmed/28161214).. How should we manage it? There have been calls for CPRIC management guidelines. (www.resuscitationjournal.com/article/S0300-9572(16)00085-X/pdf). Guidelines on management are desired by clinicians (www.ncbi.nlm.nih.gov/pubmed/27478148) and are emerging in different countries (e.g. Netherlands, Australia, New Zealand, US). They include chemical options like Ketamine, Midazolam, Fentanyl (www.ingentaconnect.com/content/tcop/bpj/2016/00000001/00000002/art00004?crawler=true&mimetype=application/pdf ).. . Importantly, whichever drug is used, being able to recognise CPRIC and NOT pausing the compressions (obviously after ROSC has been excluded as the cause for the consciousness) is vital.. Patients with CPRIC have a survival advantage, so it is therefore important to deliver optimal CPR. That starts by being aware that CPRIC occurs.. Fair-use copyright disclaimer – No infringements intended. This video is for educational purposes only and not for profit.. Copyright disclaimer under section 107 of the copyright act 1976, allowance is made for “fair use” for purpose such as criticism, commenting, news reporting, teaching, scholarship, and research. Fair use is a use permitted by copyright statute that might otherwise be infringing. Non-profit, educational or personal use tips the balance in favour of fair use.. This video has no negative impact on the original works (it would actually be positive for them). This video is also for teaching purposes. It is not transformative in nature. We only use bits and pieces of videos to get the point across where necessary.. We do not own the rights of these videos. They have, in accordance with fair use, been repurposed with the intent of educating and inspiring others. However, if any content owners would like their content removed, please contact us.
Dr. Conboy challenges the notion that a hospital’s default procedure should be to perform CPR (Cardio Pulmonary Resuscitation) on coding patients. She dives deep into the ethical and personal ramifications of the decision to initiate CPR, considers this procedure and the hospital cultures around it, and asks us to imagine another way that better respects patients. Dr Conboy is Director of Blessing Hospice & Palliative Care and Clinical Ethics for Blessing Health System. Jeri Conboy is Director of Blessing Hospice & Palliative Care and Clinical Ethics for Blessing Health System. She is a licensed social worker in Illinois and Missouri and has earned masters’ degrees in History, Social Work, and Health Care Ethics and a PhD. She has made presentations at state and national conferences and published articles in The Hastings Center Report and NHPCO Newline.. *The ideas presented in this talk are the ideas of the presenter and do not represent the ideas/policies of Blessing Hospital. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx
Public service announcement to promote the new “hands only” guidlines for CPR. Presented by Dr. Juan March, Professor with the Department of Emergency Medicine at East Carolina University, and emergency physician at Pitt County Memorial Hospital.
In this Ten Minute Tidbits, I sat down with friend and associate Joel Green to talk about something controversial: patients waking up during CPR. Is it a good thing or a bad thing? And what does it mean for your patients? Do you have any stories about patients waking up during CPR? Leave your responses in the comments below! http://nicolekupchikconsulting.com/. Facebook: https://www.facebook.com/NicoleKupchikConsultingEducation/. Instagram: @nicolekupchik. ********************************************. The views and opinions expressed on this channel and/or in the videos on this channel are that of myself and not of any educational institution. In compliance with HIPAA and to ensure patient privacy, all patient identifiers in all videos have been deleted and/or altered. The views expressed on this channel and/or in the videos on this channel are personal opinions. The information I present is for general knowledge purposes only.. ********************************************
I saw this video on a ‘doctor group’ and there was a lot of criticism and ridicule being made to the person performing the CPR because you should not do CPR in an awake patient. To the lay person, it might seem as if the patient was being forced to be ventilated and CPR performed.. But…this is totally possible.. I myself had a case very similar to this where the patient would wake up during CPR and push us out of the way. We wound stop CPR and she would collapse and flat line on the monitor. It ended up being a case of hyperkalemia (where the heart cannot beat properly due to the severe electrolyte imbalance).
TUESDAY, June 5, 2018 (HealthDay News) It’s your worst nightmare: As doctors race to save your life while performing CPR, you’re actually awake and conscious of what they are doing. A new report shows it happened for one man for up to 90 minutes, and the finding suggests that sedation during CPR should be contemplated. TUESDAY, June 5, 2018 (HealthDay News) It’s your worst nightmare: As doctors race to save your life while performing CPR, you’re actually awake and. Though rare, awareness during CPR may be more common than many people think. In the 2014 study, 2% of cardiac arrest survivors could explicitly recall “seeing” or “hearing” actual events related.
“Awareness during CPR is an extremely rare event,” Lundsgaard told Healthline, “and was first reported in medical literature in 1989.” He. The AHA’s 2015 guidance that bag-mask ventilation be considered as good as intubation during CPR will likely take years to be accepted in practice, if ever. It’s hard to un-teach Johnny (and Jane). It’s especially hard for us to un-learn our ABCs. Don’t you know they’re your CABs, now?
You probably forgot, because CABs sounds lame. When a patient has an art line in, we typically expect to achieve normal blood pressures. I’ve done CPR on a number of patients who are fully awake while chest compressions are in progress despite having no intrinsic cardiac activity during pulse checks and bedside echo.
It can improve oxygenation and circulation while CPR is being performed. A study of CPR patients in Arizona found that patients who were reported to have gasped after having an out-of-hospital cardiac arrest had better survival rates, especially when given CPR (39% compared to 9% in those who did not gasp). This can lead to long-term health complications.
4. Abdominal Distension: As a result of air being forced into the lungs, the abdomen usually becomes distended (bloated) and full of air during CPR, leading to compression of the lungs (making ventilation more difficult) and an increased chance of vomiting. 5. People without CPR training can perform hands-only CPR by following the steps below.
1. Survey the scene. Make sure it’s safe for you to reach the person in need of help. Cardiopulmonary resuscitation (CPR) can help save a life during a cardiac or breathing emergency. However, even after training, remembering the CPR steps and administering them correctly can be a challenge.
In order to help you help someone in need, we’ve created this simple step-by-step guide that you can print up and place on your.
List of related literature:
When a patient, family member, friend, or stranger stops breathing, his/her heart stops beating, or is found unresponsive, it can be one of the scariest situations of your career.
Early studies in anesthetized, paralyzed humans suggested that the airway would not remain open in the unconscious,” leading to the teaching that airway control and artificial ventilation must accompany chest compressions.
from Clinical Anesthesia by Paul G. Barash Wolters Kluwer/Lippincott Williams & Wilkins, 2009
If a pulse is not present after opening the airway and ventilating the patient or is absent after checking for up to 1 minute, cardiopulmonary resuscitation (CPR) is begun.
If a lone health care rescuer responds to suspected asphyxia or respiratory-related cardiac arrest (e.g. immersion or drowning), it is still reasonable for the health care rescuer to provide 2 minutes of CPR before leaving the victim alone to activate EMS.
If an unresponsive patient has a pulse, but is not breathing (or has only agonal gasps), you must open the airway manually to provide rescue breathing.
Pediatric patients who are both apneic and without pulse, or apneic and unresponsive to rescue breathing are designated as Black and considered deceased or expectant deceased.
With the advent of effective cardiopulmonary resuscitation (CPR) techniques and mechanical ventilation, a person could be resuscitated and ventilated successfully, maintaining a heartbeat while yet exhibiting complete unresponsiveness, absence of spontaneous respirations, and fixed and dilated pupils.
Little did I know at the time that this first experience with simulation would be the reason I would be able to save one of my actual patient’s life by performing that exact procedure during my first year of practice when my patient’s airway became completely obstructed during an attempted awake fiberoptic intubation.
The transferred patient’s conscious state will vary from fully anaesthetised, to semi-conscious (with the possibility of an unprotected airway), to awake and alert.
Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.
Hi Joel it’s your former minion. I remember a code we had wherein the patient was doing the ‘zombie arm’ and opening eyes and I distinctly remember our doc that bemoaning “I cannot believe I’m considering giving propofol during a code”. Obviously not the best drug in that situation but probably the most available. Ketamine would be ideal, amnestic and analgesic with a very fast onset, short duration and an advantageous hemodynamic profile. Probably would have to be sent up from pharmacy if you’re on a unit though, not ideal but something to consider for an RSI kit if your facility is willing to put a controlled substance in it.
Yes absolutely that has happened. Like you said they are actually getting cardiac output but everytime we stop CPR he is pulselss. The delima is when do you stop CPR. Of course this was before HMC ECMO program. The code went on for an hour. I finally asked the team to use the US to ECHO his heart and he had no squeeze and the code was called.
I appreciate the effect of versed. Either that or an equivalent. Of all the procedures I’ve stood by with BMV, the amnesiac component I think would prevent PTSD to the survivor.
Wow, I have never seen anything like this. Thank you so much for explaining. So flipping interesting. I love learning about all the different illnesses, treatments, and various symptoms etc…..
OMG I didn’t know you have to turn the bell on. I feel really dumb now but I didn’t turn on the other bells on the other channel. Anyway I am excited that I will get notifications.
Yes, had+ seen a few patients wake up during compressions. My question is, how many people clearly remember getting CPR? I’ve heard some patients recall bits and pieces. The vast majority of my patients who are able to speak at some point post CPR do not have a memory of resuscitation events. Anecdotal, would be interesting to study this. Perhaps these memories are repressed and could later come out, or contribute to PTSD as Nichole said. With quicker response times and a movement towards high quality compressions, I do appreciate that healthcare teams are seriously considering sedation (whether it should or shouldn’t be done, I dunno, but it’s great that it’s being examined.)
If the patient survives to a high level of functioning, I’d also like to point out the importance of the near death experience that some folks have. NDEs seem to be hugely impactful on the lives of those who experience them. But, who’s to say that versed would necessarily sedate or prohibit the actual NDE from happening?
Hi Joel it’s your former minion. I remember a code we had wherein the patient was doing the ‘zombie arm’ and opening eyes and I distinctly remember our doc that bemoaning “I cannot believe I’m considering giving propofol during a code”. Obviously not the best drug in that situation but probably the most available. Ketamine would be ideal, amnestic and analgesic with a very fast onset, short duration and an advantageous hemodynamic profile. Probably would have to be sent up from pharmacy if you’re on a unit though, not ideal but something to consider for an RSI kit if your facility is willing to put a controlled substance in it.
Yes absolutely that has happened. Like you said they are actually getting cardiac output but everytime we stop CPR he is pulselss. The delima is when do you stop CPR. Of course this was before HMC ECMO program. The code went on for an hour. I finally asked the team to use the US to ECHO his heart and he had no squeeze and the code was called.
I appreciate the effect of versed. Either that or an equivalent. Of all the procedures I’ve stood by with BMV, the amnesiac component I think would prevent PTSD to the survivor.
Wow, I have never seen anything like this. Thank you so much for explaining. So flipping interesting. I love learning about all the different illnesses, treatments, and various symptoms etc…..
OMG I didn’t know you have to turn the bell on. I feel really dumb now but I didn’t turn on the other bells on the other channel. Anyway I am excited that I will get notifications.
Yes, had+ seen a few patients wake up during compressions. My question is, how many people clearly remember getting CPR? I’ve heard some patients recall bits and pieces. The vast majority of my patients who are able to speak at some point post CPR do not have a memory of resuscitation events. Anecdotal, would be interesting to study this. Perhaps these memories are repressed and could later come out, or contribute to PTSD as Nichole said. With quicker response times and a movement towards high quality compressions, I do appreciate that healthcare teams are seriously considering sedation (whether it should or shouldn’t be done, I dunno, but it’s great that it’s being examined.)
If the patient survives to a high level of functioning, I’d also like to point out the importance of the near death experience that some folks have. NDEs seem to be hugely impactful on the lives of those who experience them. But, who’s to say that versed would necessarily sedate or prohibit the actual NDE from happening?
Great topic. ����
Nice summary! I’ve seen this happen a few times. We need to keep compressing not stopping and rhythm checking every few seconds!