RIALTO’S RESUSCITATION TOOLKIT
Although the RFD hasn’t found a definitive indicator that heads-up CPR is providing
increased circulation, the same improvement
in EtCO2 has been seen in those patients who
subsequently achieve ROSC when heads-up
CPR is initiated immediately after the placement of the ITD.
After heads-up CPR was added as a sur-
vivability tool, RFD crews found that many
patients who eventually achieved ROSC were
noted to gasp or provide patient-initiated ven-
tilation attempts within a short period of time
after heads-up CPR was initiated. The gasping
response hasn’t been historically documented
and is an anecdotal corollary finding. It may not
be caused by heads-up CPR; however, during
heads-up CPR, gasps have been observed along
with a discernable capnography waveform.
One of the links in the chain of survival is
early defibrillation. Matching national data,
24% of RFD patients have an initial presenting rhythm of v tach or v fib, the two classic
shockable rhythms of cardiac arrest.
The RFD provides early defibrillation to
patients in shockable rhythms whenever possible. Unfortunately, the arrival of responders
may occur after the window in which defibrillation will result in ROSC has closed.
There are three clinical findings that sug-
gest the patient is outside the window for early
defibrillation such that defibrillation may not
be successful: 1) prolonged patient downtime
in cardiac arrest; 2) very fine v fib (barely dis-
tinguishable from asystole); 10 and 3) an EtCO2
reading of less than 20 mmHg. 11 Patients
with these clinical findings are acidotic and
have hearts that are less receptive to electrical
therapy. Before defibrillation, these patients
require high-quality CPR to increase perfu-
sion, correct hypoxia and resolve the acidosis.
For patients who meet one or more of the
three clinical findings for deferred defibril-
lation, the RFD goal for this survivability
tool is to implement the four previous tools
(continuous, uninterrupted compressions
utilizing an automated CPR device; apneic
Rialto Fire Department’s goal for automated CPR delivery is to initiate and maintain continuous, uninterrupted compressions as soon as possible after patient contact.
Once the automated CPR device is in place, crews quickly move the patient to the gurney and then raise the head/shoulders to a 30-degree angle.