Welcome to the CPR/AED re-certification for 2025

Objectives

The objective of this refresher training is to provide personnel with material that meets the annual re-certification requirements for MIEMSS EMT/ALS certifications and/or licenses.  

The material in this presentation must be reviewed in its entirety before demonstrating the following skills with a CPR  Instructor: Adult 1 & 2 Rescuer CPR; use of AED, BVM, and Lucas.  The skills may be accomplished using the "Pit Crew" model as long as providers rotate through all positions during scenarios.  All providers must play the initial responder role, performing the initial assessment at least once.  Supervisors must document skill verification via MCFRSIT.

After a review of the material contained herein, personnel are expected to take and pass an exam with an accuracy of at least 80%. 

High Performance CPR (HPCPR)

Why HPCPR?  When coupled with Code Resource Management (CRM), has shown to improve survival rates for sudden out-of-hospital cardiac arrests (OHCA).  The MCFRS approach includes utilizing the Pit Crew Approach, the LUCAS device, and the Handtevy App to optimize resuscitation efforts. 

Clinical OHCA PEARLS

• For patients 1 hour old to adult, the goal of HPCPR is continuous, uninterrupted compressions. 

• DO NOT STOP HPCPR for: 

  • AED application,

  • AED pad placement associated with Vector Change or DSED

  • Removal of clothes,

  • ALS interventions

• Pulse Checks should be less than 10 seconds

• Ventilations should be given during the recoil (upstroke) of a compression 

• If using the LifePak, the CPR Boss should ensure that the LifePak is “pre-charged” approximately 15 seconds before the Pulse Check.  

HPCPR Contraindications

• Less than 24 hours old;

• Meets criteria for Pronouncement of Death in the Field protocol

Adult (>13 years old)

• Compression Rate: 100-120 per minute 

• Compression Depth: 2 to 2.4 inches 

• Ventilate every 10th compression during recoil/upstroke 

  • Adult (13 years or older) if advanced airway in place, asynchronous ventilations every 6 seconds 

Pediatric (1hr to 13 years old)

• Compression/Ventilation ratio 

  • 30:2 for single rescuer, 

  • 15:2 for two or more rescuers;

• Compression rate: 100-120 per minute

• Compression depth; 

  • • If greater than 1 year old up to 13 years old: 2 inches

    • If less than 1 year: 1.5 inches

• Ventilation

  • Pediatric (1 hour to 13 years old) if advanced airway in place, asynchronous ventilations every 3 seconds

Reference: 2024 Maryland Medical Protocols (MMP) p. 283-286 

Return of Spontaneous Circulation (ROSC)

• Refer to the ROSC protocol of the Maryland Medical Protocols (MMP) for patients that have been revived 

Reference: 2024 Maryland Medical Protocols (MMP) p. 52-53 

Lucas© (Mechanical CPR)

Contraindications

• Less than 13 years old

• LVAD patients

Best Practices

• May not apply until AFTER two 2-minute cycles of HPCPR. (Remember, the goal is for hands on the chest ASAP with a choreographed application of the LUCAS over two cycles.) 

• The following ensures pulse checks remain less than 10 seconds: 

  • First 2 minutes: Manual Chest Compressions 

  • Second 2 minutes: Backplate positioned under the patient during pulse check

  • Third 2 minutes: LUCAS device deployed

• If ROSC is achieved, the LUCAS device should remain in place during transport in the case the patient experiences a re-arrest.  

Reference: 2024 Maryland Medical Protocols (MMP) p 394-395 

Click here to be taken to the training video site for the LUCAS 3 (the newest device being purchased by some LFRDs). Choose the Pre-hospital video. 

Click here to be taken to the training video site for the LUCAS 2.  

Termination of Resuscitation (TOR)

Contraindications

• Arrest secondary to submersion or hypothermia;

• Pregnant

Pediatric TOR (<18 years old non-traumatic; <15 years old traumatic)

• BLS clinicians may not terminate for pediatric medical arrest

• BLS clinicians may terminate for pediatric trauma arrest if ALS resources generally not available and patient has received minimum of 15 two-minute cycles of HPCPR and during the five AED analyses immediately prior to TOR there was no shock indicated

Reference: 2023 Maryland Medical Protocols p. 53

Pronouncement of Death

Indications

• Decapitation;

• Rigor mortis;

• Decomposition;

• Dependent lividity;

• Pulseless, apneic in MCI where system resources required for stabilization of living patients;

• Pulseless, apneic with injury not compatible with life (except in case of obviously pregnant female, who should be resuscitated and transported to nearest appropriate facility);

• Provider has initiated TOR protocol

Reference: 2023 Maryland Medical Protocols p. 60

AED

Highlights

• Turn it on;

• Perform compressions while charging;

• Hover hands over chest during defibrillation-ready to restart compressions;

• No pulse check right after defibrillation-immediately continue chest compressions;

• If "no shock advised" after 2 minute cycle, check pulse for less than 10 seconds-if none, continue CPR

Contraindications

• Newly born (up to 1 hour after birth)

• Patient exhibiting signs of life

Watch the following video.  Note-they are not performing HPCPR, viewing is simply to review AED use.

Reference: Maryland Medical Protocols  p. 270

Clinical Practice Guidelines (NEW!)

Pregnant patients in cardiac arrest

• If a patient is more than 20 weeks pregnant.

• After the floor of care is established, the patient should be transported!

• In this order:  CPR, AED/defibrillation, mechanical CPR, Uterine Displacement, Ventilation and Airway, Treating reversible causes.

• Early Emergency Department notification is crucial (not Suburban).

• Expect to hold uterine displacement until patient transfer to definitive care.

Vector Change

• If a patient is in Ventricular Fibrillation (VF) and receives more than 3 defibrillation attempts.

• A second set of AED pads for the next defibrillation will be placed in an Anterior/Posterior position.

  1. • Adding the second set of pads will be done in a 10 sec pulse-check window.

     • Pre-plan placing the second set of pads and communicate the plan! 10 secs is a very short window of time!

Narcan

• We no longer give Narcan in cardiac arrests.

• Even in the case of known opioid overdose.

  1. • Narcan fixes their respiratory drive --> So does your BVM!

• Expect to use a BVM instead of Narcan.

Reference:  MCFRS Clinical Practice Guidelines

Reference: https://www.miemss.org/home/Portals/0/Docs/Guidelines_Protocols/MD-Medical-Protocols-2024-Web-20240612.pdf#page=295