This site has been taken down for viewing. This is due to its violation of the terms of service or program policies. The content is blocked from being served1.1 High Quality CPR – Adult

Only for arrests of Cardiac etiology.  For primary respiratory etiology, ventilate immediately as part of CPR.

• Perform 2 minutes cycles of uninterrupted chest compressions

• Interrupt chest compressions only after each 2 minute cycle

• Follow current AHA/ILCOR recommendations for cardiac arrest management.

FR/EMT STANDING ORDERS

• 1.0 Routine Patient Care -with focus on HQCPR

• Immediate chest compressions at a rate of 100-120 per minute

• Use AED as soon as possible with minimal interruption of chest compressions

• Continue 2 minute cycles of uninterrupted chest compressions followed by 

      AED analysis and shock for 4 cycles (8 minutes)

• Place an oral or nasal airway

• Ventilation / oxygenation options during 4 cycles (8 minutes):

      o BVM ventilation during recoil and without interrupting compressions, OR

      o If part of a care bundle, apply high flow oxygen via NRB

• After 4 cycles (8 MINUTES):

 o Continue 2 minute cycles of uninterrupted chest compressions

        o If passive insufflation was used, switch to BVM ventilation.  

        o If trained and authorized consider supraglottic airway placement.

    ADVANCED EMT STANDING ORDERS 

∙ Consider placement of a supraglottic airway device

• Place IV/IO without interrupting chest compressions

PARAMEDIC STANDING ORDERS

• If utilizing a BVM, monitor quantitative waveform capnography throughout resuscitation to assess CPR quality and to monitor for signs of return of spontaneous circulation (ROSC)

• Provide manual defibrillation as indicated after each 2 minute cycle

• After 4 cycles (8 minutes):

O         Consider endotracheal intubation or use an alternative airway without interrupting chest  

    compressions

• If authorized and trained by AHMD, Paramedics may use mechanical ventilators in  

    rate control mode with the following settings: 

• Rate of 8-12 breaths per minute

• Tidal volume 300-500mL 

• Start at FiO2 1.0 (100%) then titrate to maintain SpO2  > 94% (90% for COPD   

       patients)

• Relief pressure 45-60 cmH2O

Paramedics may utilize a mechanical ventilator following the initiation of respiratory component at least 8 minutes after start of resuscitation even if ROSC has occurred. 

PEARLS:

• It is expected, unless special circumstances are present, initial 8 minutes of resuscitation will be                    performed on scene.

• Early CPR and defibrillation are the most effective therapies for cardiac arrest care.

• Minimize interruptions in chest compression, as pauses rapidly return the blood pressure to zero            and stop perfusion to the heart and brain.

• Recognizing the goal of immediate uninterrupted chest compressions, consider delaying application of mechanical CPR devices until after the first four cycles (8 minutes).  If applied during the first 4 cycles, the goal is to limit interruptions.  Mechanical devices should only be used by services that are practiced and skilled at their application.

• Switch compressors at least every two minutes to minimize fatigue.

• Perform chest compressions while defibrillator is charging and resume compressions immediately after the shock is delivered.