Many moons ago it was common practice that as soon as we had a pulse back from an arrested patient we would throw them in the ambulance and drive fast to hospital with little, if any, further management…
This has changed and now there are a number of goals we try to achieve prior too and during transport. This podcast is about the management of the post-arrest patient and why we do what we do in these situations.
I hope you enjoy it and as always feedback is appreciated.
AmboFOAM 
Reblogged this on PHARM.
Rob, listened to these two “cardiac arrest” podcasts and the “human factors” (tips for new ambos pt 3) podcast this evening on drive up from Kangaroo Island to the mainland.
Can I say, well done!
As a simple cuntry doctor, I found your explanations and discussion easy to follow and as relevant for me in the small rural ED as it is at the roadside.
Some great tips and pearls in these talks.
Whatever you do, don;t stop podcasting. We need to work on clearing up your sound quality 9as do I) and perhaps getting ’em onto iTunes, but this is all ‘good shit’
Please carry on….
Great work Rob!
It is critically important to be taking people who are post-cardiac arrest and whose ABC’s are OK straight to the cath lab for PCI bypassing ED or even bypassing a non-cath lab hospital, or let me put that another way, going straight to the cath lab hospital even if they have an ABC problem you can manage on the way. We know from major trauma there is no (or little) role for “stopping” en-route to a trauma centre unless the patient has a life threatening problem that cannot wait until they get to the major trauma centre. Same deal here; RSI them and take them straight to a cath lab.
Here in New Zealand such is a massive challenge outside of Metropolitan Auckland; cath lab hospitals are often many hours apart (Rob I know you know this but lots of places are thrombolysis and transfer only … Whangarei has no cath lab, neither does Palmy North, I do not think Hawkes Bay does (apologies if I am wrong Craig Ellis!)). This means you are forced by default to go to the local hospital and transfer the patient out usually by air. Now this opens up a whole possibility of thrombolysis and direct-to-transfer (bypassing the hospital) in the pre-arrest phase but it makes post-cardiac arrest management a bit tricker. I am significantly jealous of my days in the USA when there was a cath lab on every second corner and on the alternate corners was a major trauma centre!
It’s interesting you mention ambo initiated therapeutic hypothermia; I will have to review the evidence for this. The latest I heard was the RINSE trial and the results weren’t statistically significant in favour of TH.
Cheers mate, keep it up!
Thanks for the comments Ben.
You’ll find towards the end of this podcast, specifically the section on therapeutic hypothermia (TH), I mention that there is no evidence that prehospital initiation of cooling confers any benefit over in hospital cooling. However, patients were more likely to be cooled in hospital if cooled in the field and we felt that this was still going to be of benefit to the patient in the long run, hence continuing with the procedure. This was the result of the RICH trial (http://circ.ahajournals.org/content/122/7/737.full)
The RINSE trial which is examining therapeutic hypothermia intra-arrest rather than post-arrest is ongoing, and to the best of my knowledge no interim data has been released. This is also true of the CHEER study which is looking at the feasibility of TH, ECMO and PCI in refractory out of hospital arrest in certain populations.