“What Should Resuscitation Look Like in 2024?”

A talk by David Stanton - Summarised

Listening this evening to an awesome talk given by David Stanton on the following topic:

“What Should Resuscitation Look Like in 2024?”

The information shared was so important, and so pertinent to the clinical environment in South African practice that I couldnt help but post something sharing the learning I took away - maybe there is something here for others to learn from too!

Basically - good resuscitation is not as difficult to get resuscitation right as we seem to think. The basics are still the only things proven to work - so spend time on getting these things right!

Major Takeaway Points:

1. Resuscitation Appropriateness:

Resuscitation efforts should be focused on patients who are likely to benefit from it, rather than attempting CPR on individuals for whom it is unlikely to change the outcome, such as those on a frailty or terminal illness trajectory.

2. End-of-Life Considerations:

Healthcare providers need to have mature conversations with patients and their families about end-of-life decisions, recognizing that CPR is not always appropriate for natural dying processes.

3. Guidelines and Systems:

Effective resuscitation requires adherence to well-established guidelines, which have become more globally standardized through organizations like ILCOR. Hospitals should have systems in place to prevent in-hospital cardiac arrests and ensure high-quality resuscitation practices.

Key Interventions in Resuscitation

Three critical interventions significantly impact survival in cardiac arrest:

1. High-quality chest compressions (correct rate, depth, and minimal interruptions).

2. Prompt defibrillation for shockable rhythms.

3. Identifying and reversing the underlying cause of the cardiac arrest.

Teamwork and Training is also very important to get the major interventions done correctly:

High-performance resuscitation teams require regular training together, ideally in their actual work environment, to ensure smooth operations and adherence to guidelines during real emergencies.

Prioritized Actions for Healthcare Providers in Cardiac Arrest:

1. Focus on High-Quality Chest Compressions:

Ensure compressions are done at the correct rate (100-120/min), depth (5-6 cm), and with minimal interruptions. This should be the priority as it is crucial for patient survival.

2. Defibrillation for Shockable Rhythms:

If the patient has a shockable rhythm (VF/VT), deliver shocks promptly and ensure effective defibrillation, which is indicated by the rhythm converting to asystole briefly post-shock.

3. Search for Reversible Causes:

Quickly assess and address potential reversible causes of the arrest, such as hypoxia, hypovolemia, tamponade, and tension pneumothorax.

4. Proper Documentation and Communication:

Ensure that all resuscitation efforts, decisions, and end-of-life care preferences are well-documented and communicated clearly to all involved parties.

The learning I took away:

1. CPR is Not for Everyone!

CPR should not be administered as a routine intervention for patients expected to die due to natural disease progression. This aligns with ethical considerations and respects the patient’s end-of-life wishes.

2. Systemic Improvements:

Hospitals and prehospital systems should focus on improving systems that prevent in-hospital cardiac arrests, including regular training and quality improvement measures to ensure all staff are proficient in the latest resuscitation techniques.

3. Use of Technology:

New tools such as CPR feedback devices and ultrasound are becoming integral in managing resuscitations, helping to maintain high-quality compressions and diagnose underlying causes during resuscitation.

4. Global Collaboration and Local Adaptation:

Guidelines are increasingly standardized globally, but local adaptations, especially in developing countries, are necessary to address specific resource limitations and patient needs.

5. End-of-Life Education:

There is a need for more education and awareness around the importance of end-of-life care, including when to opt for palliative care over aggressive resuscitation efforts.

This is a summary of a talk delivered and prepared by David Stanton for Netcare Waxing Clinical - 28 August 2024