Manual pressure augmentation in OHCA - David Anderson - TBS24
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This document summarizes a presentation on manual pressure augmentation (MPA) for out-of-hospital cardiac arrest. MPA involves a paramedic applying firm, even pressure over electrode pads or paddles during defibrillation attempts to potentially improve current delivery to the heart. The presentation reviewed prior studies showing MPA improved defibrillation success for atrial fibrillation. It proposed a new study called AUGMENT-VA to evaluate if MPA could also benefit patients in ventricular fibrillation/ventricular tachycardia. The trial would randomize paramedics to provide standard care or MPA in addition to standard care during cardiac arrest resuscitation efforts, with the goal of improving survival to hospital discharge rates.
Manual pressure augmentation in OHCA - David Anderson - TBS24
- 1. MANUAL PRESSURE AUGMENTATION David Anderson MStJ MBChB FCICM Medical Director - Ambulance Victoria Intensivist – The Alfred ICU Adj. Assoc.Prof. - Monash Paramedicine @expensivecare In Out of Hospital Cardiac Arrest Lead Investigators: Alex Voskoboinik Ziad Nehme Dion Stub
- 3. 227,444 km2 41,285 km2 1 million calls/year 5000 paramedics 7800 cardiac arrests/year 500 critical care paramedics
- 5. VACAR 2022
- 6. VACAR 2022 *Average Patient: • 64 years old • Cardiac aetiology • Arrests at home • 9.2 min response time • Bystander witnessed • Bystander CPR • Shocked first by paramedics Probability of Surviving Cardiac Arrest for the ‘Average’ Patient*
- 8. Young, Anaes & ICM, 2021
- 12. Why use MPA? Squara, Heart Rhythm, 2021
- 13. Why use MPA? Ramirez, Europace, 2019
- 14. MPA for AF in Obese Patients Voskoboinik, JCE, 2019 Paddles > Pads 30% DCCV success rate MPA > Paddles 80% MPA success rate VC No difference
- 16. “Alex - Great study in AF…. Imagine what we could do for patients in VF/VT”
- 17. Potential Benefits of MPA in VF/VT ↓ Lung volume ↓ Transthoracic Impedance ↑ Current to heart
- 18. Routinely used in many hospitals for cardioversion in AF No reported serious adverse events in clinical practice or literature. Is MPA safe?
- 20. Stephens, Resus Plus, 2022
- 21. Voskoboinik, Resus, 2022 59Ω 1 60Ω 2 49Ω +MPA 3 No perceptible current felt by paramedics
- 22. The AUGMENT-VA Trial P Adults in VF or VT I MPA C Standard ACLS O Survival to Hospital Discharge
- 23. Standard care (BLUE TEAM) How did we randomize? MPA Standard MPA (RED TEAM)
- 24. How do we perform MPA? Clenched fist Heel of palm
- 26. Paramedic Experience 96 Paramedics surveyed Perceptible current?: 1/96 Would you use it again?: 96/96
- 27. Recruitment…😬
- 28. The Age, 2023
- 29. Image: National Museum of American History
- 31. Cheskes, NEJM, 2022 Richardson, SJTREM, 2023 Moore, Resusc, 2022 ? ?????? ?????? ?????? ?????? ?????? ?????? ??????