The State of Cardiac Resuscitation: It’s about the BLS

If an EMS system wanted to improve their survival rate for out-of-hospital cardiac arrest, the most important things they can do are at the BLS level. Not to say there isn’t a place for ALS, but it’s all about the BLS. (Insert Meghan Trainor music here.)

As we anxiously await the 2015 AHA guidelines being released on October 15th, 2015 there are a few things that seem to be trending. Here are five of our picks:

1.  Compressions are king

It appears that the most important thing we can do is compress. It appears to be the single most important thing we can do to improve survival. We were taught to push hard, push fast in 2010. The 2015 version of this has evolved to High Performance CPR (HP CPR) or a “Pit Crew” approach. The Resuscitation Academy  is a great place to learn more.

2. Don’t forget defibrillation

With all the talk about compression we mustn’t forget about defibrillation. It doesn’t seem like we can come to consensus on whether CPR is necessary before defibrillation. Many systems say yes—especially if it is a longer or unknown down time.

3. So many protocols, so little time

The days when everyone in EMS did the same CPR is over. There are many variations in CPR and the jury is out on which is best. One trend is emerging consistently—compressions may be more important than ventilations in the first few minutes. Minimally Interrupted Cardiac Resuscitation (MICR) is one of those trends. It often involves between 2 or more minutes of compressions without ventilations. In some places the patient is placed on an oxygen mask or cannula to provide some passive oxygenation.

4. Too much oxygen is (still) bad

We fought this for a long time. While many of us have come to accept the change, there are still holdouts. Not only do EMS providers need to know this to deliver the best patient care, they also need to know this to pass the NREMT. The days of the universal NRB are gone. This article by EMS1.com columnist Mike McEvoy explains why.

5. You need to stay cool—not cool your patient

It seems that prehospital cooling (induced therapeutic hypothermia) after return of spontaneous circulation is losing favor in EMS. We believe this is for two reasons. The first is that it hasn’t been shown as beneficial in research. The second is that we believe there are better things we could be doing with our personnel like monitoring our patients carefully at a very critical time. Dr. Bryan Bledsoe offers his take in this article.

There are certainly more things going on. Mechanical CPR, when we should terminate resuscitation (hint: some say we aren’t trying long enough) and more.

We hope you found these interesting. We’d love to hear you thoughts—and what your system is doing. Do you have any guesses on what the AHA will recommend later this year?  Questions available for public comment are available here.