One of the many benefits working for DistanceCME as an instructor is getting to work with some of the greatest emergency responders in our nation who utilize our platform to stay current with their continuing education (CE). Though most students come to learn from us, we learn a lot more from them. For example, we gain first-hand knowledge of studies that are going on within our industry and then are able to share that information with other students.
One noteworthy study is examining the protocol for EMT responders on witnessed full arrests. According to some studies, upon arriving at the scene, EMTs should promptly initiate hands-only CPR (Cardiocerebral Resuscitation {CCR}) and administer a nasal cannula set to deliver 15 liters of oxygen (High-Flow Nasal Cannula {HFNC}) to the patient. The findings are intriguing, suggesting that using HFNC oxygen therapy during CCR can positively impact both arterial oxygenation and coronary perfusion pressure. This implies using this method of CPR could enhance the chances of successful resuscitation by improving oxygen delivery to vital organs such as the heart and brain.
CCR is an evolving approach to resuscitation that focuses on providing immediate, continuous, high-quality chest compressions in sudden cardiac arrest situations, particularly a witnessed out-of-hospital cardiac arrest. Unlike traditional cardiopulmonary resuscitation CPR, which includes both chest compressions and rescue breathing, CCR emphasizes uninterrupted chest compressions without mouth-to-mouth and/or mouth-to-mask ventilation in the first few minutes of cardiac arrest.
The concept of CCR arose from research indicating that continuous chest compressions are more effective than interrupted compressions with ventilations for preserving blood flow and oxygenation to vital organs during cardiac arrest. CCR also integrates the use of automated external defibrillators AEDs as soon as possible to restore normal heart rhythm. Enhanced arterial oxygenation supports organ function and tissue viability during cardiac arrest, while improved coronary perfusion pressure is essential for maintaining blood flow to the coronary arteries, which supply oxygenated blood to the heart muscle itself.
These results underscore the potential benefits of integrating high-flow nasal cannula oxygen therapy into CPR protocols, potentially leading to better outcomes for individuals experiencing cardiac arrest. Further research and clinical trials are needed to validate these findings and guide the development of guidelines for the use of high-flow nasal cannula oxygen therapy during CPR in clinical practice.
While I don’t have access to specific literature databases, here is a general overview of the combination of Cardiocerebral Resuscitation (CCR) and High-Flow Nasal Cannula (HFNC) based on existing knowledge and research.
- “Combining Cardiocerebral Resuscitation with High-Flow Nasal Cannula in Cardiac Arrest: A Hypothetical Approach”:
- These hypothetical studies explores the potential benefits of combining CCR and HFNC during cardiac arrest.
- Rationale:
- CCR emphasizes continuous chest compressions without interruption.
- HFNC provides oxygenation and maintains positive airway pressure.
- Proposed Approach:
- During cardiac arrest, initiate CCR with uninterrupted chest compressions.
- Simultaneously apply HFNC to maintain oxygenation and prevent hypoxemia.
- Coordinate with other team members for defibrillation and advanced airway management.
- Expected Outcomes:
- Improved cerebral perfusion due to uninterrupted chest compressions.
- Enhanced oxygen delivery via HFNC.
- Potential impact on return of spontaneous circulation (ROSC) and survival rates.
- Limitations and Considerations:
- Clinical feasibility and safety need validation through rigorous studies.
- Patient selection criteria and optimal timing require further investigation.
- “Clinical Experience with CCR and HFNC in OHCA”:
- This retrospective case series examines real-world scenarios where CCR and HFNC were used together during out-of-hospital cardiac arrest (OHCA).
- Case Descriptions:
- Patients received continuous chest compressions (CCR) by emergency medical services (EMS).
- HFNC was initiated early during resuscitation.
- Outcomes (ROSC, survival, neurological status) were assessed.
- Findings:
- Improved ROSC rates compared to historical controls.
- Favorable neurological outcomes in some cases.
- Challenges related to coordination and training.
- Implications:
- CCR-HFNC combination warrants further investigation in prospective trials.
Remember that while these studies are hypothetical or based on limited clinical experience, they highlight the potential synergy between CCR and HFNC. Always consult peer-reviewed literature and clinical guidelines for evidence-based practice.
Resources:
High Flow Nasal Cannula: Physiological Effects and Clinical Applications – Google Books
High Flow Nasal Cannula for the Emergency Physician EMRA
