Targeted temperature management (TTM), Therapeutic hypothermia, Post-cardiac arrest resuscitation care
Ryde Station's insight:
Although we don't actively cool cardiac arrest post ROSC in NSW Ambulance, it is always good to stay ahead of what is current best practice. Whilst some early data showed good improvements in outcomes from cooling to 32 degrees, and particularly with the prehospital activation of the cooling, two recent large and rigorous RCT's have shown no benefit to cooling to this range. The new paradigm is targeted temperature management to 36 degrees, and the avoidance of higher temperature ranges.
NSW ambulance interventions to achieve a SBP>100 post ROSC are boluses/infusion of adrenaline. This article highlights that not pursuing this endstate as part of our post cardiac arrest care can lead to lower survival rates.
START Second Tier Arrest Response Trial START is a six-month feasibility study exploring the operational and logistical opportunities and challenges for new technologies in Out-of-Hospital Cardiac ...
Ryde Station's insight:
The training package for the Second Tier Arrest Response Trial can be found here, whilst in theory it runs in a radius from the bankstown HEMS base, the Road Retrieval crews range around so we may find ourselves getting backed up by them on a 1A. Regardless, there is some great info in here on the mechanics and theory behind some of the most important concepts in prehospital managment of cardiac arrest. The mechanical CPR devices are being assessed in the trial, but what is really important here are getting the basics right, as they are the factors that have evidence to show their benefit in cardiac arrest. I strongly reccomend having a good read through this resource.
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