Ep 169 Cardiac Arrest Controversies – Chest Compressions, Dual Defibrillation, Medications and Airway

In this first part of our 2-part series on Cardiac Arrest Controversies, Rob Simard, Bourke Tillman, Sara Gray and Scott Weingart discuss with Anton how best to ensure high quality chest compressions, the pros and cons of mechanical CPR, the literature on dual sequential defibrillation and optimizing pad placement, epinephrine vs vasopressin, amiodarone vs lidocaine, when to consider IV calcium and sodium bicarbonate, esmolol, airway considerations, sedation in cardiac arrest, the pros and cons of end-tidal CO2 and much more...



Podcast production, sound design & editing by Anton Helman

Written Summary and blog post by Anton Helman May, 2022

Cite this podcast as: Helman, A. Gray, S. Weingart, S. Tillmann, B. Episode 169 - Cardiac Arrest Controversies: Chest Compressions, Dual Defibrillation, Medications and Airway. Emergency Medicine Cases. May, 2022. https://emergencymedicinecases.com/cardiac-arrest-controversies-chest-compressions-dual-defibrillation-medications-airway. Accessed [date]

Go to part 2 of this 2-part podcast on cardiac arrest care

Previously on EM Cases....

Episode 71 ACLS Guidelines 2015 - Cardiac Arrest Controversies Part 1

Episode 72 ACLS Guidelines 2015 - Post Arrest Care

EM Quick Hits 27 Bicarb in Cardiac Arrest

A New Frontier in Cardiac Arrest Management with Salim Rezaie Video from EMU Conference

Journal Jam 14 Epinephrine in Cardiac Arrest

Episode 96 Beyond ACLS Cardiac Arrest Video from EMU Conference

Journal Jam 7 Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest - ALPs Trial

Episode 131 PEA arrest, PseudoPEA and PREM with Rob Simard and Scott Weingart

Best Case Ever 73 Esmolol in Refractory VF

Maximizing high quality chest compressions in cardiac arrest

Perhaps the most important aspect of cardiac arrest care is providing high quality chest compressions with a depth of at least 5 cm (but no more than 6 cm), a rate of between 100 and 120 compressions per minute, allowing full chest recoil between compressions and minimizing interruptions. The goal is near continuous compressions that pause only for defibrillation and brief pulse checks. Good neurologic outcomes after out-of-hospital cardiac arrest (OHCA) correlates well with target ranges of chest compression rate and depth.

Strategies to ensure high quality chest compressions and minimize pauses in chest compressions



Feedback monitor devices for rate, depth and recoil of compressions

Metronome for rate of compressions (smartphone metronome is a “poor person’s” feedback monitor device)

Dedicated chest compression coach (note that chest recoil is difficult for the coach to assess)

Changing chest compressors every 2 minutes (even fit chest compressors tire...