AED

It was only a few months ago, during a rather heated debate on how to utilize the Lifepack 15 monitors, and during a cardiac arrest, that I had a learning moment. The medical directors were coming to a consensus, after reviewing a code stat that was utilizing the AED mode. The code was showing prolonged analyzing times, ridiculous times off the chest, (in fact one pause was over a minute and a half). This seemed unexplainable.

We felt the AED mode was making the codes more difficult and knew that, as ED physicians, we were all only using the manual mode. I have always said that I would never ask a medic to do something wouldn’t do. As we were ready to toss the Analyze button (the button you press to go into AED mode) into the trash bin, Don Zimmerman spoke up.

He explained the AED mode as another tool for the frontline providers to use and did not want to take any tool away from the providers. He put together a program that detailed the use of the Lucas, or Lifepack 15, video that guided intubation equipment and IOs. He then asked to evaluate a very busy department to compare the code stats before and after training. He picked Shaker Fire Department and trained each shift.

In the May meeting, he compared the department code stats from January to their May code stats. The real-time data was significantly improved. In fact, the code stat that really stood out was a 24-minute resuscitation that was analyzed 13 times and each time was less than 10 seconds. I believe one was just over 10 seconds. The code was run perfectly with the use of the Analyze AED mode. I was so impressed that I now plan on using this in the ED.

The advantage to AED mode includes rechecks every two minutes, auto charging and advancing energy levels without fumbling with the buttons. Returning to manual function is as simple as hitting the home button. Silencing the metronome ticking can be done by pressing the CPR button.

I understand that many of you utilize different monitor platforms, but the Lifepack 15 remains the method in which we receive the most data. We have been able to identify causes of delays in compressions, defibrillations as well as longest times off the chest in cardiac arrest. It is amazing that every time Don and I give this lecture, we learn something else about Code Stat.

Bullet Points from the lecture:

1. Get on the chest as soon as possible with manual CPR.
   
2. During a ventilation pause, place the Lucas backboard, and get back on the chest.
   
3. Turn the Lucas on its side, clip in the side away from the person compressing.
   
4. On the next ventilation break, pull the Lucas over and clip in the second clip, while the non-compressor individual hits the Lucas buttons as #1 pull plunger to chest, #2 press number 2, the plunger is set, and #3 hit number 3 and let the Lucas run. Remember you cannot use the Lucas, per the FDA, without the neck strap. This will avoid chest and abdominal trauma from a moving Lucas.
   
5. Best adult access, when no quick IV is available, is the bariatric needle in the proximal humeral bone. Remember 8X the flow and meds are closer to the heart.
   
6. If not getting reminded by the AED, you must recheck your patient every 2 minutes. Every minute you do not shock in a shockable rhythm reduces the chances of ROSC by 10%.
   
7. Do not treat the King Vision, or any other video assist intubation equipment, like a laryngoscope blade. The movement and muscle memory are completely different. Use the up and down method, and remember the tube appears in the lower right corner of the video.
   
8. PPE is critical especially during these Covid-19 times.
   
9. Remember we are using the following criteria for field termination of resuscitations.
   
   • No ROSC in 20 minutes.
     
   • Non-Shockable rhythm.
     
   • Unwitnessed by EMS: These patients should not be put in the ambulance. A call to medical direction should be placed for termination of efforts.