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Because I missed it live, I'm going to "recorded" tweet Vinay Nadkarni's lecture from February 4th entitled: Staying Alive: The Evolution of CPR and Resuscitation. #CCC50 #PedsICU
Nadkarni: an olympic ring chain of survival, we've been able to double the chain of survival #CCC50 #PedsICU
Nadkarni: modern closed chest massage began with observations of blood pressure effects of defibrillation paddle pressure on the chest #CCC50 #PedsICU
Nadkarni: this was brought to the Operating room, where goal directed therapy - monitoring the arterial blood pressure, could be used #CCC50 #PedsICU
Nadkarni: studied and monitored, by Peter Safar, where he showed lay people could be trained to successfully resuscitate with exhaled air. #CCC50 #PedsICU
Nadkarni: then creating mannequins and training tools that have led to modern day resuscitation #CCC50 #PedsICU
Nadkarni: We have learned that there are 3 phases of VF cardiac arrest: The electrical phase, the hemodynamic phase, and the metabolic phase #CCC50 #PedsICU
Nadkarni: we have learned that providing early CPR and Defibrillation and ultimately ACLS and ECLS can dramatically improve survival #CCC50 #PedsICU
Nadkarni: we have learned over the years that the medications are not as important as early effective circulation and attention to detail for effective therapies for both the heart and brain #CCC50 #PedsICU
Nadkarni: we have learned that myocardial depression, much like in sepsis can be supported in the first 24 hours post-arrest #CCC50 #PedsICU
Nadkarni: and the some of the things we thought we so helpful, like 100% O2 are sometimes harmful to the heart and the brain #CCC50 #PedsICU
Nadkarni: the monitoring and titration of therapies to the electrical and physiological condition of the brain, is one of the most important things we can do #CCC50 #PedsICU
Nadkarni: therapeutic hypothermia - now refined to Targeted temperature management, used as early as the 1960s, and the understanding of how, when and who to apply it to has become somewhat clearer #CCC50 #PedsICU
Nadkarni: the tools of the critical care team at the bedside have become critically important and advanced #CCC50 #PedsICU
Nadkarni: using extra corporeal therapies in a goal directed manner may make signficantly improved outcomes possible #CCC50 #PedsICU
Nadkarni: technology can not do it alone. If people are not trained to use the devices, this situation where an athlete was carried off the court rather than immediately defibrillated can still happen #CCC50 #PedsICU
Nadkarni: initial work suggested therapeutic hypothermia was beneficial post-arrest, but more recent studies suggested it was more avoidance of hyperthermia, we know the controls were not equivalent #CCC50 #PedsICU
Nadkarni: more recently Hyperion study showed that if we controlled the temperature in both groups we could see an improvement in neurologic outcome, but not mortality. #CCC50 #PedsICU
Nadkarni: we need to measure elements before during and after the events including Quality of Life then train the individual, the system and environment to achieve better outcomes #CCC50 #PedsICU
Nadkarni: and in the near and far future, we are developing algorithms to continuously scroll the EHR to improve the early recognition and response to prevent and treat cardiac arrest before or when it happens #CCC50 #PedsICU
Nadkarni: we are developing adjuncts, that are not people vs. machines but are people and machines to improve outcomes #CCC50 #PedsICU
Nadkarni: we are learning how to measure and adjust cerebral hemodynamic and electrophysiology both to improve outcomes, but know when to stop #CCC50 #PedsICU
Nadkarni: mitochondrial resuscitation, how we can improve the function of these organelles that are crucial to survival and repair of cells #CCC50 #PedsICU
Nadkarni: and we are adapting techniques from our sports colleagues both in coaching and feedback, as well as monitoring of our 'team mates' including stress level and task load. As well as performance features #CCC50 #PedsICU
Nadkarni: we are learning human factors data that our forefathers couldnt think of to use to train and command center type structures to monitor and train our team #CCC50 #PedsICU
Nadkarni: and we are developing new techniques to deliver the life saving tools, such as drone dispatch of an AED, that will support and eventually improve the time critical response for ACLS #CCC50 #PedsICU
Nadkarni: the future, multiple steps, but also making them simple and low-tech so they can be spread to LMIC, where we can also learn how to simplify and deploy in better ways #CCC50 #PedsICU
Nadkarni: the AHA has now added a 6th link in the chain of survivcal: Recovery Paying not just attention to the short term outcomes, but the long term outcomes #CCC50 #PedsICU
Nadkarni: the challenges we face are leading to a formula for survival - including Medical Science quality, educational efficiency, and local implementation efficiency which are all key to survival and survivorship #CCC50 #PedsICU
a 17 minute talk that only took me 40 minutes to watch/tweet. I encourage people who have access to watch the video.
