Bernard - Refractory Cardiac Arrest

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Professor Stephen Bernard is an Intensive Care Physician at The Alfred Hospital and Medical Advisor to Ambulance Victoria. His research interests include the use of therapeutic hypothermia for the treatment of neurological injury after resuscitation from out-of hospital cardiac arrest. Here he provides a presentation on recent advances in the management of refractory cardiac arrest in the out of hospital setting.

Salud y medicina

$Refractory Cardiac Arrest Stephen Bernard MD FACEM FCICM FCCM ASM$

$The Victorian setting: Refractory Arrest – 12 month period (2012) – Age < 65 years – VF as initial cardiac rhythm • 222 patients • 149 (67%) ROSC • (Survival of these = 55%) • 68 no ROSC • 5/68 transported with CPR (Autopulse) • 63 declared deceased at scene$

$Refractory Arrest – No ambulance transport due to: • Risk of unrestrained CPR • “Futility”$

$The CHEER Trial – Pilot observational trial – Refractory cardiac arrest – No ROSC at 30 minutes • CPR mechanical to The Alfred ED • Hypothermia with IV cold saline • ECMO • Emergency • Reperfusion$

$Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER Trial) Resuscitation 2015; 86:88-94$

HERALD SUN 2/9/16 THE MAN DOCTORS BROUGHT
BACK TO LIFE AFTER BEING DEAD FOR 73 MINUTES
A MELBOURNE man has been brought back to life after spending a
staggering 73 minutes clinically dead. Robert Kinderman has praised his
survival as a miracle, while his stunned doctors at The Alfred hospital say
his remarkable case redefines what is possible for cardiac arrest patients
around the world.

$Non-ECPR treatments for refractory cardiac arrest Mechanical CPR to cardiac catheterisation laboratory? New anti-arrhythmics? Wagner H, et al. Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010; 81:383-7 3. Driver BE, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85:1337-41$

$Refractory Arrest: “CHEER2” Clinical Practice Guideline Commenced 8/10/15 29 LUCAS2™ CPR machines for transport to metro ED for ECMO or Cath lab$

$Refractory Arrest in Rural: Autopulse™ in rural Victoria for “extra pair of hands” 14 Units available Issues about fitting in car ?Transport to ED ?Transport by HEMS$

Thank you!
s.bernard@Alfred.org.au
@AmbVicMedic

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Professor Andrew Davies is an Intensivist working at Peninsula Health in Melbourne. He has performed clinical research in the field of critical care for 20 years, as a participating investigator in over 50 studies (mostly clinical trials), predominantly in the areas of critical care nutrition, mechanical ventilation and acute lung injury and severe sepsis. He is a past Vice Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) with a special interest in nutrition in the ICU, and is a past Chair of the Australian and New Zealand Society of Parenteral and Enteral Nutrition (AuSPEN). In this talk, Professor Davies tackles the often overlooked aspect of nutrition in the ICU and it’s potential benefits for our patients.

Davies - Nutrition in Intensive Care

Intensive Care Network Victoria

Haines- Developing puzzle icu outcomes

Intensive Care Network Victoria

Professor Rinaldo Bellomo is an Intensivist at the Austin Hospital in Melbourne. He is Professor of Medicine at Melbourne University, and Honorary Professor of Medicine at Monash University, Melbourne and The University of Sydney. He is one of the most eminent researchers in Intensive Care Medicine today and has been named one of the most influential scientific minds of our time. In this thought-provoking talk Professor Bellomo discusses glycemic control of critically ill diabetic patients in the ICU.

ICN Vic - glucose control in diabetics

Intensive Care Network Victoria

Anderson - Never Ever Die

Intensive Care Network Victoria

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Intensive Care Network Victoria

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Intensive Care Network Victoria

Cattigan- Doing it for the Kids

Intensive Care Network Victoria

McGloughlin -Good Bugs, Bad Bugs

Intensive Care Network Victoria

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Intensive Care Network Victoria

ICN Victoria presents Professor Oliver Cornely, Professor of Internal Medicine and Director for Clinical Trials at University Hospital, Cologne, Germany. His research interests include invasive fungal diseases in haematology/oncology and in the ICU setting. Dr Cornely is also a clinical infectious diseases consultant at the University Hospital of Cologne. Professor Cornely gives an entertaining talk on the pervasiveness, invasiveness, diagnosis and treatment of fungal infections in ICU patients.

ICN Victoria: Cornely on "Being a Fun-gi in ICU"

Intensive Care Network Victoria

ICN Victoria: Buck on "Teaching Gen Y Doctors - Should We Bother?"

Intensive Care Network Victoria

ICN Victoria: Buck on "Resus Room Management"

Intensive Care Network Victoria

ICN Victoria: Davies on "Intensive care for Intensivists"

Intensive Care Network Victoria

ICN Victoria: Iwashyna on "Stop Wasting RCT Data!"

Intensive Care Network Victoria

ICN Victoria: Burrell on "RV Failure for the Intensivist"

Intensive Care Network Victoria

ICN Victoria: Burrell on "Optimising your Non-Clinical Time"

Intensive Care Network Victoria

ICN Victoria: Padiglione on "Antimicrobial Stewardship in ICU"

Intensive Care Network Victoria

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Intensive Care Network Victoria

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ICN Victoria: Burrell on "RV Failure for the Intensivist"

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ICN Victoria: Padiglione on "Antimicrobial Stewardship in ICU"

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Bernard - Refractory Cardiac Arrest

1. Refractory Cardiac Arrest Stephen Bernard MD FACEM FCICM FCCM ASM

8. The Victorian setting: Refractory Arrest – 12 month period (2012) – Age < 65 years – VF as initial cardiac rhythm • 222 patients • 149 (67%) ROSC • (Survival of these = 55%) • 68 no ROSC • 5/68 transported with CPR (Autopulse) • 63 declared deceased at scene

9. The Victorian setting: Refractory Arrest – 12 month period (2012) – Age < 65 years – VF as initial cardiac rhythm • 222 patients • 149 (67%) ROSC • (Survival of these = 55%) • 68 no ROSC • 5/68 transported with CPR (Autopulse) • 63 declared deceased at scene

10. Refractory Arrest – No ambulance transport due to: • Risk of unrestrained CPR • “Futility”

11. The CHEER Trial – Pilot observational trial – Refractory cardiac arrest – No ROSC at 30 minutes • CPR mechanical to The Alfred ED • Hypothermia with IV cold saline • ECMO • Emergency • Reperfusion

12. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER Trial) Resuscitation 2015; 86:88-94

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14. HERALD SUN 2/9/16 THE MAN DOCTORS BROUGHT BACK TO LIFE AFTER BEING DEAD FOR 73 MINUTES A MELBOURNE man has been brought back to life after spending a staggering 73 minutes clinically dead. Robert Kinderman has praised his survival as a miracle, while his stunned doctors at The Alfred hospital say his remarkable case redefines what is possible for cardiac arrest patients around the world.

15.

16. What about me?  What about me? 

17. Non-ECPR treatments for refractory cardiac arrest Mechanical CPR to cardiac catheterisation laboratory? New anti-arrhythmics? Wagner H, et al. Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010; 81:383-7 3. Driver BE, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85:1337-41

18.

19. Refractory Arrest: “CHEER2” Clinical Practice Guideline Commenced 8/10/15 29 LUCAS2™ CPR machines for transport to metro ED for ECMO or Cath lab

20.

21.

22. Refractory Arrest in Rural: Autopulse™ in rural Victoria for “extra pair of hands” 14 Units available Issues about fitting in car ?Transport to ED ?Transport by HEMS

23. The RINSE trial:

24. The RINSE trial:

25. The RINSE trial:

26. Thank you! s.bernard@Alfred.org.au @AmbVicMedic