Alyeska Method Hi Performance CPR
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- เผยแพร่เมื่อ 10 ก.ย. 2024
- Simulation of the Alyeska Method of High Performance CPR in a rescue toboggan As discussed in the NSP Fall 2016, Volume 34, Issue 1 of Ski Patrol magazine.
Originally posted on Facebook @ www.facebook.c...
Alyeska Resort Ski Patrol was challenged by our medical director to see if we could effectively perform Hi Performance CPR in a Cascade Rescue Company rescue toboggan while in transit, complete with application of an AED. Over the last few years we have developed a system that is being called the Alyeska Method. The National Ski Patrol magazine has published our findings and comments from our medical director. In conjunction with the development of the method, and continuing training for our pro patrol, I put together this edit that we hope illustrates some of the techniques we have incorporated. Please share far and wide!
shot and edited with GoPro
For more information, contact Alyeska Resort Ski Patrol
Huge kudos to Alyeska Ski Patrol. The idea of how or if to provide CPR on the ski hill has been bounced around forever. This method actually works, providing good CPR in a difficult environment (check out the article for metrics). Potential lifesaver while also providing a reasonably safe environment for the patrollers. Note the changeouts for compressors, choreography, time on chest, integration of AED and especially the fact that the victim is transported head upslope (the only way this can work due to the mechanics of compression). Michael Levy MD Medical Sponsor Alyeska Ski Patrol
Thanks Dr. Levy!
Need to find a way to bag though
Wow, ski patrol are intense! Imagine saving someone's life like that. Huge props to you guys and gals. Heroes in my book.
Brilliant video Ryan, I think many folks have read and thought about this, but showing how its actually done really helps. Looks like you have put a lot of thought into this, and the small things like leaving the defib storage door open, clear communication on analysis, strapping the patroller feet in to give them some stability etc are key to success here. Superb effort. We will be sharing this with our audience soon.
I know this is old but this training practice video was intense! Keep up the good work to all the Ski Patrols out there. Stay safe everyone.
Inspiring, a clear demonstration of the teamwork that makes Ski Patrol so effective!
Excellent example of well-practiced teamwork. Very impressed.
Great work. Taking this to the CSP for review and implementation. Looking forward to practicing this.
that is completely insane, cant wait to practice that.
That's pretty cool... But the patrollers in the last closeup shot were doing absolutely terrible ineffective chest compressions. It looked like the ones doing compressions while moving down the mountain were doing much better.
A Lucas like device would be amazing in this situation
I’ve heard Autopulses are better, but that would be a huge simplification.
@@allegraadams3037 lol, I don’t know much about the various CPR machine options…I was using Lucas device generically…I will take your word on the auto pulse, but I do agree that in rescue toboggan setting, cpr machines are very beneficial
a crew of 5 !
Good Job!!!
Are there studies/anecdotes about whether having the pt feet first/head first/sideways down the slope matters? Hopefully the period of field CPR is brief, but ideally the efficacy could be maximized. I've never thought about toboggan CPR before. That's got to be challenging to hear the AED commands as well. What a difficult situation!
E Bellyfish : some evidence shows increased perfusion with head downhill, but in our experience, effective compression and rebound cannot be achieved in that position, thus eliminating any advantage. I am unaware of anyone transporting patients accords the toboggan. The backboard and patient would likely hit the snow with any turn and it would be extremely unstable.
I don’t think I could do compressions properly if I were facing downhill. That would require that I use the chest to maintain proper positioning and I doubt I could manage to provide adequate chest recoil.
Now those are the men and woman I want there on my worst day
🍎 3:24
Are ventilations incorporated into this process?
No. This is High Performance CPR, so ventilations are not incorporated. Effective compressions and rebound (ie deep enough compressions and full rebound) provide enough perfusion of the brain with oxygen in the blood. In addition, the compressions and rebound are essentially operating the lungs, drawing more atmospheric oxygen into the system. To learn more about Hi Pro CPR, visit www.resuscitationacademy.org/
Summary of Key Issues and Major Changes
Key issues and major changes in the 2015 Guidelines
Update recommendations for HCPs include the following:
• These recommendations allow flexibility for activation of the
emergency response system to better match the HCP’s clinical setting.
• Trained rescuers are encouraged to simultaneously perform some
steps (ie, checking for breathing and pulse at the same time), in an
effort to reduce the time to first chest compression.
• Integrated teams of highly trained rescuers may use a choreographed
approach that accomplishes multiple steps and assessments
simultaneously rather than the sequential manner used by individual
rescuers (eg, one rescuer activates the emergency response system
while another begins chest compressions, a third either provides
ventilation or retrieves the bag-mask device for rescue breaths, and a
fourth retrieves and sets up a defibrillator).
• Increased emphasis has been placed on high-quality CPR using
performance targets (compressions of adequate rate and depth,
allowing complete chest recoil between compressions, minimizing
interruptions in compressions, and avoiding excessive ventilation).
See Table 1.
• Compression rate is modified to a range of 100 to 120/min.
• Compression depth for adults is modified to at least 2 inches (5
cm) but should not exceed 2.4 inches (6 cm).
• To allow full chest wall recoil after each compression, rescuers
must avoid leaning on the chest between compressions.
• Criteria for minimizing interruptions is clarified with a goal of
chest compression fraction as high as possible, with a target of at
least 60%.
• Where EMS systems have adopted bundles of care involving
continuous chest compressions, the use of passive ventilation
techniques may be considered as part of that bundle for victims
of OHCA.
• For patients with ongoing CPR and an advanced airway in place, a
simplified ventilation rate of 1 breath every 6 seconds (10 breaths
per minute) is recommended.
I disagree, respirations are important too. In CPR it is CAB Circulatory, Airway, Breathing. When an adult or adolescent has a sudden cardiac arrest (SCA), the person becomes unresponsive and stops breathing. The person’s body is still loaded with oxygen, it’s just that the heart has stopped beating and the oxygen is not being circulated.
‘Compression-only’ or ‘hands-only’ CPR is chest compressions without rescue breaths. It is a public service initiative for untrained rescuers to easily learn how to call 911 and then provide immediate chest compressions when they witness an SCA of an adult or adolescent.
Increasing bystander compression-only CPR rates should help increase survival of out-of-hospital SCA. Studies show that there is some air exchange with compression-only CPR. Besides, rescue breaths are tough enough for trained rescuers, let alone untrained.
Compression-only CPR does work, but only for a very specific type of cardiac arrest: Witnessed SCA of an adult or adolescent. Physiologically speaking, CPR with rescue breaths is better overall. In some circumstances, compression-only CPR is not recommended:
Child and infant CPR: Most causes of pediatric cardiac arrest are related to respiratory failure, or more simply put, breathing stops first. Children, generally speaking, are healthy and don’t have cardiac issues. When a child or infant needs CPR it’s usually because of a severe breathing problem. Once a child or infant is in cardiac arrest, the oxygen level is already severely depleted, making rescue breaths with CPR very important.
Respiratory failure leading to cardiac arrest: Drowning, overdose, choking, trauma, and sudden illnesses like severe allergic reaction and asthma attacks cause some cardiac arrests. In these cases the oxygen level is also severely depleted. Breaths are needed with chest compressions.
Unwitnessed cardiac arrest: When cardiac arrest is unwitnessed, the person may have been down for a while. Like the circumstances above, the body is oxygen-depleted and the person will benefit more from CPR with rescue breaths than with compression-only CPR.
An Instructor's job is to teach traditional CPR, which includes rescue breaths. At the scene, the student becomes the rescuer and he or she will decide whether or not to give breaths. At the end of the day, students should understand that compressions without breaths is much better than doing nothing, but compressions with breaths give the best odds for survival (and are needed to get certified in CPR)!
@@dalekinnison4846 Hi Dale, I know I'm 3 years late to the party, and some new evidence has come out, but I have to disagree with your perspective here.
In OHCA, The first 8 minutes are the most important for providing continuous circulation of blood to preserve the brain, even in the event of a cardiac arrest, high quality compressions will keep oxygen circulating enough to preserve the brain in that time. As a cardiac arrest goes on, ventilation will become important, but some studies suggest even trained rescuers should without ventilation in favor of an NRB and "passive oxygenation" until that 8 minute mark. At my agency, paramedics are advised not to attempt an advanced airway until that time.
While agencies and studies still vary slightly, one thing that's clear is that high quality compressions are far and away the most important aspect within that first 8 minutes, immediately followed by early defibrillation if the rhythm calls for it. Perfusion in the brain can be reduced in as little as 10 seconds, so even short pauses to ventilate can reduce cerebral Perfusion significantly in anything less than a well trained and well practiced crew working in a good environment.
I believe the idea here is to maintain that cerebral Perfusion as well as possible and as fast as possible, working in a difficult environment, and rapidly extricating the patient to (ideally) an ALS ambulance where an advanced airway and cardiac meds can be effectively delivered.
Edit: I should list my qualifications so you know I'm not just some schmuck. I'm an EMT in a busy 911 system, a Wilderness EMT, and an instructor for AHA and ASHI. I also helped develop Wilderness Cardiac Arrest protocols for a wilderness program I teach with. I don't claim to be an expert on the subject, but I am passionate about improving prehospital cardiac arrest care.
I believe that a simple bag could be kept on the sled and used during shifts in compressors
good vid lol
1 5:03
🍐🍐 4:14 4:17 4:21
Ummm they haven’t had any oxygen in 5 minutes....
Hi pro CPR is hands only…
I understand the difficulty of bringing a bag down the mountain but it appears that this team trades out compressors when possible. It seems feasible to provide a few breaths during this transition?
@@jamesb2148 usually AED tells you to stop for analysing. at every 5 reps of 30 compressions followed by 2 ventilation (not required in high performance cpr) so around 2min you have to stop for analysing and its a good time to switch the compressor.
@@joelricheme I think you missed his point entirely. James, they could potentially use the mask with the big air balloon thing they squeeze to give air, which would avoid the bodily fluid issue, but I think it's safe to assume this was considered and for some reason it's better in this situation not to worry about rescue breaths. Just because CPR has adapted to be no rescue breaths does not mean it's better, it's faster, easier, and safer for the rescuers, but not better for the patient.
Probably should compress a little faster.....