I've been waiting for this one for a long time. I get to interview Dr. Stephen Bernard on the topic of post-arrest care.

 

Professor Stephen Bernard

Senior Intensivist, The Alfred Hospital

Professor Stephen Bernard is a senior Intensive Care Physician at the Alfred Hospital and Director of Intensive Care at Knox Private Hospital in Victoria, Australia. He is also Medical Advisor to Ambulance Victoria.

 

Last Week, I posted Part I of this interview on Post-Arrest Care 2013

This is Part II.

My discussion with Dr. Bernard was based on a talk he gave at the Australasian College for Emergency Medicine

Photo by Brian Burns

MAP Goals

SBP of 120 mm hg? The paper was just published ahead-of-print

The other paper Dr. Bernard Mentioned is Gaieski et al. (Resuscitation 2007;73:29-39)

Sedate

If cooling to 36, it is a lot easier to get away with standard sedation practice as the hypothermia-slowed metabolism is no longer a big problem

Cath lab with ECMO or LUCAS2 for refractory arrest

It can be done! And if we can do it, is "stay-and-play" on scene still a good strategy?

CHEER trial (CPR, Hypothermia, ECMO and Early Reperfusion)

CHEER Trial Protocol

15 F arterial cath and a 17-19 F venous catheter under ultrasound guidance, with the only pause during compressions being the initial vessel puncture and 1st wire advancement

Intraarrest Hypothermia?

The animal data look good, but need human trials that show benefit. If you do it, then these patients may need a deeper degree of hypothermia (33 C?).

Prehospital Hypothermia and is Quicker Better?

Dr. Bernard's trial did not show benefit for prehospital cooling [cite source='pubmed']20679551[/cite]

and the in-press study by Kim et al. showed the same [cite source='pubmed']24240712[/cite]

More from Steve can be found at the EDECMO Podcast Site

Now, on to the Podcast...