Elegard - Adult

Procedure Guidelines

Elegard - Adult

Therapeutic Goal To recognize the patient requiring cardiopulmonary resuscitation and to restore a stable cardiac rhythm with adequate cardiac output and perfusion leading to neurologically intact survival.

• This protocol is for medical cardiac arrest and does not apply to hemorrhagic cardiac arrest.
• The first few minutes are critical and must be focused on establishing optimal perfusion (BLS). Utilize the “carry less do more” strategy to immediately begin care while remainder of crew gathers other equipment.
• Do NOT delay compressions waiting for Lucas device. Move the patient to an open space as needed to facilitate a high-quality resuscitation.
• Control equipment placement and activity within the “critical triangle”.
• Place Elegard under patient as soon as possible. When appropriate attached defib pads on bare chest and attached Lucas device.
• Seal the airway with a supraglottic airway and RESQPOD attached.
  • SIZE 5 for MALE, SIZE 4 for FEMALE. If there is concern for poor seal, dislodgement, or poor ETCO2 pull supraglottic airway and make one intubation attempt with video laryngoscope while compressions are occurring.
• Complete pulse check, rhythm check and defibrillate as indicated before starting 2-minute timer for priming. Do not pause compressions for more than 5 seconds.
• Switch compressor frequently and ensure a seamless transition. Compressor should ensure adequate rate and compression depth. Do not pause compressions during priming.

CARDIAC ARREST WILL BE WORKED ON SCENE WITHOUT MOVING THE PATIENT FOR A MINIMUM OF 25 MINUTES OR UNTIL ROSC

If criteria for field termination are not met after this, transport to nearest appropriate ER.

Patient Management

General Care

• Ensure the patient is pulseless and that resuscitation is indicated.
• Perform a rapid scene survey for any evidence of a valid DNR order and or directive.
• Utilize time in-between procedures to optimize care and troubleshoot any H’s and T’s.

Ensure High Quality Compressions

• Perform high quality compressions continuously throughout the code, swapping compressors every 2 minutes and or until the Lucas device is in operation.

EleGARD / LUCAS

• Power on the EleGARD device (Button 1) and place under patient as soon as possible. (Interruption in CPR should be <6 seconds when placing Elegard.)
• Place a supraglottic airway and secure in place with RESQPOD attached (if not already completed).
• Switch to LUCAS device. If unable to complete within 6 seconds restart priming phase. Start the timer on EleGARD (Button 2) and perform CPR for two minutes. .
• Begin elevating the head (Button 3).
• Once elevation is complete leave in elevated position and secure. Frequently monitor Lucas compression site to ensure correct positioning.
• Mark compression site on chest with marker.
• Check to make sure all airway devices (supraglottic airway, RESQPOD, filter, ETCO2 monitor) are secure after head elevation.
• Continue working the cardiac arrest on the scene for a minimum of 25 minutes, or until ROSC, before deciding next steps.
• Provide Adequate, Appropriately Timed Ventilations
• Attach ETCO2 filter line above the ResQPOD.
• Continually reassess for proper airway placement.
• Use timing light on RESQPOD to assist with ventilations.
• Initiate IV/IO for medication administration.
  • AC IV or humeral/femoral IO placement is the initial access point.
• Reassess rhythm and pulse every 2 min.

VFIB / PUSELESS VTACH:

• Refer to section 4.08 cardiac arrest - ventricular fibrillation / pulseless ventricular tachycardia
• Compressions should be continued while the defibrillator is charging. CPR should be resumed immediately for at least 2 minutes following any defibrillation. Do not stop LUCAS to shock.

ASYSTOLE / PEA:

• Refer to Section 4.02 ASYSTOLE and 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) protocols.

  Post ROSC Care

• If ROSC occurs remove RESQPOD immediately from the ventilation circuit (even if ventilations need to be supported).
• Post arrest ROSC patients often re-arrest. Be prepared.
• All transported cardiac arrest patients will be taken to the closest appropriate receiving facility.

Decision Point

• If ROSC does not occur decide whether patient meets criteria for field termination or prepare for transport. If deemed appropriate by circumstances, resuscitation may be terminated as per protocols.

Pearls and Pitfalls

• Transport late term gravid pregnant and hypothermic cardiac arrests patients expeditiously.
• Consider the possibility of hyperkalemia in patients on dialysis or renal failure.
• The supraglottic airway must be monitored. If working well, continue using. If doubt exists (low end tidal, poor ventilations) consider removing.
• High End Tidal CO2 levels or witnessed VF/VT arrest, are predictive of possible good outcomes and may warrant staying on scene longer without moving the patient to attempt to achieve ROSC.
• CPR induced consciousness: Consider Ketamine 0.5 -1 mg/kg IV or IO, titrated to effect if this occurs.