Greater Sydney Area HEMS

Hello and welcome back to the Sydney HEMS debrief, focus on cardiac arrest.

This week, we are very excited to deep dive into defibrillation. Join us as we talk through the physics of defibrillation, what is needed to get defibrillation as good as it can be, and what to do when defibrillation is simply not working.

We are delighted to be joined this week by Michael Heller. Michael is a paramedic by background, who now works as a medical engineer focused on defibrillation. Michael studied Rescue Engineering in Germany, and combining his clinical background is now a defining expert voice on defibrillation, and an excellent educator.

Too, we are delighted to be joined again by CCP Jackie, the educator for the Sydney pre-hospital ECMO/cardiac arrest car. In this episode, Jackie reflects on her experience backing up crews attending cardiac arrests, and how this experience has shaped her appreciation of the importance of good and judicious defibrillation, the barriers to making this happen, and how we as providers can all improve our defibrillation practice.

We hope you enjoy this episode, and as ever please send any feedback to me (Sam).

Have a great week!

Hello and welcome back to the Sydney HEMS debrief, focus on cardiac arrest.

This week, we are joined by a Sydney local – Prof Jimmy Chien, as we talk about PE in cardiac arrest.

Jimmy is a Senior Staff Specialist (Senior Consultant) in Respiratory Medicine, with a sub-speciality focus on pulmonary embolism. Jimmy has been fundamental in the creation of the PE emergency response team at his tertiary facility in Sydney, as well as in the roll-out of similar multi-disciplinary teams across Australia. On a daily basis, Jimmy and his team encounter the most challenging PE patients – those with intermediate or high risk PE, as well as those in arrest.

In this episode, Nat, Jimmy and I unpack how a PE causes an arrest, how to ascertain if a patient has arrested secondary to a massive PE, the therapies available to those patients who have arrested due to a known or suspected PE, and the role of mechanical support including ECMO. Too, we quiz Jimmy on where the literature is taking us to help manage this cohort of patients, as well as some of the emerging post-therapy care plans.

Jimmy is a wealth of knowledge, and we sure hope you enjoy the episode as much as we did recording it.

Hello and welcome back.

This week, we are joined by Dr Felipe Teran from New York, discussing trans-oesophageal ECHO (TOE) in arrest.

Felipe is an Associate Professor of Emergency Medicine at Weill Cornell Medical College, New York. Additionally, Felipe is a clinical scientist and educational leader specifically focused on the utility and application of TOE during cardiac arrest. Indeed, Felipe is leading the way integrating this intervention into ACLS efforts.

In this episode, myself (Sam), Nat and CCP Jackie chat with Felipe about the literature to date demonstrating the application of TOE in arrest to best optimise chest compression position to promote forward flow. In so doing, resuscitation providers can attempt to avoid a left ventricular outflow tract obstruction, and are better able to continually assess the effectiveness of ACLS – noting that the heart can change position throughout arrest.

Additionally, Nat talks about her and the team’s experience of pre-hospital TOE within the New South Wales Ambulance system, in particular how TOE can be utilised as part of a toolkit of assessment during arrest to assess the effectiveness of a resuscitation – even in the absence of placing a patient onto ECMO. Linked to this, Jackie describes the effect of live physiologic guidance and feedback to the paramedic workforce in New South Wales.

We certainly hope you enjoy this episode, and we look forward to talking with you again soon.

Hello and welcome back.

As we continue to discuss cardiac arrest, this week we talk with Prof Laurie Morrison from Toronto about:

• How to integrate cardiac arrest research into an existing systems
• How to gather and interpret physiologic data during arrest – particularly ventilation data – and what to do with this data to optimise arrest care
• How to be a leader in this research field

Prof Morrison is an academic and Clinical Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Sunnybrook Health Sciences Centre. Her program of research focuses on the evaluation and implementation of time sensitive interventions in acute emergencies, including cardiac arrest.

Laurie is a member of ILCOR, where she has been named a ‘Giant in Resuscitation’. Outside of ILCOR, Laurie has led the way establishing ‘Rescu’ – a collaborative prehospital research network wherein investigators conduct randomised controlled trials and outcome validation studies in resuscitation research. Laurie continues to provide leadership to several committees including the network of Canadian Emergency Medicine Researchers, and she has has received honorary membership to the European Resuscitation Council for life time achievement in resuscitation science.

We hope you enjoy this episode, and as ever please send us feedback or questions.

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Hello, and welcome back to the Sydney HEMS debrief, focus on cardiac arrest.

This is the second half of our chat with Dr Hans van Schuppen from Amsterdam as we put the P back into CPR.

In today’s episode, we discuss amongst other things:

• Lung recruitment intra-arrest
• The impact of tidal volumes during arrest
• To PEEP or not to PEEP during arrest
• How to use ventilation to prevent acidosis during arrest

Join now as we continue to pick Hans’ brain, and as ever we hope you enjoy this and subsequent episodes.

Please remember to hit subscribe!

Here is a link to the text Hans’ references concerning common terminology of ventilation during cardiopulmonary resuscitation: https://pubmed.ncbi.nlm.nih.gov/39848430/

(Please excuse the re-post, poor editing on my part (Sam’s) means we are re-posting this episode)

Hello, and welcome back to the Sydney HEMS debrief, focus on cardiac arrest.

This is episode 3, and today it is all about ventilation during arrest. It is time to put the P back into CPR. Ventilation has been neglected in cardiac arrest management, and this two part episode focuses on how ventilation can not only help achieve a ROSC but the importance of ventilation too in achieving neurologically intact survival

• We debate 30:2 or continuous ventilation and the merits of LMA vs intubation vs BVM

• We talk about the complexities of heart lung interactions 

• Where the research is heading in understanding how best to ventilate these patients

We are delighted to be joined by an absolute expert in this area, Dr Hans van Schuppen from Holland.

Hans is an anesthesiologist and HEMS physician at the Amsterdam University Medical Centre. Hans is a combined researcher, clinician and leader. He is an ERC Advanced Life Support Course Director, co-founder of the ResusNL conference, member of the expert group on national ambulance guidelines on resuscitation and is a member of the jury of the Dutch National Resuscitation Competition. As a member of the Dutch Resuscitation Council, he co-authored the national resuscitation guidelines, and helped to develop and implement a nationwide standard operating procedure for the handover of out-of-hospital cardiac arrest patients.

Currently, Hans is the chair of the Medical Committee and board member of the Dutch Resuscitation Council. His research evolved into a formal PhD with the ARREST (AmsteRdam REsuscitation STudies) group and the department of Anesthesiology, resulting in his thesis “Prehospital Advanced Life Support”. He now serves as director of resuscitation science of ARREST and works towards close collaboration between clinical care, education, research and innovation in resuscitation.

We could not stop talking to Hans, so please tune back in next week for the second half of our conversation.