One of the things that is frequently missed is that there is a great potential that the patient may have acidosis, as well as a resultant hyperkalemia. There has been great debate over sodium bicarbonate during cardiac arrest since the first iteration of the ACLS program. A number of studies in the 1980s demonstrated the issue of bicarb during arrest actually resulting in higher intracellular CO2 levels, which were deleterious to a good outcome. Bicarb may yet have a role in a prolonged arrest, and more likely post-arrest. When I think of the past 49 years since the first iteration of ACLS, it still boils down to certain basics from good CPR, quality of defibrillation, and epinephrine. The reality is that in most situations we are dealing with an ailing, possibly failing myocardium, and over the past decade, profoundly complicated comorbidities that cloud resuscitation further.
What about post arrest OMI but isn’t a STEMI? Not sure if there’s literature on that. We usually just repeat and see what evolves if cards doesn’t just take to cath lab
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Got me excited to see Dr. Mattu. Always concise, on-point, and substantive lecture.
Great lecture🙏
This was great and to the point. Appreciate you sharing your knowledge 👌🏽
One of the things that is frequently missed is that there is a great potential that the patient may have acidosis, as well as a resultant hyperkalemia. There has been great debate over sodium bicarbonate during cardiac arrest since the first iteration of the ACLS program. A number of studies in the 1980s demonstrated the issue of bicarb during arrest actually resulting in higher intracellular CO2 levels, which were deleterious to a good outcome. Bicarb may yet have a role in a prolonged arrest, and more likely post-arrest.
When I think of the past 49 years since the first iteration of ACLS, it still boils down to certain basics from good CPR, quality of defibrillation, and epinephrine. The reality is that in most situations we are dealing with an ailing, possibly failing myocardium, and over the past decade, profoundly complicated comorbidities that cloud resuscitation further.
So which anti arrhythmic do you suggest we use in prolonged Qtc
What about post arrest OMI but isn’t a STEMI? Not sure if there’s literature on that. We usually just repeat and see what evolves if cards doesn’t just take to cath lab