When the American Heart Association (AHA) published updated guidelines for advanced cardiac life support (ACLS) in 2015, it presented evidence that a low end-tidal carbon dioxide (EtCO2) level in intubated patients was linked to a very low success rate for resuscitation (AHA, 2015). As a result, the ability to monitor EtCO2 during resuscitation efforts became a priority.
In response to this new information, all major defibrillator manufacturers have added the ability to monitor EtCO2 to their manual equipment. Defibrillator models used in both the acute care and EMS settings have this ability. The healthcare team can now assess the EtCO2 along with other vital signs during resuscitation and adjust the plan of care in real time.
Immediate feedback is key
Emphasis at any level of CPR training—from community-based to advanced training—is on the rescuer performing high-quality CPR. Manufactures have begun to incorporate software in their devices that gives immediate feedback to the rescuer regarding the quality of compressions. If an Automated External Defibrillator (AED) is in use, the feedback may be as simple as a digital message that reads “Push Harder” or “Good Compressions,” or a visual meter that give color feedback as compressions are performed.
Software is also available for manual defibrillators that can provide feedback during resuscitative efforts as well as information that can be directly transferred to the electronic medical record (EMR) after the event. This enables the kind of quality review that is vital for the resuscitation team, and it provides real-time, accurate documentation in the patient’s medical record. This real-time documentation has an impact on the patient’s plan of care and on hospital coding and billing information.
Considering the waveform
Both manual and automated defibrillators use biphasic waveforms that come in three different forms: biphasic truncated, rectilinear biphasic, and pulsed biphasic. They all deliver peak energy at the same programmed settings but differ in how they adjust energy output in relation to physical impedance. There is now mounting evidence that shows a greater effectiveness for the biphasic truncated and rectilinear biphasic compared to the pulsed biphasic waveform. This information should be considered when contemplating purchase of both automated and manual defibrillation devices.
AEDs have become so commonplace that they are expected to be available in public venues such as sports arenas, airports, and even on airplanes. First approved by the FDA in 1990s, AED training became a part of the American Red Cross basic CPR course in 1999.
American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 7: Adult Advanced Cardiovascular Life Support. ECCguidelines.heart.org