Cardiopulmonary Resuscitation with Dr. Tarif Choudhury, Part 2
Dec 11, 2023
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Dr. Tarif Choudhury, pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons, discusses topics such as optimizing CPR, monitoring patients during CPR, controversies of using epinephrine, bike-carb, and ultrasound in cardiac arrest.
Monitoring diastolic blood pressure, end-tidal CO2 levels, and pulse ox waveform during CPR can provide valuable information for managing the patient.
Understanding lesion-specific considerations and alternatives to epinephrine is important for optimizing outcomes in pediatric cardiac arrest.
Deep dives
Monitoring indicators during CPR
During CPR, specific tracings and numbers on the monitor are crucial for determining the effectiveness of interventions. These include diastolic blood pressure, end-tidal CO2 levels, and the pulse ox waveform. Diastolic blood pressure above 25-30 is associated with more favorable outcomes. An end-tidal CO2 greater than 20 is desirable, indicating good ventilation. Monitoring these indicators can provide valuable information to guide the management of the patient during CPR.
The role of epinephrine in cardiac arrest
Epinephrine is an essential medication used in cardiac arrest due to its ability to increase systemic vascular tone and drive coronary perfusion pressure. While other drugs like vasopressin and phenylephrine have been discussed in adult literature, in pediatric resuscitation, epinephrine remains the standard choice. However, there is ongoing debate about the use of epinephrine in certain cases, such as patients with pulmonary hypertension. Understanding lesion-specific considerations and potential alternatives to epinephrine is important for optimizing outcomes in cardiac arrest.
Considerations for bicarbonate administration
The administration of bicarbonate during cardiac arrest depends on the patient's condition and the underlying cause. In patients with primary respiratory arrest or metabolic acidosis, bicarbonate may be beneficial. However, for patients with respiratory-mediated arrest or a metabolic-driven acidosis, bicarbonate administration may not be helpful. Additionally, assessing calcium and potassium levels before giving bicarbonate is important to avoid further electrolyte imbalances. The decision to administer bicarbonate should be based on individual patient factors and the overall goals of resuscitation.
Family involvement during CPR and post-arrest discussions
Involving the family during CPR and providing ongoing communication is crucial. Ideally, a dedicated individual should communicate with the family during the resuscitation process, providing updates and addressing their concerns. In certain cases, having the family present during CPR may be appropriate, as it allows them to witness the team's dedication and efforts. Effective communication with the family should start as early as possible, preparing them for potential outcomes and involving them in decision-making. Debriefing sessions after the resuscitation should be conducted in a psychologically safe space, encouraging open discussion and a collective commitment to improve future outcomes.
Dr. Tarif Choudhury is a pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons. After finishing his residency in pediatrics at Cohen Children’s Medical Center, he completed his cardiology fellowship at Lurie Children’s Hospital in Chicago followed by a pediatric critical care fellowship at Morgan Stanley Children’s Hospital at Columbia University School of Medicine. His areas of interest are the impact of clinical simulation to improve team performance, clinical outcomes of PCICU patients and clinical outcomes of patients on mechanical circulatory support in the PCICU.
Dr. Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University’s critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.
Objectives By the end of this podcast series, listeners should be able to:
Strategize how to approach an arrest as the code leader
Recognize the key elements of high-quality CPR and how to optimize perfusion during an arrest
Recall airway management, oxygenation, and ventilation during CPR
Recall different approaches to physiological monitoring during an arrest to guide therapy
Recognize appropriate resuscitation drug administration and timing during CPR
Recall management with manual defibrillation for arrests with a shockable rhythm
Develop approach to determining code duration and when to discontinue CPR
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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