What Constitutes a CPR Save ?

[BD6413]

Question....Wondering if anyone knows what is considered an actual CPR Save. I have two examples:

Dispatched to a Reported Chest Pains/Clammy - While Enroute we are advised CPR Instructions are being given over the phone. - We arrive ALS Doing Compressions - Took over Compressions and assisted ALS. - After 10 minutes we had a stable heart rate and assisted ventilations {Resps were 4-6 per minute.} Patient lived approximatley 7 days Does this count ????

2nd. Example: Patient walks into Fire Station Watch Room on My Night Tour and complains of Chest Pains, He's Clammy, and sweating. - I grab a Volunteer Driver who was hanging out and we take off for the hospital in the bus with another Volunteer EMT/Trainee - I request ALS to meet us enroute, and start to obtain vitals and history on this guy and BOOM !! He Arrests. AED Pads placed, Air-Way Secured, and Ventilations started - AED Advises Shock after one Round of CPR - ALS Meets us and a Strong-Heart-Beat is re-stored. - Patient is transported, admitted and released after 7 days in Hospital....I'm leaning this one counts more so than my 1st one but wasn't sure anyone know ?

[IAMedic]

I consider a save as anyone that come back to lead a productive life, no matter how long. If we brought them back and they are able to spend 7 days laughing, joking, and talking with family...it's a save. If they are comatose with no signs of life besides a ventilator, then as I say "we arrived too soon".

[DaSharkie]

I am with IAMedic here, I don't call it a save unless they are walking and talking with little to no deficit. If they are going to nursing home because they are now gorked out of their mind then it is not a true save. In 8 years I have only had 1 save.

If my little pea brain is operating properly this early in the morning, a save is actually considered a save if you got a rhythm back and they survive in the hospital with a rhythm for 24 or 48 hours. Explain to me how that is a save? I understand that the family has gotten a bit of time to prepare for the loss, see them one last time, etc... but I just don't call it a save.

[Medic162]

If they leave (or never visit) the ICU and go home to feed the bulldog with normal brain function... It's a save.

[ff7134]

In the 5 years I have been an EMT I have 3 saves...ie: walking around, haveing fun with family and such. All 3 saves have been in the last year. But I have went 0-5 since my last one. I kind of figure those will probably be the last.



Anyone notice that with biphasic we are getting rhythms back more often??? We have been talking about this for awhile around the station..seems kind of funny.

[DrParasite]

in my opinion, if you arrive and they don't have a pulse, and when you turn them over the the ER they do have a pulse, then it's a save. if the ER killed them later, it's their problem :D

there are different types of saves. CPR save (using only CPR), Defib Save (when the AED restarts his heart), and ALS save (using lifepack, epi, Sodium BiCarb, etc). if they walk ouf of the hospital, that is great. if they are better off when you drop them off than when you picked them up, then I consider that a save.

[firenresq77]

I was always told it wasn't considered a "save" unless they left the hospital under their own powers..........

If that's the case, I've had 2 that I can remember........

[Weruj1]

I am with Brad on this ..............in 17 years ......I am saying maybe half a dozen I can count.With CPR all by itself ...........1 ....and in every case there was someone doing something to try and help the person, wether it was good CPR, bad CPR, or tryng to "get 'em to breathe". ........

[ALS142]

Personally, I consider it a "save" if they're admitted to the hospital (and I don't mean the ED). If they're discharged from the ED to another location (i.e., ICU), then it's a save. If they die in the ED, then it's not. If they are pronounced deceased in the ED, then it doesn't go against the mortality and morbidity report.

I'm not sure, but I believe the Utstein template considers it a save if the patient survives to discharge from the hospital, no matter the neurological outcome. It also measures the one year and five year survival rates.

[MikeWard]

Resuscitation
Patient who has had pulse restored before arrival at the hospital. Also called "Return Of Spontaneous Circulation" (ROSC)

Save
Patient who was clinically dead (without pulse) at some point in the out-of-hospital phase. Resuscitated and neurologically intact 12 months after event. This was the standard used in the AED studies in Chicago/Midway airports and American Airlines.

For one system that averages a medical cardiac arrest every day:
20-30% of the pulseless patients are "resuscitated"
about 5% of the pulseless patients are "saved"

The difference between a resuscitation and a save is based on two things:

The time it took for medical aide to begin. About half of the saves in that system recieved citizen cpr, public access aed or other intervention before the fire department or paramedics arrived.

The pre-existing clinical condition of the patient. The person who has preexisting heart failure, with smoker's emphysema and diabetes may still die even if he arrested in front of the cardiac intensive care unit.

Mike
Adjunct Assistant Professor of Emergency Medicine
Emergency Health Services
The George Washington University

[MikeWard]

http://216.185.112.5/presenter.jhtml?identifier=1456

Survival should be used to refer to existence beyond return of spontaneous circulation and the immediate postarrest period. Some studies have reported 96-hour survival rates, but studies that measure survival 24 hours after resuscitation can be reasonably called survival studies. Such studies allow determination of neurological status, detection of multisystem failure, and assessment of cardiovascular physiology following withdrawal of pharmacocirculatory support. Studies that use the term survival should extend to at least 24 hours and should explain the rationale for using the term.

________________

So, BD6413, both of your examples would qualify as a "save."

Just like a friend of mine, who had a ROSC after the ambulance was t-boned in an intersection accident. They were doing CPR while transporting. The stretcher broke loose, landing on top of him. The patient lived more than 24 hours and he had a disability retirement due to spinal cord trauma.

Mike

[FireHAZMEDIC]

Its all about discharge. As pre-hospital providers I believe we have to look more to function at discharge than just getting our patient to ER. Planning for discharge begins with inital patient contact and should effect everything we do. This is not only good patient care but good stewardship of the healthcare dollar.

[Resq14]

Playing frisbee with Captain Kirk on "Rescue 911."

THAT's how you know it was a save.

;)

[shammrock54]

Well I lay low for a while and some things just don't change!

I would have to agree with IAMedic :eek:

[IAMedic]

Where ya been Brian?? Are you done with school??