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¿Que es pit crew CPR? (HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association)

(HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association)

Aspectos destacados de las guías de la american heart association del 2020 para RCP y ACE

(HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association)

Aspectos destacados de las guías de la american heart association del 2020 para RCP y ACE

Dr. Ramon Reyes, MD
parte del curso de instructor #AHA #ACLS - RCP de alto rendimiento con la ayuda de un dispositivo de retroalimentación

¿Que es pit crew CPR? (HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) Aparentemente lo nuevo en la avenida. Realmente No, no es algo nuevo. El concepto de pit crew CPR es algo que ha estado circulando hace varios años ya. Se habla de varias faces o pasos durante la rcp. En realidad esto es basado en evidencia cientifica todo salido de las guidelines de la ILCOR y la AHA. ¿Por que explico esto?, por que personas sin escrupulos que han  convertido este concepto en una clase "CURSO", sin aval, con la finalidad de sacar dinero $$$$. La AHA enseña este concepto cuando se habla de CCF ( chest compression fraction) donde el enfasis consiste en compressiones cardiacas de ALTA CALIDAD (Para los fines de mantener una buena persfusion Coronaria y Cerebral) y donde se habla minimizar el tiempo durante las interrupciones obligatorias durante procedimientos obligatorios, como el cambio de rescatistas en las compresiones, esto se debe de hacer de una manera agil y efectiva. Asi Como los pit crew de Nascar, durante el pit crew cpr cada miembro del equipo tiene una funcion ( via aerea, compressor, DEA, administracion de medicamentos, etc). Entiendo que nuestro objectivo es estar preparados para salvar vidas, pero usar este concepto para obtener ganancias monetarias y sin ningun aval, no creo sea el objectivo de ILCOR o la AHA. Estas clases de pit crew cpr usan una mezcla de BLS y ACLS, cuando en realidad las ultimas recommendationes hablan de mas enfasis en compressiones cardiacas. ¡No se dejen engañar!

Christian Goring. EMS I/C
Diagrama de la AHA para RCP de Alto Rendimiento, Pit Crew CPR
AHA regional faculty, MA USA.


“How can we do better?” That was the rallying cry of the late Seattle Fire Captain Craig Aman, a tireless advocate for improving cardiac arrest survival rates.
As the resuscitation community knows, out-of-hospital cardiac arrest is a leading cause of premature death worldwide. Survival is variable (often less than 5%) and depends on effective CPR and early defibrillation. To improve these dismal statistics, it’s important to understand and optimize modifiable predictors of outcome — including the quality of CPR.[i]
In pursuit of that goal, one often hears the phrase, “high-performance CPR”. But what does that mean in practical terms? And how can EMS teams know they’re actually doing it?
The impetus behind HP-CPR
Resuscitation Academy faculty member Mike Helbock offers some context for the development of HP-CPR.
“Decades ago, Seattle Fire began recording metrics like compression rates, depth and chest recoil. And, surprise — we found that we weren’t nearly as good as we thought we were.” According to Helbock, that led to the discovery that excessive pauses between compressions were occurring during CPR.
“Did a pause have anything to do with the outcome? Science has proven, absolutely. We began looking at ways to tighten the mechanics of CPR and decrease pauses in every way possible.  We completely rebuilt our approach from the ground up, started measuring individual as well as team performance — and began to see an increase in performance and survival rates,” Helbock explains.
The cause of the pause
Low compression fraction or density can occur for obvious reasons. First, to ventilate or intubate the patient. Next, the use of an AED, which does not allow for analysis of rhythm during compressions.
For Helbock, the most surprising reason was complacency among EMTs and paramedics. “On the surface, we were doing everything we were trained to do. But every pause — justified or not —represented a decrease in the chance for survival.”
The proof is in the numbers
Data from the Resuscitation Outcomes Consortium demonstrates that a one percent increase in fraction time equates to roughly a one percent increase in survival rates. “So, if you improve your 50% compression fraction to 70%, that’s a 20% better shot your patient has for survival,” says Helbock.
Fraction time for King County responders was in the 40-50% range; today, performance measures now show they’re in the mid-80% to low 90% — all because they were trained to eliminate pauses.
So why isn’t everyone doing HP-CPR?
Good question. Clearly, there are some common misconceptions preventing the widespread adoption of this proven methodology.
Misconception #1 — “We took a pit crew CPR class. It’s the same thing, right?”
The concept of a highly trained and choreographed crew is a powerful, relatable analogy for the work of an EMS team. Pit crew CPR training focuses on highly defined roles that aid in the organization of a chaotic scene.
In comparison, HP-CPR is much more than instinctively knowing where to go and what to do. It’s about routine measurement of performance and understanding how to increase that performance, which requires an incredible commitment to monitoring, remediation and retraining.
Another key difference, according to Hilton Head Island Fire Rescue Captain and South Carolina Resuscitation Academy Program Director Tom Bouthillet, is the use of instrumented manikins in HP-CPR training to perfect rate, depth, recoil, ventilation, and peri-shock pause.
Says Bouthillet, “With instrumented manikins, I can tell you that you’re at 96% compression fraction. Depth is 92%. Ventilation volume is 400cc — all spot on. But I see 82% fraction time, which means you pause too often — and now I can give you analytics to tell you how to get better. Because until you’re measured, you have no way to know how to improve.”
Misconception #2 — “HP-CPR is just a new protocol.”
A key Resuscitation Academy mantra is “performance, not protocol”. Whatever protocol you’re following, do it well — as if someone’s life depends on it.
To dismiss HP-CPR as simply the latest protocol improvement leaves out the important part: performance. Practicing it, measuring it, applying it, mastering it, then repeating the process all over again —that’s what makes HP-CPR effective.
Misconception #3 — “HP-CPR is all about training.”
Unfortunately, training is the (relatively) simple and straightforward component of HP-CPR. The challenge is recognizing that change is needed, then making it stick.
Admitting that your performance warrants improvement can be a difficult pill to swallow —especially when you’re in the business of saving lives. And acknowledging the need for change is just the first step. It needs to be bolstered by a commitment to continuous improvement through training, measurement, and recertification.

There’s no magic bullet, according to Mickey Eisenberg, MD, president of the Resuscitation Academy Foundation. “Fostering change in an entrenched culture is likely the toughest task most leaders will ever face. Until an organization truly wants to measure performance, it will not move forward.”

This change in culture is important for many reasons, adds Bouthillet. “We can talk about the ‘atmosphere of continuous quality improvement,’ but what’s often overlooked is what it does for employee morale. Who doesn’t want to be good at their job? And in this case, we’re not making widgets. We’re giving people another chance at life.”

Improved outcomes start today

Past experience tends to guide future experience. Once teams train and practice their craft as if they intend to save a life — and do — then success becomes the new normal. Start by asking yourself, your teammates and your organizational leaders, “How can we do better?”, and you’ll be on the way to a high-performance new normal.

Next post…

Tips for implementing a HP-CPR EMS training program
[i] Christenson, Jim, et al. “Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.” Circulation 120.13 (2009): 1241-1247.

Leer en la AHA sobre el sistema gratuito PIT CREW CPR 
(HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) 

(HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) 

(HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) 
¿Que es pit crew CPR? (HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) 

is a professional and International recognized continuing education provider. Todd Soard hase offered a wide range of courses to fulfill your needs since 1992 that includes CPR, ACLS, PALS, Trauma, EMT Refresher, and Paramedic Refresher, plus much more. We are an AHA Training Center and welcome qualified AHA instructors to be part of our family. EMT & PARAMEDIC REFRESHER INFO SEASONED PROS ALL OF OUR INSTRUCTORS HAVE YEARS OF EXPERIENCE THAT SURPASSES OTHERS AHA COURSES EETI offers all AHA courses and is a Training Center for the AHA. Learn More Our professional staff includes medical personnel with years of experience that surpasses other Training Centers. While others are instructing, our vast staff of Instructors are teaching you to be a better provider in caring for others. 
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Cursos de Trauma Reconocidos a Nivel Internacional,,, No tires tu dinero
Dr. Ramon Reyes, MD

¿Que es pit crew CPR? (HIGH QUALITY CPR-AHA (RCP de Alta Calidad del ILCOR American Heart Association) http://emssolutionsint.blogspot.com.es/2017/03/que-es-pit-crew-cpr-high-quality-cpr.html

EMS Providers Resources

Cardiocerebral Resuscitation (CCR) Demonstration Project
The purpose of this project is to improve survival from out-of-hospital cardiac arrest (OHCA).
The Cardiocerebral Resuscitation Demonstration Project was initiated in January, 2005, after approval by the Bureau of EMS & Trauma System and the EMS Council of Arizona.
This protocol is specifically for trained EMS providers after training and approval by their Administrative Medical Director. The training is provided by the Bureau of EMS & Trauma System.
The CCR protocol is designed for adult cardiac arrest. Patients less than 8 years of age, drowning patients, drug overdose patients, trauma patients, and respiratory arrest patients are excluded.
The CCR protocol focuses on providing the optimal timing for defibrillation, minimizing interruptions to chest compressions, minimizing pauses between chest compressions and defibrillation, early administration of intravenous epinephrine, and minimizing over-ventilation during cardiac arrest.
To be eligible for participation in the CCR Demonstration Project, EMS agencies must first provide a minimum of 6 months of historic OHCA data and commit to providing continued OHCA data to the secure HIPAA compliant SHARE database.

No data is revealed to any other entity.
Cardiocerebral Resuscitation Research Training Videos 
Cardiocerebral Resuscitation Research & Articles
Additional Resources

MANUAL DE ATENCIÓN AL PARTO EN EL ÁMBITO EXTRAHOSPITALARIO. Ministerio de Sanidad, Servicios Sociales e Igualdad. España

Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR http://emssolutionsint.blogspot.com/2017/09/guia-para-el-manejo-medico-quirurgico.html
CIRUGÍA DE GUERRA TRABAJAR CON RECURSOS LIMITADOS EN CONFLICTOS ARMADOS Y OTRAS SITUACIONES DE VIOLENCIA VOLUMEN 1 C. Giannou M. Baldan CICR http://emssolutionsint.blogspot.com.es/2013/01/cirugia-de-guerra-trabajar-con-recursos.html

Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España http://emssolutionsint.blogspot.com/2017/09/manual-suturas-ligaduras-nudos-y.html

Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina http://emssolutionsint.blogspot.com/2015/01/tecnicas-de-suturas-para-enfermeria.html

Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria http://emssolutionsint.blogspot.com/2013/09/manual-practico-de-cirugia-menor.html

Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016 http://emssolutionsint.blogspot.com/2016/09/protocolo-de-atencion-para-cirugia.html
Manual de esterilización para centros de salud. Organización Panamericana de la Salud http://emssolutionsint.blogspot.com/2016/07/manual-de-esterilizacion-para-centros.html
  GEOLOCALIZACION Desfibriladores  
Republica Dominicana  
TELEGRAM Sociedad Iberoamericana de Emergencias https://t.me/joinchat/GRsTvEHYjNLP8yc6gPXQ9Q       

IMPEDANCIA en la RCP Avanzada y Básica BLS-ACLS
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