EMCrit Podcast EMCrit RACC 228 – Physiology-Guided Cardiac Arrest Management in 2018 with Dr. Robert Sutton
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Jul 11, 2018 Robert Sutton, pediatric intensivist and cardiac arrest researcher, outlines physiology-guided resuscitation. He covers arterial and central access strategies, arterial blood gas–driven ventilation, diastolic pressure targets for kids, use of CVP and NIRS, vasopressor strategies including epinephrine and vasopressin, when to consider ECMO, and optimizing compressions and monitoring during CPR.
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Get Early Repeated ABGs To Guide Arrest Care
- Obtain an arterial blood gas early and repeat roughly every 6 minutes to find reversible causes and guide ventilation.
- Sutton uses ABGs to detect fixable derangements (glucose, K, Ca, pH) and to titrate ventilation strategy during CPR.
CVP Trends Inform Volume And Pulmonary Resistance Decisions
- Use CVP trends to infer intravascular volume during pediatric arrests but interpret in context.
- Sutton notes low CVP may prompt venous return maneuvers or fluid, while sepsis models sometimes need pulmonary vasodilation too.
Use ITD When Hemodynamics Are Poor During CPR
- Consider using an impedance threshold device (ITD) when hemodynamic goals are unmet to improve venous return.
- Sutton thinks ITD is reasonable across ages if pressures are low despite standard CPR.