What is CCR?
Cardio Cerebral Resuscitation (CCR) is a systematic approach to delivering resuscitative care to the patient in cardiac arrest. It is comprised of three pieces:
- Hands only bystander CPR
- Prehospital provider CPR focusing on high
quality compressions with minimal
interruptions, early defibrillation and
administration of epinephrine when appropriate
- Transport to a cardiac arrest center. This would be a designated tertiary care center that specializes in the patient in cardiac arrest and the post arrest patient. Transport decisions would be made for these patients much like traumas or strokes.
So… How Well Does it Work?
The research looking into the efficacy of CCR has been promising. Here are the highlights:
- A retrospective study out of Wisconsin looked at the survival rates from their first year of implementing CCR. They tripled their neurologically normal survival rates compared to the 3 years prior to implementing a CCR protocol.
- A study out of Arizona, that included multiple EMS agencies, saw the state’s cardiac arrest survival rates jump from 5% to 18%.
How is it Done?
The EMS component of CCR is fairly simple. When the EMS crew arrives on scene, the provider will continue compressions at a rate of 100 per minute for 200 compressions. At the end of 200 compressions, the provider will do a cardiac rhythm analysis and deliver a shock. This will be immediately followed by 200 more compressions. As soon as possible, IV/IO access should be established and Epinephrine should be administered if indicated. Airway management should be delayed and should be limited to passive oxygenation via non-rebreather mask at a high flow rate. If there are other providers available, the airway management may include an oropharyngeal or nasopharyngeal airway in the early stages of resuscitation. The provider may switch to a conventional ACLS approach after 4 rounds of CCR. Transport should be to a designated Cardiac Care Center.