A story worth studying - well done to All involved @EMDocJB @DrPaulRees and others

@thepasteurpoint @EduardArgudo @ERC_resus @LDNairamb Indeed! Though it’s very pleasing to see physiology-guided resuscitation finally make it into the guidelines for medical cardiac arrest - using intra-arterial DBP >30 mmHg and EtCO2 >3.3KPa where this is deployed Agree with my learned friend @EMDocJB that a DBP (as a surrogate

@DrPaulRees @HaldenHB @DefProfEM @Pipes_n_pumps @emccdoc @phemDM @ShadmanAziz2 @talherer @nigeltai @ZackShinar @EMManchester @MaxMarsden83 Oh, and the amazing @TheResusRoom legends for producing this podcast summarising all of the above and more! https://t.co/Gb3u2iW5ie

Finally, a massive thank you to everyone who has been part of this crazy #SPEAR journey Co-founder: @DrPaulRees Friends, colleagues, supporters: @HaldenHB @DefProfEM @Pipes_n_pumps @emccdoc @phemDM @ShadmanAziz2 @talherer @nigeltai @ZackShinar @EMManchester @MaxMarsden83

And the training continues… We want to make this a technique that can be used by all “resuscitators” The worldwide presence continues in 🇧🇪 🇳🇱 🇩🇪 🇫🇷 🇧🇷 🇬🇧 @emtaccs @HaldenHB @LionelLamhaut @alice_hutin @EviSteen https://t.co/y3oqL7ujgx

So what next? Physiology-guided CPR needs to be augmented with other exciting work looking at area of maximal effective compression, avoidance of LVOT compression and optimising pharmacological support to OHCA, potentially utilising closed loop feedback models (AI again 🤦‍♂️)

To be recognised in the latest guidelines is a fantastic step forward. Arguably the DBP target recommendation should be higher (35mmHg) and I disagree with the “specialist settings” and “expert resuscitators” comments as they are hard to define But it’s all positive progress!

Due to the insane dedication of @ShadmanAziz2 we were finally able to clean the data and evidence what we were seeing clinically - improved DBP leads to improved ROSC ➡️ https://t.co/2COg8dBH5d

Then came the data! Using the @zollemsfire X series monitor we were able to download a huge amount of data from each and every case we attended and utilised invasive blood pressure monitoring But analysis was challenging

We realised there must be more we could do to augment DBP. Using our experience from introducing REBOA to the @DMS_MilMed we started to write a protocol for the ERICA-ARREST study - using Z1 REBOA in OHCA ➡️ https://t.co/UEr9HqOVIa ➡️➡️ https://t.co/gnzXhgnfAJ More to follow!

This rapidly became a standard of care and we were able to train more providers to successfully implement the technique in the field. Feedback was positive “much easier to recognise ROSC” “I could see the diastolic improving, I knew we were doing the right thing”

Next came implementation: cautious, progressive, safe Delivering focused skills training and utilising the highest specification of kit to maximise chances of success and reducing the risk of complications ➡️

We took inspiration from other teams around the world who had already developed protocols based on measuring the IBP Specifically, looking at improving the Diastolic (DBP) - the main determinant of coronary perfusion

In order to undertake IBP monitoring in OHCA the femoral artery is preferred, but first we needed an ultrasound device that would allow visualization of the deeper vessels during CPR @ButterflyNetInc @emccdoc ➡️

At @EastAngliAirAmb IBP monitoring was already implemented for monitoring head injured patients or those undergoing PHEA. This was undertaken at Physician discretion using radial “flow switch” devices ➡️

We noted that invasive blood pressure measurement is an established standard of care in critical care, yet for the most critical medical emergency (cardiac arrest) we relied on highly inaccurate “pulse checks” and surrogate markers of perfusion - etCO2/cerebration

“Physiology-Guided CPR” 🚨🚨🚨 The inclusion of “physiology-guided CPR” in the ERC resuscitation guidelines marks a significant milestone in progress. So here are my reflections on the journey we have undertaken and thoughts on the future directions #SPEAR 🧵

Such an exciting development @EMDocJB ! We’ve talked about this becoming reality for many years! 💪 #cardiacarrest #advancedresuscitation #beyondthealgorithm

An exciting development for the #SPEAR course happened overnight. Cannot wait to see what the next phase holds and to advance resuscitation training in the UK beyond the algorithm #IYKYK @DrPaulRees @HaldenHB @Pipes_n_pumps

Congratulations to the winners of our Lightning Presentation and Poster Competitions! We received an incredible number of high-quality submissions this year, and our judges were truly impressed by the educational depth and rigour on display. 🏆 Lightning Presentation 🥇 First