CARDIO PULMONARY RESUSCITATION 2010

Djayanti Sari

Cardiopulmonary resuscitation (CPR): is a series of life saving actions that improve the chance of survival following cardiac arrest. Optimal approach to CPR may vary, depending on the rescuer, the victim and resources, still the fundamental challenges remains: how to achieve early and effective CPR

Cardiac arrest occurs: in and out of hospital In US & Canada: 350.000 people/yr (half in hospital) cardiac arrest and receive attempted resuscitation. Not included without attempted resuscitation. Inappropriate resuscitation many lives & life-years lost

Successfull resuscitation requires an integrated set of coordinated actions Chain of survival

immediate recognition and activation early CPR rapid defibrilation effective advance life support integrated post-cardiac arrest care

BASIC LIFE SUPPORT

Basic Life Support (BLS) is the foundation for saving lives following cardiac arrest Fundamental aspects of BLS:

immediate recognition of sudden cardiac arrest (SCA) and Activation of emergency response system Early cardiopulmonary resuscitation (CPR) rapid defibrillation with automated external defibrillator (AED)

The universal Adult Basic Life Support is a conceptual framework for all levels of rescuers setting.

Early recognition & activation

Ensuring the scene is safe Check unresponsiveness: no movement no response on stimulation (shouting or tapping his shoulder) activate the emergency response (call 911) check breathing: no breathing

abnormal breathing (ie gasping)

check pulse
For:

lay rescuer: shouldnt check! suddenly collapses/unresponsive, no/abnormal breathing assume cardiac arrrest start chest compression health provider: <10 !! more start chest compression

Early CPR
CHEST COMPRESSION
-

consist of forceful rhythmic of pressure over the lower half of the sternum Create blood flow by increasing intrathoracic pressures & directly compressing the heart blood flow & oxygen delivery to myocardium & brain effective essential chest compression are

How to do chest compression ?

lower half of sternum push hard, push fast at least 100 compression/minutes at least 2 inch or 5 cm depth allow complete recoil compression & ventilation ratio= 30:2 minimal compression interruption

It is recommended to switch chest compressors @2 mnt or after 5 cycles, and should <5 seconds to check pulse after cycles, NOT recommended for lay rescuers (do not stop the chest compression). But, its ok for health provider, and still <10 s.

interuption for health care provider: to check pulse, to intubate and to defib.

Rescue breaths:
start immediately, after head positioning, but after chest compression mouth to mouth or bag mask ventilation each over 1 second sufficient tidal volume visible chest rise

normal VT 8-10 ml/kg is sufficient in CPR patients (with CO 25-33%), VT 6-7 should be sufficient

ratio with compression still 30:2 risk excessive ventilation: gastric inflation: regurgitation & aspiration intrathoracic pressurevenous returncardiac output survival

Early defibrillation with an AED

VF is common & treatable initial rhythm in adults with witnessed cardiac arrest VF case, survival highest when CPR is provided & defib occurs within 3-5 of collapse Rapid defib is tx of choice for VF of short duration such as witnessed out of hospital or hospitalized patient cardiac arrest. AED should be used as rapidly as possible Defibrillation sequence:
Turn on the AED follow the AED prompts Resume chest compression immediately after the shock (minimize interruptions)

Rescuers specific strategies:

1. Untrained Lay rescuer: Hand-only CPR until AED or health provider arrive. push hard and push fast or by emergency medical dispatchers direction 2. Trained Lay rescuer: chest compression and breathing ratio= 30:2 do until EMS arrive or health care provider take over

3. Health care provider: 30:2 cycle until advanced airway is placed after that, give ventilation, 1 breath: 6-8 second, or 8-10 x/mnt Avoid excess ventilation To activate EMS for lone provider: as seen the patient get collpase or ie in drowning or airway obstruction case, 5 CPR cycles first, then activate EMS

Adult BLS for health care provider

managing the airway

for trained Lay rescuer who could do both chest comp & ventilation head tilt & chin lift for hands-only cpr insufficient evidence to recommend them to use of any specific passive airway for health care provider:
-

no cervical spine injury head tilt & chin lift

susp cervical spine injury:

initially use manual spinal motion restriction (eg placing 1 hand on either side of patients head to hold it still) rather than immobilization devices

jaw thrust without head extention.

when advanced airway device is placed, no interuption anymore for ventilation. - chest compression: 100x/mnt - ventilation : every 6-8 second, or 8-10 breaths/mnt

Recovery Position
is used for unresponsive patient who clearly have normal breathing and effective circulation

Key changes & continued points of emphasis from the 2005 BLS:
immediate recognition of SCA based on unresponsiveness & absence of normal breathing Look, Listen and Feel removed from BLS Hands-Only CPR for untrained lay-rescuer Sequence ABC CAB Health care providers continue CPR untill return of spontaneous circulation or termination of resuscitative efforts Increased focus on methods to ensure high quality CPR is performed

continued de-emphasis on pulse check for health care providers *a simplified adult BLS algorithm is introduced Recommendation of simultaneous, choreographed approach for chest compression, airway management, rescue breathing, rhythm detection, and shocks (if appropriate) by an integrated team of highly-trained rescuers in appropriate setting