CARDIOPULMONAR

Y RESUSCITATION

Advisor : dr.Nicholas P.S, Sp.An

By :
Clarissa Maya T (2008.04.0090)
Yoseph Jappi (2009.04.0.0088)

Definition
An emergency procedure performed in an
effort to manually preserve intact brain
function until further measures are taken to
restore spontaneous blood circulation and
breathing in a person who is in cardiac arrest

Indication
Any person unresponsive to
stimulation with no breathing or
breathing only in occasional agonal
gasps, as it is most likely that they are
in cardiac arrest

Contraindication
Death sign
In circumstances when the CPR
would be medically futile

Goals
Preserve the cardiac output and
oxygen delivery to the vital organs
especially brain until the return of
spontaneous circulation (ROSC) is
achieved

CPR procedure
Basic Life Support (BLS) : by the lay
responder or the health care provider at the
scene
Advanced Life Support (ALS) : by the
health care provider at the hospital
The actions included in BLS and ALS is a
continuum, and these collectively named by
AHA as chain of survivals

Components of chain of survivals :

Immediate recognition and activation of
emergency response system
Early CPR, w/emphasis on chest compressions
Rapid defibrillation if indicated
Effective advanced life support
Integrated post-cardiac arrest care

BLS
BLS is foundation for saving lives following
cardiac arrest
The fundamental components of BLS :
1. Immediate recognition of sudden cardiac
arrest an activation of the emergency
response system
2. Early CPR w/emphasis on chest compressions
3. Rapid defibrillation if indicated

Simplifie
d adult
BLS
algorithm

Recognition
Although the gold standard to diagnose cardiac
arrest is the absence of the carotid or femoral
pulse, but for the lay responder, due to the
difficulty in detecting pulse, pulse checking is
not recommended
Every unresponsive, non breathing or
abnormal breathing adults should be
considered as cardiac arrest

Early CPR
To provide effective chest compressions, push
hard and push fast over the lower half of the
sternum
At a rate of at least 100 compressions per
minute with a compression depth of at least 2
inches/5 cm
Rescuers should allow complete recoil of the
chest after each compression, to allow the
heart to fill completely before the next
compression

If multiple rescuers is present, they

should rotate the task of compressions
every 2 minutes

Compression is critical
The chest compressions should be delivered first
before rescue breathing (A-B-C C-A-B)
This is related to the fact that in cardiac arrest, the
oxygen delivery to the vital organs is determined
largely by the blood flow rather than blood oxygen
content
Attempt to insert advanced airway should not
delayed the compression
Hand only CPR (only compression) has the
equivalent survival outcome compared to the
conventional CPR

Airway (C-A-B)
Clean the airway
Open the airway : triple airway
manuever
1. Head tilt
2. Chin lift
3. Jaw thrust
.Head tilt and chin lift is contraindicated
in suspected cervical vertebra trauma

Breathing (C-A-B)
Breathing become more important in cardiac arrest due to
respiratory problems which common in children, drowning
case, and prolonged cardiac arrest
Deliver each rescue breath over 1 second
Give a sufficient tidal volume to produce visible chest rise
1.

Mouth to mouth rescue breathing

2.

Mouth to barrier device breathing

3.

Bag and mask ventilation

4.

Advanced airway

Mouth-to-mouth rescue breathing provides

oxygen and ventilation to the victim.
To provide mouth-to-mouth rescue breaths, open
the victims airway, pinch the victims nose,and
create an airtight mouth-to-mouth seal.
Give 1 breath over 1 second, take a regular (not
a deep) breath, and give a second rescue breath
over 1 second
Taking a regular rather than a deep breath
prevents the rescuer from getting dizzy or
lightheaded and prevents overinflation of the

When the victim has an advanced airway in

place during CPR, continuous chest
compressions are performed at a rate of at
least 100 per minute without pauses for
ventilation, and ventilations are delivered at
the rate of 1 breath about every 6 to 8 seconds
(which will deliver approximately 8 to 10
breaths per minute).

Automated External
Defibrillator (AED)
Cardiopulmonary resuscitation and the use of
AEDs by public safety first responders are
recommended to increase survival rates for outof-hospital sudden cardiac arrest. The 2010 AHA
Guidelines for CPR and ECC again recommend the
establishment of AED programs in public locations
where there is a relatively high likelihood of
witnessed cardiac arrest (eg, airports, casinos,
sports facilities).

BLS for
health
care
provider

Advanced life support

1. High-quality chest compressions with
minimal interruptions
2. Airway management and ventilation
3. Intravenous access and drugs
4. The identification and correction of
reversible factors

Foundation of successful ACLS is good BLS.

Airway management and

ventilation
1. Endo Tracheal Tube
2. Laringeal Mask Airway

 Key changes from ACLS 2005 :

1.

Continuous quantitative waveform capnography is

recommended for confirmation and monitoring of
endotracheal tube placement.

2.

Cardiac arrest algorithms are simplified and redesigned to

emphasize the importance of high-quality CPR

3.

Atropine is no longer recommended for routine use in the

management of pulseless electrical activity (PEA)/asystole.

4.

Chronotropic drug infusions are recommended as an

alternative to pacing in symptomatic and unstable
bradycardia.

Non-shockable rhythms (PEA and asystole)

1. Start cpr 30:2 and give adrenaline 1 mg i.v
2. Give adrenaline 1 mg i.v every 3-5 min
3. If there is doubt about whether the rhythm is
asystole or fine VF, do not attempt defibrilation;
instead, continue chest compressions and
ventilation.
4.Considered advanced airway and capnography

Post-cardiac arrest
care
To emphasize importance of comprehensive multidisciplinary
care through hospital discharge and beyond
Includes:Optimizing vital organ perfusion
Titration of FiO2 to maintain O2 sat 94% and < 100%
Transport to comprehensive post-arrest system of care
Emergent coronary reperfusion for STEMI or high suspicion
of AMI
Temperature control
Anticipation, treatment, & prevents multiple organ
dysfunction.

When do we stop
resuscitation
1. Return of Spontaneous Circulation
2. Rescuer too tired
3. There is someone who can replace us
4. After 30 min 1 hour without
improvement
5. Patient already death definitely

Complications
1. Rib fractures; the most common
2. Sternal fractures
3. Anterior mediastinum bleeding
4. Heart contusion
5. Hemopericardium
6. Pulmonary complications : pnemothorax,
hemothorax, lung contusion
7. Abdominal organ injury : lacerations of the liver
and spleen, damage abdominal viscus