AHA 2010 - 2015

Guidlines for CPR

by
Dody Firmanda
 HISTORICAL REVIEW
 5000 - first artificial mouth to mouth
3000 BC ventilation
 1780 – first attempt to rescucitate a newborn
by blowing
 1874 – first experimental direct cardiac
massage
 1901 – first successful direct human cardiac
massage
 1946 – first experimental indirect cardiac
massage and defibrillation
 1960 – indirect cardiac massage
 1980 – development of cardiopulmonary
resuscitation arrising from the works of
Peter Safar

2
 all cases accompanied by
hypoxia
extracardiac

Causes of cardiac
arrest

cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors 3
 Causes of circulation arrest
Cardiac Extracardiac
Ischemic heart disease
(myocardial infarction, airway obstruction
stenocardia)
Arrhythmias of different
acute respiratory failure
origin and character shock
Electrolytic disorders
Valvular disease reflector cardiac arrest
Cardiac tamponade embolisms of different
Pulmonary artery origin
thromboembolism
Ruptured aneurysm of drug overdose
aorta
poisoning
4
ABC  CAB
2005 : 2 rescue breaths followed by 30 chest
compressions and then 2 breaths
2010 : initial chest compression before
ventilation
Reasons :
Chest compression deliveres blood to heart and brain
Early compression had good outcome


Elimination Look, Listen, Feel
2005 : Look, listen and feel used to assess
breathing after opening airway
2010 : After 30 compressions the lone rescuer
opened victim’s airway and delivered 2 breaths
Reasons :
With the new chest compression, first sequence CPR
is performed if the adult is unresponsive and not
breathing or not breathing normaly (C-A-B sequence)
Chest compression at least 100 per minute

2005 : Compress at a rate 100 per minute

2010 : reasonable for a lay and healthcare
provider to perform chest compression at least
100 per minute
Reasons :
Push hard and fast
Compression delivered per minute is an important
determinant of ROSC
More compressions are associated with higher
survival rates
Chest compression Depth

2005 : The adult sternum should be depressed

approximately 1,5 to 2 inches (4-5cm)
2010 : sternum should be depressed at least 2
inches (5cm)
Reasons :
Compression creates blood flow primarily by increasing
intrathoracic pressure and directly compressing the
heart. Compressions generate critical blood flow,
oxygen and energy delivery to the heart and brain
Shock first vs CPR First

2010 (Reaffirmed 2005)

When any rescuer witnessing an out-of-hospital
arrest and AED,and who is immedietly available
on site, should start CPR with chest
compressions and use the AED as soon as
possible
1-shock vs 3 shock sequence

2010 (no change from 2005)

Jika 1 syok gagal untuk menghilangkan VF,
manfaat tambahan dari syok yang lainnya
adalah perawatan yang rendah pada serangan
jantung VF
Defibrilation waveforms and energy Levels

2010 (no change from 2005)

• Data menunjukkan bahwa biphasic gelombang
shock pada pengaturan energi sebanding
dengan atau lebih rendah dari 200-J kejutan
monophasic setara atau lebih tinggi memiliki
keberhasilan dalam mengakhiri VF
• Defibrilator pada dosis maksimum dapat
diperhitungkan.
Supraventricular Tachyarrhytmia

2005 : The recommended initial monophasic

energy dose for cardioversion of AF is 100 to
200 J
2010 : recommended initial biphasic energy
dose for cardioversion of AF is 120-200 J, And
monophasic is 200 J
Ventricular Tachycardia

2010 :
o Adult stable monomorphic VT responds well
to monophasic or biphasic cardioversion shock
at initial energies of 100 J
o Cardioversion should also not be used for
pulseless VT or polymorphic VT (irregular VT)
New Medication Protocols

2010 : Atropine is not recommended for routine

use in the management of PEA/Asystole and
has been romoved from the ACLS Cardiac
Arrest Algorithm
Adenosine is recomended in the initial diagnosis
and treatment of stable, monophormic wide
complex tachycardia
Atropine unlikely have therapeutic benefits
during PEA or asystole
Tapering of inspired Oxygen
Concentration After ROCS based on
monitored Oxyhemoglobin Saturation

2005 : No Specific information about weaning

was provided
2010 :
Once the circulation is restored, monitor arterial
oxyhemoglobin saturation
Titrate oxygen administration to maintain the
arterial oxyhemoglobin saturation ≥ 94%
Cont.......

Why :
An Oxygen saturation of 100% may correspond
to a PaO2 anywhere between approximately 80
and 500 mmHg
A recent study has documented the harmful
effects of hyperoxia after ROSC
 Perawatan setelah henti jantung
• Mengoptimalkan fungsi cardiopulmonary dan
perfusi organ vital setelah ROSC
• Transportasi ke rumah sakit atau unit perawatan
kritis dengan sistem perawatan komprehensif paska
henti jantung
• Identifikasi dan intervensi untuk sindrom koroner
akut (ACS)
• Suhu kontrol untuk mengoptimalkan pemulihan
neurologis
• Antisipasi, pengobatan, dan pencegahan disfungsi
organ multiple
 DC shock
Oles dulu paddles
dengan jelly ECG tipis
rata, baru kemudian :

1. Switch ON
Pasang paddles pada posisi
apex dan parasternal sternum
(boleh terbalik)

apex
2. Charge 360 Joules DC shock
(Non-synchronized)
Ucapkan dengan keras :
Awas semua lepas dari pasien!
nafas buatan berhenti dulu
bawah bebas,
samping bebas,
atas bebas, sternum
saya bebas!
3. Shock!! apex apex
(tekan dua tombol paddles bersama)
Lepas paddles dari dada,
lanjutkan chest compression.
4. Segera pijat jantung lagi 2 menit
baru raba lagi/ baca lagi ECG
Position
of the paddles electrodes
on thorax of an infant sternum

apex

Size of paddle electrode

- 4.5 cm diameter for infants and small children
- 8-12 cm diameter larger children
Jelly kurang rata, menekan paddles kurang kuat - luka bakar
INDICATIONS
Defibrillation (Non-Synchronized DC Shock):
VF
Pulseless VT
Recommended joule: 360 J

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INDICATIONS

Synchronized DC Shock (Only with unstable

hemodynamic):

AF
Atrial Flutter start with 50 J
SVT

VT with pulse
start with 100 J
(despite of
Infant and Children: 2
medication) J/kg

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 VT / Ventricular Tachycardia
|
| |
carotis (+) carotis (-)

• Amiodaron • a single shoc 360

300mg Joules
atau • CPR 30 : 2
• Lidocain
1 - 1.5 mg/kg • Managemen VT/ VF
iv cepat
 DO NOT SHOCK!!!
Asystole

Pulseless Electrical Activity

Electro Mechanical Dissociation

Heart Block
Stable hemodynamic with AF, Atrial Flutter, SVT, &
VT with pulse

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 Fine VF :
If there is a doubt about whether
the rhythm is asystole or fine-VF
do NOT attempt defibrilation,
continuous chest compression and
ventilation
Fine Ventriculer Fibrilation

Coarse Ventriculer Fibrilation

 VF / pulseless VT

1). a single shock

Biphasic 150-200 Joule
Defibrilation strategy Monophasic 360 Joule
CPR 30 : 2
2 MINUTES, 30 : 2

NO Check ECG
YES
Check pulse

2). a single shock ROSC

Biphasic 150-360
Joule Recovery of
2 MINUTES, 30 : 2 Spontaneous
Monophasic 360 Joule
Circulation
Adrenaline
 VF/ VT
Intubasi : as soon as possible, without stop CPR Pijat >100x/menit
Nafas 8-10x/menit

Cardiac adrenalin adrenalin

arrest VF / VT
2 menit 2 menit

2 menit 2 menit
CPR -1 Amiodaron
a single shock a single shock a single shock a single shock
30 : 2 a single shock
CPR-2 CPR-3 CPR-4 CPR-6
CPR-5
CALL adrenalin
FOR Amiodaron is the first choice
HELP 300 mg, bolus. Repeated 150 mg
Adrenaline: 1 mg, iv,
for reccurrent VT/VF. Followed by
PASANG repeated every 3-5
900 mg infusion over 24 hours
MONITOR minutes
LIDOCAIN. Do not exceed
a total dose of 3 mg/kg,
Evaluasi CPR : tiap 2 menit during the first hour.
TERIMA KASIH