CARDIOPULMONARY 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

IndicationAny 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 procedureBasic 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

BLSBLS 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

Simplified 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 criticalThe 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 victim’s airway, pinch the victim’s 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 victim’s lungs.

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 out-of-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