Berg et al. Circulation 2001

9e9e

Chest Compressions effectiveness

Figure 3. Survival with chest compression with and without assisted ventilation. Five minutes after ventricular fibrillation, swine were treated for 8 additional minutes with simulated mouth-to-mouth exhaled gas ventilation (17% O2 and 4% CO2) plus chest compression (CC & vent), chest compression alone (CC alone), or no CPR. No differences could be detected between groups with or without ventilation if chest compression was provided. Both CPR groups tended toward improved survival compared with no CPR. Open bar indicates return of spontaneous circulation; solid bar, 24-hour survival. Data from Berg et al.

Berg RA, Kern KB, Hilwig RW, Berg MD, Sanders AB, Otto CW, Ewy GA. Assistedventilation does not improve outcome in a porcine model of single-rescuerbystander cardiopulmonary resuscitation. Circulation.. 1997;95:1635-1641.

Figure 4. Survival rates in comparison of good quality chest-compression-only CPR. The quality of bystander CPR was assessed by physician observers on ambulances. Comparisons of long-term survival rates are demonstrated after good quality chest-compression-only bystander CPR (CC alone), good quality chest-compression-plus-mouth-to-mouth-ventilation bystander CPR (CC&MMV), good quality mouth-to-mouth-ventilation-only CPR (MMV alone), and no bystander CPR. Outcome after chest-compression-only bystander CPR or chest-compression-plus-mouth-to-mouth-ventilation bystander CPR did not differ. Survival with either of these techniques was superior to survival with no bystander CPR (P<.001). Data derived from two studies of the Belgian Cerebral Resuscitation Study Group.

Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H, Belgian Cerebral Resuscitation Study Group. Quality and efficiency of bystander CPR. Resuscitation.. 1993;26:47-52

Novembre 2003

Call 911

Chest compressions onlyNo more mouth to mouth

Use AED if availlable

Bénéfice du massage cardiaque seul

SOS-KANTO study group. Lancet 2007; 369: 920-26

Plus simple, mieux accepté, continu, échanges d’air passifs…

9 novembre 2007

Suppression du BAB pour le premier témoin dans les recommandations de l’AHA

Minimally Interrupted Cardiac Resuscitation

by Emergency Medical Services

for Out-of-Hospital Cardiac Arrest

BJ. Bobrow et al. JAMA. 2008;299(10):1158-1165

RCP conventionnelle vs MCE continu (MICR: 200 compr. DF 200 comp.)

survie sortie hôpital 1.8 à 5.4% (OR:3)

Bobrow et coll, Circulation. 2009;120:S1443

• A total of 506 patients (mean age 64 years; 80% men) were enrolled from seven sites and 78 agencies. All patients had confirmed ventricular fibrillation or ventricular tachycardia prior to EMS arrival between December 2005 and March 2007.

• In addition, – 34% arrested in a public location, – 71% were witnessed by bystanders,– 51% received bystander CPR.

• The presence and frequency of chest compressions for each patient were measured with automated external defibrillators.

• Overall, 117 of the patients ( 23% ) survived to hospital discharge.

Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009;.

• Return to spontaneous circulation was achieved – 58% of the time when the CCF was 0% to 20%, – 73% when the CCF was 21% to 40%, – 76% when the CCF was 41% to 60%, – 73% when the CCF was 61% to 80%, – 79% when the CCF was 81% to 100%.

Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009;.

ROSC %

50556065707580859095

100

0-20 21-40 41-60 61-80 81-100

ROSC %

• Survival to hospital discharge occurred in – 12% of the patients when the CCF was 0% to 20%,– 22.9% when the CCF was 21% to 40%, – 24.8% when the CCF was 41% to 60%, – 28.7% when the CCF was 61% to 80%.– 25% when the CCF was 81% to 100%.

Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009;.

STHD %

0

5

10

15

20

25

30

35

0-20 21-40 41-60 61-80 81-100

STHD %

Et l’oxygène ?

ACAC

Phase de RCPPhase de RCP

Réanimation post RACSRéanimation post RACS

RACSRACS

LowLow flowflowPhase Phase

circulatoirecirculatoire

No flowNo flowPhase Phase

électriqueélectrique

ReperfusionReperfusionPhase Phase

métaboliquemétabolique

Déb

it ca

rdia

que

Déb

it ca

rdia

que

Perf

usio

n tis

sula

ire (%

)Pe

rfus

ion

tissu

laire

(%)

100100

5050

00

HypothermieHypothermie

min 0 4 10

MCE + O2MCE + O2DAEDAE

Copyright restrictions may apply.

Wik, L. et al. JAMA 2003;289:1389-1395.

Estimated Probability of Survival to Hospital Discharge Plotted Against Response Time

AED first CPR first

Mais arrêt de ROC PRIMED 2

Prehospital Resuscitation using an IMpedance valve and Early versus Delayed

CEE immédiat versus CEE après 3 minutes de CT

Valve d’impédance

Pas de différence…

9 novembre 2009

11500 ACR inclus

AUTOPULSE LUCASLUCASDISPOSITIFS AUTOMATIQUES

VOIE IV > IO > IT

Hypothermie ?

• Sérum salé 30 ml/kg 4 °C • Pré-hospitalier

MILD HYPOTHERMIA