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ADULT CPRADULT CPR
dr. Alfan Mahdi Nugroho, SpAnDept Anestesiologi & Intensive Care
RSCM - FKUI
How the guidelines put together ?
ILCOR
AHA ERC
International Liaison Committee On Resuscitation
HSFC RCA ANZCORRCSA IAHF
ILCOR worksheethttp://www.ilcor.org/en/consensus-2010/worksheets-2010/
AHA guidelines ERC guidelineshttps://www.erc.edu/index.php/doclibrary/en/209/1/http://circ.ahajournals.org/content/vol122/18_suppl_3/
The ChangesAHA 2005
AHA 2010
ERC 2010
CaveatsAHA 2010
ADULT BLS
•IMMEDIATE RECOGNITION•ACTIVATE RESPONSE•CPR•EARLY DEFIBRILLATION
AHA 2010
AHA 2010
•Check pulse (10s)
• breath 8 - 10 X, recheck pulse
ERC 2010
BLS KEY CHANGES AND point of
emphasis•No responsiveness and absence of
normal breathing. ~ immediate recog.•LOOK LISTEN and FEEL •CAB from ABC•Chest compression quality•de-emphasis pulse check•building blocks...
AHA 2010
BLS KEY CHANGES AND point of emphasis
High Quality Compression
•adequate rate (100 X /menit)•adequate depth (5 cm adult and children,
4 cm infants or 1/3 ap diameter)•allow recoil•minimize interruption (exc adv airway &
defib)
•avoid excessive ventilation•rotation (2 minutes or 5 cycles)
AHA 2010
~ provide 25-33% normal CO
CAB vs ABC
•No evidence showed improved outcomes
•Flow depends on compressions•Shorter delay, cut interruption
CAB vs ABC
CAB vs HANDS ONLY CPR
AHA 2010
Building blocks of CPR AHA 2010
Remember the blocks
Airway•Mouth to mouth or mouth to mask•bag mask ventilation (trained, lone
rescuer not recommended)
•endotracheal tube (trained and freq only, interruption should < 10 sec)
•esophageal tracheal tube, laryngeal tube, laryngeal mask ~ alternatives
Breathing•30:2 visible chest raise (6-7
kg/BW) over 1 sec•>40% FiO2 for HCP•10-12 times/minute or every 5-6
seconds•Non synchronous if intubated
ALS KEY CHANGES AND point of
emphasis•Continuous quantitative waveform
capnography•Emphasizing chest compressions•Atropine•Emphasis on physiologic monitoring•Adenosine recommended for regular
monomorphic wide-complex tachycardia
AHA 2010
ALS KEY CHANGES AND point of
emphasis
AHA 2010
AHA 2010
ERC 2010
Post Cardiac Arrest Care AHA 2010
post cardiac arrest care
•Therapeutic hypothermia for comatose, unresponsive pts
•32-34oC for 12-24 hours•Monitor continuously core
temperature •Passive rewarming
OUTCOME
•ROSC•SURVIVAL•HOSPITAL DISCHARGE•+ DISABILITY?
Circulation. 2006;114:2760 –2765.
Caveats•Early CPR and rapid defibrilation
significantly increase chance for survival to hospital discharge
•ACLS tx ~ some meds and advanced airways increase rate of ROSC but have not been shown to increase rate survival and hospital discharge
Circulation 2006;114;2839-2849
Caveats
Peds
TERIMA KASIH
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