CPR based on 2010 guidelines

1. CARDIOPULMONARY
RESUSCITATION
SANIL VARGHESE

2. HISTORICAL REVIEW
• In the 19th century, Doctor H. R. Silvester
described a method “The Silvester Method”.
• Holger Neilson technique was in the United States
in 1911.
• In the 20th century at Johns Hopkins University
where the technique of CPR was originally
developed. The first effort at testing the
technique was performed on a dog by Redding,
Safar and JW Perason. Soon afterward, the
technique was used to save the life of a child.
• Peter Safar wrote the book ABC of resuscitation in
1957.

3. CPR For Health Care Providers
• Adult
• Child
• Infant

4. Terminology
• BLS / BCLS
• ALS / ACLS
• Arrest, Cardiac
Arrest, Code, Code
Blue
• Respiratory Arrest
• Ventilations

5. Diagnosis of cardiac arrest
Blood pressure measurement

Taking the pulse on peripheral arteries

Auscultation of cardiac tones
Loss of time !!!
Symptoms of cardiac arrest
absence of pulse on carotid arteries – a
pathognomonic symptom
3
3 respiration arrest – may be in 30 seconds after
cardiac arrest
3 enlargement of pupils – may be in 90 seconds after
5
cardiac arrest

6. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Health Care Provider*
 “PUSH HARD AND PUSH FAST”
 At least 100 COMPRESSIONS / MINUTE*
 Allow the chest to recoil -- equal compression and relaxation times
 <10 seconds for pulse checks or rescue breaths
 Compression Depth*
 Adults 2”
 Child/Infant 1/3 depth of chest
 Avoid excessive ventilations
1.5" infant
2" child

7. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
 A-B-C changed to C-A-B*
 Critical element is chest compressions
 Delay in A-B
 Avoidance of A & B
 Early defib
 If alone--call and retrieve AED
 Exception asphyxial arrest

8. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
• Cricoid pressure not recommended
• Advanced airway = 1 every 6-8 seconds
• Adult: 1 every 5-6 Peds: 1 every 3
• With advanced airway- no pause

9. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
AHA ECC Adult Chain of Survival - New

10. AMERICAN HEART ASSOCIATION:2010 GUIDELINES
Simplified Universal
BLS algorithm

11. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Electrical Therapies
• Shock first vs CPR first
• No precordial thump
• AED in hospital (goal to shock =< 3 mins)
• Use in infants (with or without attenuator)

12. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
ACLS
•
•
•
•
•
•
•
Simplified algorithm
Optimized CPR quality with monitoring
Waveform capnography (>12 mmHg)
Atropine deleted (PEA/Asystole)
Chronotropic drugs for brady, then pacing
Adenosine safe for monomorphic wide tachs
Post-cardiac arrest

13. AMERICAN HEART ASSOCIATION
CAPNOGRAPHY

14. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Post-Cardiac Arrest – ROSC
• Therapeutic Hypothermia
– Remain comatose
– 32-34 degree C (all ages) (89.6-93.2 F)
– 12-24 hours
• PCI
• O2 sat ≥94% & PETCO 35-40

15. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Special Resuscitation Situations
• Asthma
• Hypothermia
• Anaphylaxis
• Avalanche
• Pregnancy
• Drowning
• Morbid obesity
• PE
• Electrolyte imbalance
• Toxins
• Electric shock/lightening
• PCI
• Cardiac tamponade
• Cardiac surgery

16. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Acute Coronary Syndromes
• Out of hospital 12-lead
• Triage to PCI
• Oxygen – > 94 % is the goal (capno)
• Morphine – use with caution in UA/non-STEMI

17. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Stroke
• Stroke-prepared hospitals
• Triage to stroke centers
• TPA up to 4.5 hours

18. C. Circulation
Restore the circulation, that is
start external cardiac massage
18

19. Hand Position
• At the nipple line
• Off the zyphoid process
2 fingers = infant
1 hand = child
2 hands = adult

20. A (Airway)
ensure open
airway
20

21. Open the airway using a head
tilt lifting of chin. Do not tilt the
head too far back
Check the pulse on
carotid artery using
fingers of the other hand
21

22. B (Breathing)
Tilt the head back
and listen for. If
not breathing
normally, pinch
nose and cover
the mouth with
yours and blow
until you see the
chest rise.
22

23. VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA
Witnessed
Unwitnessed
Precordial thump
Check pulse, if none:
Begin CPR
Defibrillate with 200 joules
Defibrillate with 200-300 joules
Establish IV access, intubate
Adrenaline 1 mg push
Defibrillate with 360 joules
Lidocaine 1 mg/kg IV, ET
Defibrillate with 360 joules
23

24. Operations in case of asystole
Asystole
Start CPR
• IV line
• Adrenaline:IV 1 mg, each 3-5 min.
-or
- intratracheal 2 - 2.5 mg
- in the absence of effect increase
the dose
-Atropine 1 mg push (repeated once
in 5 min)
•
•Na Bicarbonate 1 Eq/kg IV
•Consider pacing
24

25. Drugs used in CPR
• Atropine – can be injected bolus, max 3 mg to
block vagal tone, which plays significant role in
some cases of cardiac arrest
• Adrenaline – large doses have been
withdrawn from the algorithm. The
recommended dose is 1 mg in each 3-5 min.
• Vasopresine – in some cases 40 U can
replace adrenaline
• Amiodarone - should be included in algorithm
• Lidocaine – should be used only in ventricular
fibrillation
25

26. Public Access Defibrillation -PAD
•
•
•
•
•
Casinos
Airports
City buildings
Senior centers
Gated communities

28. Complications of Compressions
•
•
•
•
fractured ribs
fractured sternum
lacerated lungs
lacerated liver, blood vessels, etc,.

29. 2010 AHA GUIDELINES
Recommendations
Component
Recognition
Adults
Children
Infants
Unresponsive (for all ages)
No breathing or
no normal
breathing (ie, only
gasping)
No breathing or only gasping
No pulse palpated within 10 seconds for all ages (HCP only)
CPR sequence
Compression rate
Compression
depth
C-A-B
At least 100/min
At least 2 inches (5 At least 2 inches (5
cm)
cm)
About 1. inches (4
cm)

30. Component
Adults
Recommendations
Children
Infants
Chest wall recoil
Allow complete recoil between compressions
HCPs rotate compressors every 2 minutes
Compression
interruptions
Minimize interruptions in chest compressions
Attempt to limit interrruptions to <10 seconds
Airway
Compression-toventilation
ratio (until advanced
airway placed)
Ventilations: when
rescuer
untrained or trained and
not proficient
Head tilt–chin lift (HCP suspected trauma: jaw thrust)
30:2
1 or 2
rescuers
30:2
Single rescuer
15:2
2 HCP rescuers
Compressions only

31. Ventilations with
advanced
airway (HCP)
Defibrillation
1 breath every 6-8 seconds (8-10
breaths/min)
Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
Attach and use AED as soon as available.
Minimize interruptions in chest
compressions before and after shock;
resume CPR beginning with compressions
immediately after each shock.

32. Thank you