Mini PPT CPR 2010

2010 American H eart Association
Guidelin es for Cardiopulm on ary

Resuscitation an d Em ergen cy
Cardiovascular Care
Anumillah Arini Zidna
ANAESTHESIA AND REANIMATION

CLERKSHIP
PERSAHABATAN HOSPITAL
RAWAMANGUN, JAKARTA
NOVEMBER 23RD- DECEMBER 25TH 2015
2010 American Heart Association. All rights reserved.
Key Changes in 2010 AHA Guidelines
Basic Life Support (Early recognition &

activation, Early CPR, Defibrillation)
Adult Basic life Support
Pediatric Basic Life Support
ACLS
Post cardiac arrest care

Introduction: CPR Overview
CPR a series of lifesaving actions that
improve the chance of survival following
cardiac arrest.
CPR traditionally has integrated chest
compressions and rescue breathing
optimizing circulation and oxygenation.
Rescuer and victim characteristics may
influence the optimal application of the
components of CPR.
Part of BLS.
Travers et al., 2010. Part 4: CPR Overview in 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Journal of The American Heart
Association, vol. 122, no. 18, supp. 3
Introduction: CPR Overview
Chest Compression Rescue Breathing
Forceful rythmic application Done after chest
of pressure over the lower compression w/ ratio 30:2
half of the sternum Delivered each over 1 sec,
MoA: intrathoracic give a sufficient tidal
pressure, directly volume to produce visible
compressing the heart chest rise
blood flow O2 to
myocardium & brain
Berg et al., 2010. Part 5: Adult Basic Life Support in 2010 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. Journal of The American Heart Association, vol. 122, no. 18, supp. 3
Basic Life Support
Basic life support (BLS) foundation for
saving lives following cardiac arrest.
Fundamental aspect in BLS:
Immediate recognition and activation of
emergency response system
Early CPR, w/emphasis on chest compressions
Rapid defibrillation
Simplified BLS algorithm
2005
2010
Basic Life Support
Chain of Survival set of actions
provides a universal strategy for achieving
successful resuscitation
Adult Basic Life Support
New AHA Adult Chain of Survival:
Immediate recognition and activation of
emergency response system
Early CPR, w/emphasis on chest compressions
Rapid defibrillation
Effective advanced life support
Integrated post-cardiac arrest care new link
in 2010 chain of survival

Immediate Recognition & Activation
of the Emergency Response System
1. Ensure the scene is safe
2. Recognize: Suddenly collapse, Unresponsive,
No breathing or abnormal breathing
Lay Rescuers Healthcare provider
3. Activate emergency
3. Activate emergency
response system
response system
4. Early CPR (can be
4. Pulse check
guided by the
5. Early CPR
dispatcher)
Early CPR
Highlight in AHA 2010 Guideline:
Changes the sequence from A-B-C C-
A-B
Elimination of look, listen and feel for
breathing
Emphasizes on chest compression and
high-quality CPR
Hazinzki, M.F., 2010, Highlight of the 2010 American Heart Association Guidelines for CPR and ECC
Changes A-B-C C-A-B
Why?
during 1st min of SCA
rescue breaths are not as
important as chest
compression
attempts to open airway
may delay the initiation of
chest compression
Technique of chest
compression
Place the victim on a firm surface (when possible)
in a supine position.
The rescuer kneeling beside the victims chest/
standing beside the bed.
Place the heel of the dominant hand on the
center of the victim chest (1/2 lower of the
sternum) and the other on the top of the first
hand.
Do the high-quality CPR
Technique of rescue breathing
1. Mouth-to-mouth
Open the victims airway triple maneuver
Pinch the victims nose
Create an airtight mouth-to-mouth seal
Give 1 breath over 1 sec, take a regular breath (not a
deep) breath
Rescue breath in a palpable pulse victim: 1 breath
every 5-6 sec (10-12 breaths/min), 1 breath over 1 sec,
cause visible rise
2. Mouth-to-nose
3. Mouth-to-stoma
Elimination of look, listen & feel
2005 (old) 2010 (new)

look, feel and listen C chest
used to assess compression (30
breathing after times)
opening the airway A open airway
B give 2 rescue
breaths
Why? (1) Rescuer checks for response and no breathing or

no normal breathing in adult before beginning CPR, (2)
Starting CPR with compressions minimizes delay to action
Emphasizes on chest compression
CPR intervention by 3 prototypical rescuers
Untrained Lay Trained Lay Healthcare
Rescuers Rescuers Providers
Perform Hands- Perform chest Perform chest
only CPR, compression + compressions +
emphasis on rescue breaths rescue breaths
Push Hard-Push w/ ratio 30:2 in cycles w/ ratio
Fast OR follow 30:2 until
the dispatcher advance airway
instruction is placed
Emphasizes on chest compression
Why?
Hands-Only CPR is easy to perform for adult
victims and can be readily guided by EMS
dispatchers over phone.
When all adult cardiac arrests reported,
survival rates similar whether bystander
provides Hands-Only CPR or traditional CPR.
Emphasizes on high-quality
CPR
Push at least 100 times/min
Push at least 2 inches (5 cm) depth
Allowing for complete chest recoil after
each compression
Minimizing interruptions in chest
compressions
Avoiding excessive ventilation
High-quality CPR: Chest
compression rate
2005 (old) 2010 (new)
Compress at a rate Compress at a rate

about 100/min of at least 100/min
Why?
Absolute number of compressions delivered
per minute has been linked with survival.
Actual compression rate is often well below 100/min
High-quality CPR: Chest
compression depth
2005 (old) 2010 (new)
Depressed Depressed at least 2
approximately 1 to 2 inches (5 cm)
inches (4-5 cm)
Why?
More effective than those of 1 inches.
Rescuers often do not push hard enough.
Confusion may result when range of depth is recommended.
Emphasizes on high-quality
CPR
Minimizing interruptions in chest
compressions important determinant of
ROSC & neurological intact survival.
Avoiding excessive ventilation
intrathoracic pressure, venous return to the
heart cardiac output and survival rate
Cricoid Pressure
2005 (old) 2010 (new)
Cricoid pressure should Cricoid pressure in

be used only if the victim cardiac arrest is not
is deeply unconscious recommended
Why?
Cricoid pressure can interfere with ventilation and
advanced airway placement.
Not proven to prevent aspiration or gastric insufflation
during cardiac arrest.
Pediatric Resuscitation
Revised pediatric chain of survival
Similarities in pediatric BLS and adult
BLS:
C-A-B rather than A-B-C sequence
Continued emphasis on high-quality CPR
Removal of look, listen and feel
De-emphasis of pulse check for HCPs
Berg et al., 2010. Part 13: Pediatric Basic Life Support in 2010 American Heart Association Guidelines for Cardiopulmonary
Difference between Pediatric BLS and Adult
BLS:
Chest compression depth at least 1/3 of the
anterior-posterior diameter of the chest
Infants: about 1 inches
Children: about 2 inches
Lone rescuer provides 2 min of CPR before
activating emergency response
Two rescuers use 15:2 compression to ventilation
ratio
Traditional CPR by bystanders higher survival
than chest compression alone
CPR Technique for Infants and
Children
Infants (< 1 year)
compress the sternum w/ 2
fingers placed just below the
intramammary line. The 2-
thumb-encircling hands
technique (by 2 rescuers).
At least 1/3 depth of the
chest (4 cm).
Berg et al., 2010. Part 13: Pediatric Basic Life Support in 2010 American
Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Journal of The American Heart
Hazinzki, M.F., 2010, Highlight of the 2010 American Heart Association
Guidelines for CPR and ECC
CPR Technique for Infants and
Children
Child (> 1 year) = Adult.
Rescuers may use either 1 or 2 hands to
compress the childs chest. Make sure to
achieve an adequate compression
Resuscitation in infants & children best
outcomes chest compression +
ventilation.
Neonatal Resuscitation
General assessment: Routine Care
Term gestation? YES Provide warmth
Crying or breathing? Clear airway
Good muscle tone? Dry
NO Ongoing evaluation
Start Resuscitation
Initial steps in stabilization A-B-C
Ventilation
Chest compression sequence
Epinephrine and/or volume expansion
Kattwinkel et al., 2010. Part 15: Neonatal Resuscitation in 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Journal of The American Heart Association, vol. 122,
no. 18, supp. 3
Neonatal Resuscitation: Initial Steps
Temperature Control
Very low-birth-weight (< 1500 g) preterm
babies likely to become hypothermic
additional warming recommended (eg,
prewarming the delivery room to 26C, covering in
plastic wrapping, placing under radiant heat).
Goal: achieve normothermia and avoid
iatrogenic hyperthermia.
no. 18, supp. 3
Clearing the airway
2005 (old) 2010 (new)
Suction infants nose & Suctioning immediately
mouth after shoulders after birth babies w/
but before chest delivery obvious obstruction to
Meconium stained spontaneous breathing
intrapartum suctioning Insufficient evidence to
RR, muscle tone, recommend a change of
HR <100/min perform performing endotracheal
direct laryngoscopy for suctioning
suctioning
no. 18, supp. 3; Hazinzki, M.F., 2010, Highlight of the 2010 American Heart Association Guidelines for CPR and ECC
Supplementary Oxygen
2005 (old) 2010 (new)
Administration of 100% Begin w/ room air rather
oxygen cyanosis, than 100% oxygen at
bradycardia or other term babies
signs of distress are Any O2 administered
noted should be blended w/
room air, titrated based
on oxygen saturation
measured from right
upper extremity
no. 18, supp. 3; Hazinzki, M.F., 2010, Highlight of the 2010 American Heart Association Guidelines for CPR and ECC
Supplementary Oxygen
Why?
Healthy babies born at term
start with arterial
oxyhemoglobin saturation of
<60% and can require more
than 10 minutes to reach
saturations of >90%
Hyperoxia can be toxic
no. 18, supp. 3
Neonatal Resuscitation: Ventilation
Infant remains apneic or gasping, or HR remains
<100/min after initial steps
PPV (positive-pressure ventilation)

LMA (laryngeal mask airway) effective for
newborns >2000g or 34 wga
Endotracheal tube indication:
Endotracheal suction
Bag-mask ventilation ineffective
Chest compression performed
no. 18, supp. 3
Neonatal Resuscitation: Chest
Compression
HR <60/min despite adequate ventilation with
supplementary oxygen for 30 sec start chest
compression.
Delivered on the lower 1/3 of the sternum, approx
1/3 of anterior-posterior diameter of the chest.
The 2 thumb-encircling hands technique
is recommended in newborn generate
peak systolic and coronary perfusion pressure
no. 18, supp. 3
Neonatal Resuscitation: Chest
Compression
2005 (old) 2010 (new)
Compression-to- Recommended ratio
ventilation ratio should remain 3:1.
be 3:1 90 If the arrest known to be
compressions and 30 cardiac etiology 15:2
breaths per minute (higher ratio)
Why? Newborns tend to have an asphyxial arrest

no. 18, supp. 3
Assessment of HR, RR and
Oxygenation
2005 (old) 2010 (new)
Based on HR, RR and Should consist of HR, RR
evaluation of color and evaluation of state of
oxygenation by pulse
oxymeter rather than
simple assessment of
color
Why? Assessment of color is subjective

no. 18, supp. 3
Neonatal Resuscitation: Epinephrine
and/or Volume expansion
Epinephrine
Recommended dose: 0.01-0.03 mg/kg IV
via endotracheal tube route not recommended
higher dose SE: myocardial function, <<
neurological function
Volume Expansion
Considered blood loss known or suspected, HR
remains low
Isotonic crystalloid or blood recommended
Recommended dose: 10 ml/kg
no. 18, supp. 3
Withholding or Discontinuing
Rescutitation?
Withholding Discontinuing
High rate survival, Gestation, birth weight,
acceptable morbidity congenital anomalies
almost certain early
death, high morbidity
Newborn w/ remain
undetectable HR for 10
min
no. 18, supp. 3
References
2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Journal of The American Heart
Highlight of the 2010 American Heart Association
Guidelines for CPR and ECC
THANK YOU!!

Mini PPT CPR 2010

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2010 American H eart Association

Guidelin es for Cardiopulm on ary

ANAESTHESIA AND REANIMATION

Basic Life Support (Early recognition &

2010 American Heart Association. All rights reserved.

2010 American Heart Association. All rights reserved.

2005 (old) 2010 (new)

Why? (1) Rescuer checks for response and no breathing or

Compress at a rate Compress at a rate

Cricoid pressure should Cricoid pressure in

PPV (positive-pressure ventilation)

Why? Newborns tend to have an asphyxial arrest

Why? Assessment of color is subjective

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