Curriculum Vitae

Bambang Irawan SpPD [K], SpJP [K],

FIHA, FASCC, FInaSIM

 Internist [SpPD] 1981

 Cardiologist [SpJP] 2004
 Fellow Indonsian Heart Association [FIHA] 2004
 Cardiologist Consultant [K] 2005
 Professor in Cardiology [ Prof ] 2006
 Fellow Asean College Cardiology [FAsCC] 2008
 What should you do in
SUDDEN CARDIAC ARREST ?

PROF DR BAMBANG IRAWAN SpPD [K] SpJP [K]

FIHA FASCC FINASIM
Department of Cardiology and Vascular Medicine
Faculty of Medicine GadjahMada University
 CAUSES of CARDIAC ARREST

CARDIAC NON CARDIAC

MYOCARDIAL INFARCTION PULMONARY EMBOLIS

CARDIOMYOPATHY BLEEDING
VALVULAR DISEASES LUNG DISEASES
CONGENITAL HEART DEFECT STROKE
ELECTROPHY ABNORMANITIES METABOLIC / ELECTROLYTE
ABNORMALITY
TRAUMA & INTOXICATION
The vulnerable atherosclerotic
plaque

Lipid core

Adventitia
 Plaque rupture
The main releasing factors
The Grip of Angina
.
 .
• .
 CARDIAC ARREST

STATE OF WHOLE-BODY ISCHAEMIA

BRAIN INJURY

MYOCARDIAL DYSFUNCTION

SYSTEMIC COAGULATION & INFLAMMATION

 WHOLE BODY ISCHAEMIA

CESSATION OF CARDIAC PUMP FUNCTION

RAPID DECLINE BLOOD PRESSURE
BLOOD FLOW NEGATIVE
OXYGEN & GLUKOSE NEGATIVE

ELIMINATION CO2 NEGATIVE

 NEURONAL DEATH after CARDIAC
ARREST
3 – 6 S AFTER ARREST PATIENT
UNCONSIOUSNESS
IN 2 MNT O2 TENSION ZERO
ATP DEPLETED ADENOSINE LACTATE
HYDROGEN IONS ACCUMULATE
ION PUMP ZERO
ACCUMULATION OF Ca
CELLULER TOXICITY
 PROLONG ISCHAEMIA

NEURONAL NECROSIS PROGRESS

CPR & ROSC : NEURONAL ENERGY RECOVER

BUT STILL SEQUELY: IMPAIRED OF
MEMORY ATTENTION & EXECUTIVE
FUNCTIONING [ 50% ]
 MYOCARDIAL DYSFUNCTION after
CARDIAC ARREST

MARKED REDUCTION of MYOCARDIAL

FUNCTION
PRONOUNCED HEMODYNAMIC INSTABILITY
CARDIAC DAMAGE : DEFIBRILLATION
ADRENALIN

SELF LIMITING in 72 HOURS

 INFLAMATION & COAGULATION
after CARDIAC ARREST

CYTOKINES : INTERLEUKINS / TNF SYSTEMIC /

LOCAL IN BRAIN

SYSTEMIC INFLAMMATORY RESPONES

SYNDROME [ SIRS ]

COAGULATION DISORDERS : NO REFLOW

PHENOMENON
 .

WHAT SHOULD WE DO
 MECHANICAL CPR

CHEST COMPRESSIONS

VENTILATION

COMPRESSION / VENTILATION RATIO

ELECTRICAL DEFIBRILLATION
 CHEST COMPRESSION

MEAN ARTERIAL BLOOD PRESSURE 30 – 50

MMHG
CRITICAL AMOUNT OF CORONARY &
CEREBRAL BLOOD FLOW
ERC GUIDELINES 100 – 120 / MINUTE
INTERUPTIONS BY DC SHOCK AIR WAY &
DRUG IMPAIRED SUCCESFULLY
PERSON CHANGED EVERY 2 MINUTES
 VENTILATION

BAG – MASK VENTILATION

TRACHEAL INTUBATION

100% O2 if AVAILABLE

ROSC O2 SHOULD BE TITRATED

Cek for breathing
.
.
COMPRESSION / VENTILATION
RATIO

30 : 2

50 : 2

3 CYCLES OF 200 PRIOR TO

TRACHEAL INTUBATION
.
 ELECTRICAL DEFIBRILLATION

CAUSAL THERAPI :
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION

NOT INDICATED IN :
ASYSTOLE
PULSELESS ELECTRICAL ACTIVITY
DRUGS DURING CPR

ADRENALIN

AMIODARON

MAGNESIUM
BICARBONATE
THROMBOLYTICS
 ALGORITHMS for CPR

BASIC CARDIAC LIFE SUPPORT

ADVANCED CARDIAC LIFE SUPPORT

SHOCKABLE RHYTHMS
NON SHOCKABLE RHYTHMS
CRITICAL CARE after ROSC

NORMOTENSION

NORMOGLYCAEMIA

NORMOCAPNIA

NORMOXAEMIA
 THERAPEUTIC HYPOTHERMIA

CORONARY REVASCULARIZATION

PROGNOSTICATION
 CONCLUSION

OCT 2010 new CPR GUIDELINES BY ERC

CONTINUOUS & EFFECTIVE CHEST

COMPRESSIONS DURING CPR

PUSHING HARD & FAST with MINIMIZED

INTERRUPTIONS is the KEY to SAVE PATIENTS’
LIVES