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Cardiopulmonary Resuscitation (CPR) : Gözde İnan, MD Kutluk Pampal, MD

This document provides information about cardiopulmonary resuscitation (CPR) including its definition, aims, history, guidelines and protocols. It discusses cardiac arrest versus clinical and biological death. The key aspects of CPR covered are the chain of survival, safety checks, chest compressions, rescue breathing, use of an automated external defibrillator and advanced life support. Drug therapies for cardiac arrest are also outlined. The importance of early defibrillation for survival is emphasized. Ethical issues like do not resuscitate orders are also mentioned.

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Sarper Hikmet TAZE
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74 views60 pages

Cardiopulmonary Resuscitation (CPR) : Gözde İnan, MD Kutluk Pampal, MD

This document provides information about cardiopulmonary resuscitation (CPR) including its definition, aims, history, guidelines and protocols. It discusses cardiac arrest versus clinical and biological death. The key aspects of CPR covered are the chain of survival, safety checks, chest compressions, rescue breathing, use of an automated external defibrillator and advanced life support. Drug therapies for cardiac arrest are also outlined. The importance of early defibrillation for survival is emphasized. Ethical issues like do not resuscitate orders are also mentioned.

Uploaded by

Sarper Hikmet TAZE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Cardiopulmonary Resuscitation

(CPR)
Gözde İnan, MD
Kutluk Pampal, MD
Cardiopulmonary Arrest
Definit
The hi
Basic Life Support COVİD
Outline 19
Advanced Life Support

Resuscitation and Ethics


Cardiac Arrest
§  Cessation of circulation / heart's functioning

Death
§  Clinical death
NO pulse and breathing

§  Biological death


Brain death
4-6 minutes following arrest
Cardiopulmonary Resuscitation
Definition and Aim

§  A medical procedure involving repeated cycles of compression of the


chest and electrical shocks along with artificial respiration, performed to
maintain blood circulation and oxygenation in a person who has suffered
cardiac arrest

To restore effective circulation and ventilation

To prevent irreversible cerebral damage due to


anoexia
COVİD
1996 ** 2015
1966 2005
19
ILCO 4th
AHA R 2nd guideline

2020

1992 2000 2010


ERC 1st 3rd
OHCA

CHAIN OF SURVIVAL
IHCA

CHAIN OF SURVIVAL
 
SAFETY
§  Safety Of Self
§  Safety Of Patient
§  Movement of a trauma victim –
only when absolutely
necessary
unstable cervical spine – injured
spinal cord  
SAFETY
CHECK RESPONSE

Alert
Voice – “Are you alright?”
Place your hands on their
shoulders and gently shake them
Responsive    
Place  in  Recovery  Posi0on    
SAFETY
CHECK RESPONSE
CALL HELP
SAFETY
CHECK RESPONSE
CALL HELP
LOOK/LISTEN/FEEL
Check for Normal Breathing
§  Look, listen and feel for normal
breathing for no more than 10
seconds

§  Agonal gasping is best described as


infrequent, noisy gasps

§  This is not normal breathing and


they should be treated as a non-
breathing casualty
§  ABC
ABC format
A = Airway
B = Breathing
C = Circulation/Compressions

§  CAB
COMPRESSIONS
SAFETY
CHECK RESPONSE
CALL HELP
LOOK/LISTEN/FEEL
30 CHEST COMPRESSIONS
•  Middle of sternum
•  Minimum 100 min-1
•  Depth 5-6 cm
•  Compression = Decompression
•  Change every 2 min
•  Target compression fraction 60 %
OPEN AIRWAY
SAFETY
CHECK RESPONSE
CALL HELP
LOOK/LISTEN/FEEL
30 CHEST COMPRESSIONS
OPEN AIRWAY
§  Open the airway by supporting your
casualty’s forehead with one hand
and tilting it back by placing 2 fingers
under their chin and gently lifting it

§  Support the head in this position in


order to perform a breathing check
AIRWAY

Head tilt chin lift


Jaw thrust manoeuvre
manoeuvre
RESCUE BREATHS
SAFETY
CHECK RESPONSE
CALL HELP
LOOK/LISTEN/FEEL
30 CHEST COMPRESSIONS
OPEN AIRWAY
2 RB
GIVING RESCUE BREATHS
§  Use a barrier device of some type while giving breaths
§  Deliver each rescue breath over 1 second

§  Give a sufficient tidal volume to produce visible chest rise (500-600 ml)

§  Avoid rapid or forceful breaths

§  When an advanced airway is in place during 2-person CPR, ventilate at a rate
of 8 to 10 breaths per min
§  AVOİD HYPERVENTILATION
Intrathorasic pressure increases, risk for aspiration
DEFIBRILLATION
SAFETY
CHECK RESPONSE
CALL HELP
LOOK/LISTEN/FEEL
30 CHEST COMPRESSIONS
OPEN AIRWAY
2 RB
DEFIBRILLATION
Defibrillation is the application of electrical shock to help and restore the
heart’s regular rhythm
SAFETY
CHECK RESPONSE
CALL HELLP
PLACE AED
FOLLOW INSTRUCTIONS

Early defibrillation is the single most important factor in determining survival


from cardiac arrest
§  Don’ touch and Don’t let anyone
touch!
§  One shock!
Biphasic  waveform  minimum  150  J  
Monophasic  waveform  360  J    
If  you  don’t  know  the  type  of  de?i  200  J  
§  Do  not  gel  the  electrodes  with  each  other!  
§  Separate  the  ambu  /  ventilator  from  the  endotracheal  tube!  
§  Turn  off  the  oxygen  supply  if  possible!  
§  Do  not  touch  and  Do  not  let  anyone  touch!  
§  Replace  the  electrodes  immediately  after  de>ibrillation!  
30 2
30 2
100

80

Survival rate
60 10% reduce every 1
40
minute delay!!

20

0
5 10 15 20 25
Time of Defibrillation (min)
§  Use of devices for effective breathing and circulation
§  Recognition and treatment of arrhythmias by ECG monitoring
§  Ensuring IV / IO
§  Drug use
§  Differential diagnosis
§  Shockable
1.  Ventricular fibrillation (VF)
2.  Pulseless ventricular tachycardia (pulseless VT)

§  Non-shockable
1.  Asystole
2.  Pulseless electrical activity (PEA)
Normal rhythm

VF is 80% cause of arrests


Every 1 minute delay in defibrillation reduces survival by 7-10%

Defibrillation is the only treatment


§  Any rhythm without a pulse
§  Prognosis is poor
§  Consider other /treatable causes
§  Be sure first!
§  Electrode and monitor control!
§  Change lead!
§  Slim VF?
§  LMA, Combitube
§  Endotracheal Intubation
ILCOR and AHA - The ideal technique, gold standard
Provides airway patency
Regurgitation-aspiration is prevented
Enables tracheal aspiration
O2 reaches the lungs in high concentration
Route for some drugs administration
30 seconds max!
§  100%  O2  
§  Manual  /  Ventilator  
§  8-­‐10  ml  /  kg  
§  Compression  without  interruption  
§  Without  sync  
   8-­‐10  breaths  /  min  
§  NO drugs with proven benefit
§  Reasons for administrating
To provide perfusion of vital organs
Facilitating defibrillation
Prevent VT / VF
Correcting metabolic disorders
Protecting the brain and heart against the negative effects of prolonged hypoxia
§  Intravenous route
Santral venous cath. is not necessary

§  Endotracheal route is not recommended


The optimal endotracheal dose of many drugs is unknown
Plasma concentrations are not safe

§  Intraosseous route


Provides adequate plasma concentration compared to the central
venous cath.
§  The primary drug used in cardiac arrest
§  Alpha effect!
Vasoconstriction
Increases diastolic pressure
Increases cerebral blood flow
Increases coronary blood flow
§  It interacts with alkalis!
§  It is affected by light!
§  1 mg every 3-5 minutes
•  VF and Pulseless VT
•  Following the 3rd shock
Amiodarone •  Central venous cath.
•  300 mg

•  In case no amiodarone!
•  Following the 3rd shock
Lidocaine •  100 mg (1-1.5 mg kg-1)
•  Maximum 3 mg kg-1 (in 1 hour)

•  If metabolic acidosis is proven


pH <7.1 BE> -10 mmol L-1
Bicarbonate •  Hyperkalemia, Tricyclic overdose
•  Should not be given with calcium
•  No  longer  “listen  and  feel”  for  breath  sounds  
to  diagnose  CA  
•  1th  responder  can  deliver  a  shoch  (up-­‐to  3  
shocks)  
•  Do  not  remove  O2  face-­‐mask  to  deliver  a  
shock,  rather  turn  off  O2  delivery  
•  No  CPR  without  Level  3  PPE  
•  Team  includes  max  4  people  inside  the  room  
Post Resuscitation Care
Arterial blood gas O2
saturation 94-98 %
Normocarbia

Blood glucose should


be maintained at 180
mg/dL

MAP ≥65 mmHg or


Prevent hyperpyrexia >37.7°C SBP ≥90 mmHg
Surface or endovascular
cooling for 32°C - 34°C × 24
hours
§  There is no perfect way to evaluate !!
§  EtCO2
Closely related to the success of resuscitation
20 mmHg successful CPR
DNR
§  Not legal in Turkey!
§  Euthanasia = DNR
If signs of life have returned
If the professional team has come
Ongoing asystole for more than 20 minutes in the absence of
a reversible cause
Resuscitation should be continued as long as VF persists
Failure to achieve an ETCO2 of >10 mm Hg by waveform
capnography after 20 min of CPR may be considered as one
component of a multimodal approach to decide when to end
resuscitative efforts
 

59
THANK YOU

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