Update CPR: Adult BLS and ACLS Update CPR: Adult BLS and ACLS 2015 Pannawit Benjhawaleemas...

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  • Update CPR: Adult BLS and ACLS 2015

    Pannawit Benjhawaleemas

    Department of Anesthesia

    Prince of Songkla University

  • System specific Chain of survival

  • Adult Basic Life Support

  • Overview

    • Sudden Cardiac Arrest (SCA): leading cause of death in USA

    • OHCA

    – 70% occur at home

    – 50% unwitness

    • Outcome : surviving to dischage

    – OHCA : 10.8%

    – IHCA : 22.3 -25.5%

  • Early Access and Cardiac Arrest Prevention

    Early, High-Quality CPR

    Early Defibrillation

    • Dispatcher recognition of cardiac arrest

    • Dispatcher instruction

    • Starting CPR

    • Chest compression-only CPR vs conventional CPR

    • CPR before defibrillation

    • Hand positioning during compressions

    • Chest compression rate

    • Chest compression depth

    • Chest wall recoil

    • Minimizing pause in chest compressions

    • Compression-ventilation ratio

    • Timing of CPR cycles

    • Checking for circulation during BLS

    • Feedback for CPR quality

    • EMS chest compression-only vs conventional CPR

    • Passive ventilation technique

    • Harm from CPR to victims not in cardiac arrest

    • Public-access defibrillation

    • Rhythm check timing

    • Analysis of rhythm during chest compression

  • BLS algorithm

  • BLS algorithm

  • BLS algorithm

  • Hand position during compressions

    • Recommendation :

    – It is reasonable to position hands for chest compressions on the lower half of the sternum in adults with cardiac arrest and the heel of one hand on the center (middle) of the victim’s chest

  • Compression Rate

    • Recommendation :

    – It is reasonable for rescuers to perform chest compression at rate of 100 - 120/min (Class IIa, LOE C-LD)

    1960

    • 60/min

    1986

    • 80-100 /min

    2010

    • At least 100/min

    2015

    • 100-120 /min

  • Chest Compression Depth

    • Recommendation :

    – rescuer should perform chest compressions to depth of 2 inches or 5cm for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches or 6 cm) (Class I, LOE C-LD)

  • Below 40mm 46%

    40-50 mm 34%

    50-60 mm 14%

    Above 60 mm 6%

    Total bystander 3198

    Below 40mm 40-50 mm 50-60 mm Above 60 mm

    What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

    Ian G. Stiell, MD; and the Resuscitation Outcomes Consortium Investigators

    http://circ.ahajournals.org/search?author1=Ian+G.+Stiell&sortspec=date&submit=Submit

  • 28% 27%

    49%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    6 cm

    Injury Occured Hellevuo H, et al. Deeper chest compression – More complications for cardiac arrest patients?

    Resuscitation 2013

  • 57% 22%

    13%

    3% 3% 2%

    Rib fracture

    Sternal fracture

    Haematoma/rupture – heart

    Great vessel injury

    pneumothorax

    lung contusion

    Injury Occured

    Hellevuo H, et al. Deeper chest compression – More complications for cardiac arrest patients? Resuscitation 2013

  • Chest wall recoil

    • Recommendation :

    – It is reasonable for rescuers to avoid leaning on the chest between compressions to allow full chest wall recoil for adults in cardiac arrest. (Class IIa, LOE C-LD)

  • Minimizing pauses in chest compressions

    • Recommendation :

    – Total preshock and postshock pauses in chest compressions should be as short as possible. (Class I, LOE C-LD)

    – For adults in cardiac arrest receiving CPR without an advanced airway, it is reasonable to pause compressions for less than 10 seconds to deliver 2 breaths. (Class IIa, LOE C-LD)

  • Compression-Ventilation ratio

    • Recommendation :

    – Consistent with the 2010 Guidelines, it is reasonable for rescuers to provide a compression-to-ventilation ratio of 30:2 for adults in cardiac arrest. (Class IIa, LOE C-LD)

  • Advanced Cardiac Life Support (ACLS)

  • Supraglottic airways that have been studied in cardiac arrest are

    • Laryngeal mask airway (LMA),

    • Esophageal-tracheal tube (Combitube)

    • Laryngeal tube (King LT)

    Advanced Airway Placement Choice

  • Clinical Assessment of Tracheal Tube Placement

    • Attempts ETT during CPR associated with unrecognized tube misplacement or displacement as well as prolonged interruptions in chest compression

    • inadequate training, lack of experience, pt physiology (low pulmonary blood flow, gastric contents in the trachea, airway obstruction), and patient movement may contribute to tube misplacement

  • Clinical Assessment of Tracheal Tube Placement

    In addition to auscultation of the lungs and stomach, several methods eg,

    • Waveform capnography,

    • CO2 detection devices,

    • Esophageal detector device,

    • Tracheal ultrasound,

    • Fiberoptic bronchoscopy proposed to confirm successful tracheal intubation in adults during cardiac arrest

  • Clinical Assessment of Tracheal Tube Placement

    • Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of ETT(Class I, LOE C-LD)

  • Clinical Assessment of Tracheal Tube Placement

    • If continuous waveform capnometry is not available, a non waveform CO2 detector, esophageal detector device, or ultrasound used by an experienced operator is a reasonable alternative (Class IIa, LOE C-LD)

  • “double tract sign”

    comet-tail artifact

    Hyperechoic

    air–mucosa

    (A–M) interfaces

  • Oxygen Dose During CPR

    • When supplementary oxygen is available, it may be reasonable to use the maximal feasible inspired oxygen concentration during CPR (Class IIb, LOE C-EO)

  • www.facebook.com/thaicpr

    www.thaicpr.org

    http://www.thaicpr.org

  • Metabolic

    ● Avoid Hypotonic Fluids ● Rationale: May increase edema, including cerebral edema

    What you’ve

    learned,

    can save life

    Thank you