Update CPR: Adult BLS and ACLS 2015medinfo.psu.ac.th/nurse/paper_meeting/opd/22_5_61/05.pdf ·...

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Update CPR: Adult BLS and ACLS 2015 Pannawit Benjhawaleemas Department of Anesthesia Prince of Songkla University

Transcript of Update CPR: Adult BLS and ACLS 2015medinfo.psu.ac.th/nurse/paper_meeting/opd/22_5_61/05.pdf ·...

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 40mm46%

40-50 mm34%

50-60 mm14%

Above 60 mm6%

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

28% 27%

49%

0%

10%

20%

30%

40%

50%

60%

<5 cm 5-6 cm > 6 cm

Injury OccuredHellevuo 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 30:2for 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 concentrationduring CPR (Class IIb, LOE C-EO)

www.facebook.com/thaicpr

www.thaicpr.org

Metabolic

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

What you’ve

learned,

can save life

Thank you