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American Heart Association
Guidelines for CPR 2015
Wanida Chongarunngamsang, MD.
Faculty of Srinakarinwirot University
American Heart Association
Guidelines for CPR 2015
• BLS
• ACLS
– Pulseless Arrest
– Bradycardia
– Tachycardia
• Post cardiac arrest care
Chains of Survival
2015 (New): Separate Chains of Survival (Figure 4) have
been recommended that identify the different pathways
of care for patients who experience cardiac arrest in the
hospital as distinct from out-of-hospital settings
“Chain of Survival”
in-hospital cardiac arrest (IHCA)
•
•
•
•
•
Surveillance for cardiac arrest
Activate code (multidisciplinary team)
Initiate CPR by professional providers
Early defibrillation
Integrated post cardiac arrest care
“Chain of Survival”
out-of-hospital cardiac arrest (OHCA)
• Immediate recognition of cardiac arrest and
activation of the emergency response system
• Early CPR that emphasizes chest compressions
• Rapid defibrillation if indicated
• Effective advanced life support
• Integrated post cardiac arrest care
Adult Basic Life Support
(BLS)
Basic Life Support
– Used for patients with life-threatening illness or
injury before the patient can be given full medical
care.
– Generally used in the pre-hospital setting, and can
be provided without medical equipment.
– Generally does not include the use of drugs or
invasive skills.
.
unresponsesive
Breathing
and pulse
30:2
Check pulse :carotid artery
 Start Chest compression if no definite
pulse within 10 seconds
Chest compression
Push hard, Put fast
กดลึก-- ปล่ อยสุ ด -- อย่ าหยุด-- กดบ่ อย
Chest compression
Chest compression
Chest compression
กดลึก 5 cm (2 inches)
Full chest recoid
Minimal interruption
• หลัง defibrillation หรื อ shock ให้ กดหน้ าอกต่อ ไม่ต้อง
คลาชีพจร
• minimize the frequency and duration of
interruptions in compressions
• CPR without an advanced airway, goal of a chest
compression fraction as high as possible, with a
target of at least 60%.
Chest compression
กดต่อเนื่องด้ วยความเร็ว
100-120 ครัง้ ต่อนาที
Airway
Head tilt
Chin lift
Jaw thrust ถ้ าสงสั ย C-spine injury
Breathing
BLS Dos and Don’ts of Adult High-Quality CPR
Rescuers Should
Rescuers Should Not
perform chest compressions at a
Compress at a rate slower than 100/min or
faster than 120/min
rate of 100-120/min
Compress to a depth of at least 2 inches (5 Compress to a depth of less than 2 inches (5
cm) or greater than 2.4 inches (6 cm)
cm)
Allow full recoil after each compression
Lean on the chest between compressions
Minimize pauses in compressions
Interrupt compressions for greater than 10
seconds
Ventilate adequately (2 breaths after 30
Provide excessive ventilation
(ie, too many breaths or breaths with
excessive force)
compressions, each breath
delivered over 1 second, each causing chest
rise)
AED (Automated External Defibrillator)
1. เปิ ดเครื่ อง AED
2. ติด paddle ตามรูป
3. เครื่ องจะทาการวิเคราะห์ว่าให้
shock ได้ หรื อไม่
4. ถ้ าเครื่ องให้ shock ได้ ให้
กดปุ่ มshock ที่เครื่ อง
AED (Automated External Defibrillator)
AED ON
กดปุ่ มเครื่ องเปิ ด และหมุนปุ่ มAED on
AED (Automated External Defibrillator)
ติด pad ที่ sternum /apex
AED (Automated External Defibrillator)
ต่ อสาย electrode pad ต่ อเข้ ากับ
electrode cable ของตัวเครื่ อง
AED (Automated External Defibrillator)
• เครื่ องวิเคราะห์คลื่นไฟฟ้าหัวใจเมื่อเครื่ องวิเคราะห์จะรายงานขึ ้นบน
จอภาพว่าเป็ นคลื่นไฟฟ้าหัวใจแบบไหนและจะแนะนาว่าให้ ทา
defibrillation ถ้ าคลื่นไฟฟ้าหัวใจเป็ นชนิดVF หรื อVT
• ห้ ามสัมผัสผู้ป่วยเนื่องจากเครื่ องจะอ่าน EKG ผิด
• ถ้ า EKG เป็ นชนิดVF หรื อVT เครื่ องจะให้ charge พลังงาน
• ถ้ า EKG เป็ นชนิด asystole เครื่ องจะให้ CPR ต่อไป 2 นาทีแล้ วจะ
analyze EKG ใหม่
AED (Automated External Defibrillator)
กดเพื่อทาการ
shock
Simplified Adult BLS
High-quality CPR
 Adequate rate (100120/minute)
 Adequate depth
 Adults: at least 2 inches (5 cm)-2.4
inches (6 cm)
 Complete chest recoil
 Minimizing interruptions in
compressions
 Avoiding excessive ventilation
Advanced Cardiovascular
Life Support: ACLS
Advanced Cardiovascular Life
Support: ACLS
• Pulseless Arrest
• Bradycardia with Pulse
• Tachycardia with Pulse
Pulseless Arrest
shock ?
Epinephrine 1mg
(IV/IO/ET)
 Hypovolemia
Biphasic
120-200j
 Toxins
Monophasic
360j
 Hypoxia
 Tamponade
 Hydrogen ions
 (acidosis)
Tension PTX
 Hyper/hypokalemia
 Thrombosis (coronary)
 Hypothermia Thrombosis (pulmonary)
Amiodarone
300 mg—150 mg
Pulse/BP
EtCO2>40 mmHg
A-line wave form
5 Hs, 5Ts
> 2 inches (5 cm), < 2.4 inches ( 6 cm) and fast (100-120/min)
Bradycardia with Pulse
Symptomatic
bradycardia
Tachycardia with Pulse
Narrow regular
50-100 j
Narrow irregular
120-200 j
Wide regular
100 j
Wide irregular
DF
Quantitative Waveform Capnography
• Confirmation and monitoring ETT placement
• Evaluating the effectiveness of chest compressions
ETCO2 value is at least 10-20 mmHg.
• Identification of ROSC
• Failure to achieve an ETCO2of greater than 10 mm Hg
by waveform capnography after 20 minutes of CPR
decide to end resuscitative efforts but should not be
used in isolation
Capnography Recommendation
CPR Quality
• Quantitative waveform capnography
– If Petco2<10 mm Hg, attempt to improve
CPR quality
• Intra-arterial pressure
– If relaxation phase (diastolic) pressure <20
mm Hg, attempt to improve CPR quality
Defibrillator
Defibrillator
SBP >90 mmHg
MAP>65 mmHg
BT 32C-36C
Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity(PEA)
NO PULSE
Supraventricular tachycardia
New and Updated Recommendations
CPR Guideline 2015
• Separate Chain of Survival
• Chest compressions at a rate of 100 to 120/min :
extremely rapid compression rates with inadequate compression depth
• Chest compressions at a depth of at least 2 inches or
5 cm for an average adult, while avoiding excessive
chest compression depths (greater than 2.4 inches [6
cm])
New and Updated Recommendations
CPR Guideline 2015
• Delivery 1 breath every 6 seconds (10 /min) while
continuous chest compression with advance airway
• Vasopressin was removed from the ACLS Cardiac
Arrest Algorithm
• Nonshockable rhythm ,administer epinephrine as
soon as feasible (IV/IO/ET)
• Targeted temperature management 32C to 36C in 24
hr
• The routine prehospital cooling of patients with rapid infusion
of cold IV fluids after ROSC is not recommended
Thank you