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Paleerat Jariyakanjana, MDEmergency physician
26/1/59
CPR 2015
ContentsSystems of care and continuous
quality improvementAdult BLS & CPR quality: HCP BLSAdult advanced cardiovascular life
supportPost-cardiac arrest care
Systems of care and continuous quality improvement
Components of a system of care
Adult BLS & CPR quality: HCP BLS
Immediated recognition and activation of emergency response system
Chest Compression Depth -updated
2010
> 5 cm
2015
5 – 6 cm
Push Hard !Class I, LOE C-LD
Chest Compression Rate -updated
2010
> 100
2015
100 – 120 Push Fast !Class IIa, LOE C-LD
Fully Recoil !do not leaning on chest
Class IIa, LOE C-LD
Minimizing Interruptions ! -updatedAchieve chest compression fraction
(CCF)
unprotected airway ≥60%
0 9030 60 120
CCF = 105120= 87.5
Audiovisual Feedback Devices
during CPR
Delayed ventilationwitnessed OHCA with a shockable
rhythm + EMS
3 cycles of 200 continuous
compressions + passive oxygen insufflation & airway
adjuncts
Class IIb, LOE C-LD
Respiratory Rate (No advanced airway)
Avoid Hyperventilation !30 : 2 Class IIa, LOE C-LD
Respiratory Rate (advanced airway) - updated
2010
> 8-10
2015
10 Avoid Hyperventilation !
Class IIb, LOE C-LD
Team-Based Resuscitation
Adult advanced cardiovascular life support
Vasopressors for resuscitationVasopressinNo advantageRemoved from the Adult Cardiac
Arrest Algorithm
EpinephrineASAP
ETCO2 for prediction of fail resuscitationFailure 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
Post-cardiac arrest drug therapyLidocaine Inadequate evidence to support the routine
usemay be considered immediately after ROSC
from cardiac arrest due to VF/pVT
ẞ-blockers Inadequate evidence to support the routine
usemay be considered early after
hospitalization from cardiac arrest due to VF/pVT
Post-cardiac arrest care
Coronary angiographyshould be performed emergently for
OHCA pt c suspected cardiac etiology of arrest & ST elevation on ECG
Emergency coronary angiography is reasonable for select adult pt who comatose after OHCA of suspected cardiac origin but without ST elevation on ECG
Targeted temperature management
All comatose adult pt with ROSC after cardiac arrest should have TTM, with a target temperature between 32-36 ◦C selected and achieved, then maintained constantly for at least 24 hr
Continuing temperature management beyond 24 hrActively preventing fever in
comatose pt after TTM
Out-of-hospital coolingnot recommend
Hemodynamics goals after resuscitationAvoid and immediately correct
hypotension (SBP <90 mm HG, MAP <65 mm Hg)
Prognostication after cardiac arrestpt not treated with TTM: 72 hr after
cardiac arrestpt treated with TTM: 72 hr after
return to normothermia
Organ donationAll pt who are resuscitated from
cardiac arrest but who subsequently progress to death or brain death should be evaluated as potential organ donors.
THANK YOU
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