Advances in Advances in Automated CPR Automated CPR A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital Adjunct Associate Professor Duke-NUS Graduate Medical School Office of Research
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Advances in Advances in Automated CPR Automated CPR
A/Prof Marcus OngConsultant, Senior Medical Scientist& Director of ResearchDepartment of Emergency MedicineSingapore General HospitalAdjunct Associate ProfessorDuke-NUS Graduate Medical SchoolOffice of Research
Chain of Survival
Courtesy of Life Support Training Centre, Singapore General Hospital
IntroductionIntroduction
The problem with standard CPR (STD-CPR): provides only
1/3 of normal blood supply to the brain and 10-20% to the
heart
Although defibrillation is the definitive treatment for
ventricular fibrillation, its success is dependent on effective
CPR
Aortic diastolic (red) and right atrial (yellow) pressures during CPR (2 ventilations in 4-second period)
CPP at 5:1 Ratio
CPP at 15:2 Ratio
Chest Compressions and Chest Compressions and Coronary Perfusion PressureCoronary Perfusion Pressure
Pit Crew Philosophy to Integration of AutoPulseTM into Resuscitation Protocol
Efficient method of utilizing all available resources Each crew member has a defined role and
position relative to patient. AutoPulseTM readied for application while manual
compressions are being performed. DO NOT STOP AutoPulseTM during the
defibrillation shock
Deployment Sequence
Doctor 1 Nurse 1 Nurse/Doctor 2 Check responsiveness -- hello hello no response
Check breathing -- no breathing bag and
mask 2 breaths Check pulse -- no pulseinstruct nurse 2
to start manual CPR (30:2)
Run to get the AutoPulseTM machine
Cut clothes and left sleeve Start manual CPR (30:2)
Doctor 1 Nurse 1 Nurse/Doctor 2 Start cardiac monitor Put defibrillation pad---1st to the chest (apex) Slot in the AutoPulseTM machine Put on the 2nd defib pad and assess rhythm
Help to cut clothes (right sleeve) Turn on AutoPulseTM machine When doctor is ready to take the machine hand the AutoPulseTM to the doctor
Carry patient up with Nurse / Doctor 2.
Remove shirt Help to strap AutoPulseTM
Continue manual CPR Carry patient up n1 so doc 1 can slot in the AutoPulseTM (patient’s neck and head) Strap on the belt of AutoPulseTM by Open up the bands Enclose it over the
patient Lift up the band straight Ensure that band
tightens over the Chest of patient and not the abdomen
Then press the start (green) button
Is it VF?
No Yes
No need to stop compressions during shock delivery.
Charge according to protocol Stand clear and deliver shock Put on AutoPulseTM
Deployment Sequence
Doctor 1 Nurse 1 Nurse/Doctor 2 Intubate patient Check position Set IV cannula (if no other doctor available) ***If 2ND doctor is available, then Doctor 1 intubates and Doctor 2 sets IV line. Change to continuous CPR on the AutoPulseTM
Help prepare for intubation Ventilate and hold tube while doctor checks position then anchor the tube Prepare intubation set Help to connect oxylog
Insert IV line if appropriate Prepare resus drugs then give a) 1st dose of adrenaline and atropine (for SGH, give PIVOT drugs as 1st drug as appropriate) as instructed by Doctor 1. b) help to set IV line if drugs are ready c) run IV drip
Deployment Sequence
IS IT VF/ PULSELESS VT?
NO(ASYSTOLE/PEA) YES
* Restart AutoPulseTM
* Follow asystole/PEA Protocol* Give 2nd dose of adrenaline
* Restart AutoPulseTM
* Charge defib* Give 2nd dose of adrenaline* Stand clear* Deliver shock* CPR for 1 min* Follow VF protocol