Cpr 2015

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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.

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