1 / 38

Adult CPR Update 2005

Adult CPR Update 2005 . Dr Adrian Burger Emergency Medicine Registrar UCT/Stellenbosch. Background. ILCOR vs AHA 36 Months before 2005 Consensus Conference Awareness - limitations of evidence - benefits of CPR Tipping point - major changes

meryl
Download Presentation

Adult CPR Update 2005

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adult CPR Update 2005 Dr Adrian Burger Emergency Medicine Registrar UCT/Stellenbosch

  2. Background • ILCOR vs AHA • 36 Months before 2005 Consensus Conference • Awareness - limitations of evidence - benefits of CPR • Tipping point - major changes - re-affirmed others

  3. Background • USA - 250 000 to 330000 estimated annual SCA deaths per year • Survival < 6% worldwide average • Trials - short term outcomes - underpowered, small - not randomized - design limitations • Informed consent

  4. Method • Critical review of sequence and priorities • Identify factors with greatest impact on survival • Recommendations for interventions that should be performed frequently and well • Emphasis on HIGH QUALITY CPR

  5. So Why Change Then? • Poor survival not inevitable • Lay Rescuer CPR + AED Programs Witnessed VF SCA 49%-74% Survival • Make it all easier

  6. Common Elements of Success • Trained Rescuers • Rapid Recognition • Prompt CPR • Defibrillation < 5 min

  7. The Brief • Simple • Appropriate • All Ages

  8. Simple • “Lay rescuers not be expected to learn, select or perform different sequences of CPR”

  9. Appropriate • Asphyxial and VF SCA • ?Compression alone VF • ?Ventilation + Compression Asphyxial and Prolonged arrest

  10. Age Effective • Infant and Children - Asphyxial Arrests more likely • Adults - VF SCA more likely

  11. Lay Rescuers Infant under 1 year Child 1-8 years Adult 8 and older HCP Infant under 1 year Child 1 year to puberty Adult puberty & older Age Groups

  12. Airway • For Lay rescuers - Head Tilt Chin Lift • For HCP - Jaw Thrust - Head Tilt Chin Lift - Manual C-spine control in CPR • Head Tilt Chin Lift EVEN IN TRAUMA

  13. Breathing • Match Pulmonary Blood Flow & Ventilation • Not excessive ventilations -Initial O2 content adequate in VF SCA -Reduced perfusion 25%-30% of normal -Reduced venous return -Gastric Insufflation

  14. CPR For Lay Rescuers • Check normal breathing • 2 rescue breaths of 1s each • Visible chest rise • Immediate chest compressions (no pulse check) • 2 hands, centre of chest, nipple line, 100/min • AED when arrives

  15. CPR For HCP • “Phone First” for all sudden collapse and if lone rescuer • “CPR First” for unresponsive infants and children, all victims of likely hypoxic arrest and if lone rescuer • Check for adequate breathing • 2 rescue breaths of 1s each • Visible chest rise • Check response • Pulse check • Rescue breathing without compressions 10-12/min • Technique of compressions same as lay rescuers

  16. The Ratios • Universal 30:2 -All Lone Rescuers of Infants (not newborns), Children & Adults -All Lay Rescuer situations -2 Rescuer Adult CPR without advanced airway • 15:2 -2 Rescuer CPR for Infants and Children

  17. Put Simply • 30:2 - All Lone Rescuers (Lay & HCP) for All victims - 2 Rescuers Adults (no advanced airway) • 15:2 - 2 Rescuers for Infants and Children

  18. And if there’s an ETT or LMA? • Breathing rate: 8-10/min • Compression rate: 100/min • Swap roles regularly -objectively <1-2 minutes -subjectively >5 minutes

  19. HIGH QUALITY CPR • RATE - push hard, push fast 100/min • DEPTH - 1.5 TO 2 inches • COMPLETE CHEST RECOIL • MINIMISE INTERRUPTIONS • CHANGE REGULARLY Restore Coronary & Cerebral Blood Flow

  20. Technique of CPR • Push Hard and Push Fast • Complete Chest Recoil • Minimal Interruptions <10s • Change Regularly

  21. The Shocking Facts

  22. Changes • Challenged Defib first to all VF victims, especially > 4 to 5 min • Improved survival for CPR first? • Insufficient data for CPR first to all VF SCA

  23. Consensus Lay Rescuers • AED as soon as available EMS • Witnessed SCA VF: Defib • Not witnessed or > 4 to 5 min: CPR first

  24. Non Consensus • In hospital cardiac arrest • Ideal duration of CPR before defib • Ideal duration of VF to switch to CPR first

  25. Only One Shocker • No specific studies • 1st shock efficacy - termination of VF at least 5s after the shock • Monophasic defib - low 1st shock efficacy • Biphasic defib - average 90% 1st shock efficacy • If 1st shock fails - low amplitude VF, CPR greater value

  26. So the VF is terminated… • Most have a nonperfusing rhythm • PEA/Asystole = CPR • AED rhythm analysis 29-37 seconds Therefore 1 shock immediately followed by CPR for 5 cycles or 2 minutes (+ physicians discretion)

  27. How much? Adults • Biphasic Truncated Exponential Waveform use 150J to 200J • Biphasic Rectilinear Waveform use 120J • Monophasic Waveform use 360J Children • Initial 2J/kg biphasic or monophasic • Subsequent 2-4J/kg • AEDS okay for > 1 year old

  28. Drugs - To Use or not use? • “No Placebo-controlled study has shown that any medication or vasopressor given routinely at any stage during human cardiac arrest increases rate of survival to hospital discharge” • Vasopressin vs Epinephrine • No evidence for routine use of any antiarrythmic during cardiac arrest

  29. Drug administration • “LEAN” Lignocaine, epinephrine, atropine, naloxone, and vasopressin • IV or IO preferable to ET • If no IV or IO: 2.5XIV dose in 5-10ml H2O

  30. Predictable drug delivery Predictable drug effect low dose of adrenaline systemically leads to a B -adrenergic effect Vasodilatation Lower coronary artery perfusion pressure & flow Reduced potential of ROSC Pulmonary vasoconstriction IV/IO vs ET

  31. Other drugs in short • NaBic: No evidence for routine use Adverse effects of vasodilatation, alkalosis, CO2 production, catecholamine Specific instances, eg TCA, hyperkalaemia • Calcium: No benefit from routine use Indicated for hypocalcaemia, hyperkalaemia, CCB toxicity • Fluids: Indicated with hypovolaemic arrest Class indeterminate as routine Avoid glucose unless hypoglycaemic

  32. Implications • Deemphasizes drug administration • Reemphasizes BLS • Drug administration during CPR • Co-ordinate - reduced interval increases shock success • AEDS - quicker, during CPR, re-program

  33. Post Resus • Little evidence to support specific Rx • No standardized Rx • Supportive - myocardial, organ function - glucose - avoid hyperventilation - temperature • Therapeutic hypothermia - improved outcome of out-of-hospital adult VF arrest

  34. FBAO • Simplified - mild or severe • Mild - victim coughing: do not interfere • Severe - silent cough - respiratory distress - stridor - unresponsive

  35. Severe FBAO • Activate EMS • Anecdotal evidence • Adults & >1yo : abdominal thrusts first : chest thrusts • Combinations of above most effective • Chest thrusts: obese, pregnant • CPR for unresponsive patients • Look into mouth, but no blind finger sweeps

  36. 18 March 2006 www.resuscitationcouncil.co.za

  37. ?

  38. References • Circulation, 2005; 112 • Currents, winter2005-2006 • JAMA, Feb 9, 2000-Vol 283, No6 p783-790

More Related