Cardiopulmonary resuscitation (basic and advanced cardiac life support)

Cardiopulmonary Resuscitation Basic and Advanced Cardiac Life Support David Maldonado MD Mayo Clinic Rochester, MN, USA... Cardiac Arrestdisease attempted resuscitation every year... Cau

Cardiopulmonary Resuscitation (Basic and Advanced Cardiac Life

Support)

David Maldonado MD

Mayo Clinic Rochester, MN, USA

Agenda

Cardiac Arrest

disease

attempted resuscitation every year

Causes of Cardiac Arrest

(ventricular tachycardia) or chaotic

(ventricular fibrillation)

respiratory arrest/choking/drowning,

electrocution, trauma and other causes

Americanheart.org

• Brain death begins within 4-6 minutes

minutes

minute without CPR or defibrillation (not including cold-water drowning)

appropriate defibrillation are keys to

management

Americanheart.org

Cardiopulmonary Resuscitation (CPR)

Basic Life Support (BLS)

Breathing for person felt to be in cardiac arrest

definitive treatment of ACLS

(anti-arrhythmic medications, fluid

resuscitation, electrolyte restoration, etc.)

BLS Healthcare Provider Algorithm

No movement or response

Open AIRWAY, check BREATHING

If not breathing, give 2 BREATHS that make chest rise

• Give 1 breath every 5 to 6 seconds

• Recheck pulse every 2 minutes

If no response, check pulse: Definite pulse

Give cycles of 30 COMPRESSIONS and 2 BREATHS Push hard and fast (100/min) and release completely

Minimize interruptions in compression

No pulse

AED/defibrillator ARRIVES

Check rhythm Shockable rhythm?

5 cycles; continue until ALS Providers take over or victim starts to move

ABCD’s of BLS Step 1: Airway

• Head-tilt, Chin-lift maneuver

• Open airway

Step 2: Breathing Look, listen, and feel

rescue breaths, then proceed to next step

mouth-to-mouth

Smurd.com

Chest Compression Technique

Smurd.com

100 compressions/minute

Abella et al Circulation. 2005;111:428-434.

Compression Depth

4-5 cm

71:136-145.

Step 4: Defibrillation Advanced Cardiac Life Support (ACLS)

Shockable Rhythms

VF and pulseless VT

• Deliver single shock (360 J Monophasic or

200 J Biphasic)

either epinephrine 1mg every 3-5 minutes

or Vasopression 40 Units IV x 1

consider antiarrhythmics

Non-Shockable Rhythms

Asystole and PEA

• Immediate 5 cycles of CPR

Vasopressin 40 Units IV x 1

6 H’s and 5 T’s

Post-resuscitative Care

• Supportive, multi-organ care

• ?Hypothermia, ?Glucose control

• Predictors of poor outcome at 24 hrs

• Absent corneal reflex

• Absent pupillary response

• Absent withdrawl response to

pain