New Approach in

Basic Life Support

Departemen Ilmu Penyakit Dalam

FK UI/RS Cipto Mangunkusumo

Introduction
The 2005 AHA Guidelines for CPR and ECC
emphasized the importance of highquality
chest compressions (compressing at an
adequate rate and depth, allowing complete
chest recoil after each compression,
compression and
minimizing interruptions in chest
compressions).
compressions)

Continued Emphasis on
HighQuality CPR (adult)
The 2010 AHA Guidelines for CPR and ECC once again
emphasize the need for highquality CPR, including :
1. A compression rate of at least 100/min (a change
from approximately
approximately 100/min)
2. A compression depth of at least 2 inches (5 cm) in
adults
Note : the range of 1 to 2 inches is no longer used
for adults
adults.

Continued Emphasis on
HighQuality CPR (adult)
3. Allowing for complete chest recoil after each
compression
4. Minimizing interruptions in chest
h
compressions
5. Avoidingg excessive ventilation

Continued Emphasis on HighQuality CPR (adult)

There has been no change in the recommendation for a
compressiontoventilation ratio of 30:2 for single rescuers of
adults.
Th
The 2010 AHA Guidelines
G id li
for
f CPR and
d ECC continue
ti
tto recommend
d
that rescue breaths be given in approximately 1 second.
Once an advanced airway is in place,
place chest compressions can be
continuous (at a rate of at least 100/min) and no longer cycled with
ventilations.
Rescue breaths can then be provided at about 1 breath every 6 to 8
seconds (about 8 to 10 breaths per minute).
Excessive ventilation should be avoided.

Highlights of the 2010 Guidelines

A Change From ABC
A B C to CAB
CAB
The
h 20
2010
0 AHA Guidelines
G id li
ffor C
CPR and
d ECC
CC
recommend a change in the BLS sequence of
steps from
f
A B C (Ai
ABC
(Airway, B
Breathing,
hi Ch
Chest
compressions) to CAB (Chest compressions,
Ai
Airway,
B
Breathing)
hi ) for
f adults,
d l children,
hild
and
d
infants.

A Change From ABC to CAB

Why :
The vast majority of cardiac arrests occur in
adults,
d lt and
d th
the hi
highest
h t survival
i l rates
t ffrom cardiac
di
arrest are reported among patients of all ages
who have a witnessed arrest and an initial rhythm
y
of ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT).
In these patients, the critical initial elements of
p
and earlyy
BLS are chest compressions
defibrillation.

A Change From ABC to CAB

Why :
In the ABC sequence, chest compressions are often
delayed while the responder opens the airway to give
mouthtomouth breaths, retrieves a barrier device, or
ggathers and assembles ventilation equipment.
q p
By changing the sequence to CAB, chest
compressions will be initiated sooner and the delay in
ventilation should be minimal (ie, only the time
required to deliver the first cycle of 30 chest
compressions, or approximately 18 seconds

A Change From ABC

A B C to CAB
CAB

The difference between 2010 BLS AHA with 2005

Activation off Emergency
g y Response
p
System
y
2010 (New):
Check for response while looking at the patient to determine if
breathing is absent or not normal. Suspect cardiac arrest if the
victim is not breathing or only gasping
gasping.
2005 (Old):
Activated the emergency response system after finding an
unresponsive victim, then returned to the victim and opened the
airway and
d checked
h k d ffor b
breathing
h or abnormal
b
lb
breathing.
h

The difference between 2010 BLS AHA with 2005

Activation of Emergency Response System
Why :
Should not delay activation of the emergency response
system but should obtain 2 pieces of information
simultaneously: the provider should check the victim for
response and
d check
h k ffor no b
breathing
thi or no normall
breathing.

The difference between 2010 BLS AHA with 2005

Change in CPR Sequence: CAB Rather Than ABC
2010 (New):
A change in the 2010 AHA Guidelines for CPR and ECC is to
recommend the initiation of chest compressions before
ventilations.
2005 (Old):
Th sequence off adult
The
d lt CPR b
began with
ith opening
i off th
the airway,
i
checking for normal breathing, and then delivering 2 rescue
breaths followed by cycles of 30 chest compressions and 2
breaths.

The difference between 2010 BLS AHA with 2005

Change in CPR Sequence: CAB Rather Than ABC
Why:
Survival was higher when bystanders provided chest
compressions rather than no chest compressions.
Delays or interruptions in chest compressions reduce
survival.
Chest compressions can be started almost immediately,
whereas positioning the head and achieving a seal for
mouthtomouth or bagmask rescue breathing all take
time.
time

The difference between 2010 BLS AHA with 2005

Elimination of Look, Listen, and Feel for Breathing
2010 (New):
Look, listen, and feel for breathing was removed from the
sequence for
f assessment off b
breathing
h after
f opening the
h
airway. The healthcare provider briefly checks for breathing
when checkingg responsiveness
p
to detect signs
g of cardiac
arrest. After delivery of 30 compressions, the lone rescuer
opens the victims airway and delivers 2 breaths.
2005 (Old):
Look, listen,
listen and feel for breathing
breathing was used to assess
Look
breathing after the airway was opened.

The difference between 2010 BLS AHA with 2005

Eli i i off L
Elimination
Look,
k Li
Listen, and
d FFeell ffor B
Breathing
hi
Why:
CPR is performed if the victim is unresponsive and
not breathing
b
hi or not b
breathing
hi normally
ll and
db
begins
i
with compressions (CAB sequence). Breathing is
briefly checked as part of a check for cardiac arrest.
arrest
After the first set of chest compressions, the airway
is opened
p
and the rescuer delivers 2 breaths.

The difference between 2010 BLS AHA with 2005

Chest Compression Rate: At Least 100 / Minute
2010 (New):
It is
i reasonable
bl ffor llay rescuers and
dh
healthcare
lh
providers to perform chest compressions at a
rate off at lleast 100/
100/min.
i
2005 (Old):
Compress at a rate of about 100/min
100/min.

The difference between 2010 BLS AHA with 2005

Chest Compression Rate: At Least 100 / Minute
Why:
Delivery of more compressions during resuscitation
is associated with better survival, and delivery of
fewer compressions is associated with lower survival.
An inadequate compression rate or frequent
interruptions (or both) will reduce the total number
of compressions delivered per minute.

The difference between 2010 BLS AHA with 2005

Chest Compression Depth
2010 (New):
The adult sternum should be depressed at
least 2 inches (5 cm).
2005 (Old):
The adult sternum should be depressed 1 to
2 inches (approximately 4 to 5 cm)
cm).

The difference between 2010 BLS AHA with 2005

Chest C
Ch
Compression
i D
Depth
h
Why:
Compressions create blood flow primarily by
increasing intrathoracic pressure and directly
compressing the heart
heart.
Compressions generate critical blood flow and
oxygen and energy delivery to the heart and brain.
brain
Compressions of at least 2 inches are more effective
than compressions of 1 inches
inches.

The difference between 2010 BLS AHA with 2005

Cricoid Pressure
2010 (New):
pressure in cardiac arrest is
The routine use off cricoid p
not recommended.
2005 (Old):
pressure should be used onlyy iff the victim is
Cricoid p
deeply unconscious, and it usually requires a third
rescuer not involved in rescue breaths or
compressions.

The difference between 2010 BLS AHA with 2005

Cricoid Pressure
Why:
Seven randomized studies showed that cricoid
pressure can delay or prevent the placement of an
advanced airway and that some aspiration can still
occur despite application of cricoid pressure.
In addition, it is difficult to appropriately train
rescuers in use of the maneuver.

The difference between 2010 BLS AHA with 2005

The difference between 2010 BLS AHA with 2005

CPR Techniques
2010 (New):
The precordial thump should not be used for unwitnessed out
ofhospital cardiac arrest. The precordial thump may be
considered for patients with witnessed, monitored, unstable
VT (including pulseless VT) if a defibrillator is not immediately
readyy for use,, but it should not delayy CPR and shock delivery.
y
2005 (Old):
No recommendation was provided previously.

The difference between 2010 BLS AHA with 2005

CPR Techniques
Why:
A precordial thump has been reported to convert ventricular
t h
tachyarrhythmias
h th i in
i some studies.
t di
Two larger case series found that the precordial thump did
not result in ROSC for cases of VF.
Reported complications associated with precordial thump
include sternal fracture, osteomyelitis, stroke, and triggering
off malignant
li
t arrhythmias
h th i iin adults
d lt and
d children.
hild
The precordial thump should not delay initiation of CPR or
defibrillation.

Take Home Message

g

Take Home Message

Take Home Message

TERIMA KASIH