New CPR Guidelines 2010

Dr. Davide Antonelli

WHY WE DIE

Other reasons

Every year there are more than 60 cardiac arrests on 100.000 people in the world

Survival rate is between 5 and 8,4% 40% is due to cardiovascular diseases In 7 out of 10 cases, the heart rhythm is asystole

In 3 out of 10 cases, Ventricular Fibrillation (VF)

Time is life
- Every minutes delay of BLS means 7-8% less probability of a positive outcome (after 10-12 minutes of BLS delay, surviving rate is 0) - Every delay of BLS means an increased rate of brain damage, neurological impairment and poor outcome.

Why we switched from A,B,C to C,A,B

1) Much less than one third of rescuers gives rescue breaths 2) It is easier to perform only chest compressions 3) Initially chest compressions can provide a minimum air flow to and from the lungs 4) After a cardiac arrest, O2 stored is depleted in a 4 minutes. 5) Better chest compressions than nothing, but is much better chest compressions and rescue breaths than chest compressions alone

Adult Basic Life Support

Which are the fundamental aspects of BLS ?

Adult Basic Life Support

Immediate recognition of sudden cardiac arrest (SCA) Activation of the emergency response system Early cardiopulmonary resuscitation (CPR) Rapid defibrillation with an automated external defibrillator (AED) Initial recognition and response to heart attack and stroke are also considered part of BLS.

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Adult BLS Sequence

Adult Basic Life Support

Pulse Check Early CPR
Chest compressions Rescue Breaths

Early Defibrillation With an AED

Pulse Check
The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally. Healthcare providers also may take too long to check for a pulse The healthcare provider should take no more than 10 seconds to check for a pulse and, if the rescuer does not definitely feel a pulse within that time period, the rescuer should start chest compressions .

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Early CPR
30 Chest compressions 2 Rescue Breaths

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Effective chest compressions
are essential for providing blood flow during CPR. For this reason all patients in cardiac arrest should receive chest compressions (Class I). To provide effective chest compressions, push hard and push fast. (rate 100-120/min.)

Adult Basic Life Support

Compress the adult chest at a rate of at least 100 compressions per minute (Class IIa) with a compression depth of at least 2 inches/5 cm (Class IIa). Allow complete chest recoil after each compression.(Class IIa).

Adult Basic Life Support

The rescuer should place the heel of one hand on the center (middle) of the victims chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel (Class IIa). Chest compression and chest recoil/relaxation times approximately equal (Class IIb).

Adult Basic Life Support

CHEST COMPRESSIONS

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Minimize the frequency and duration of interruptions in compressions (Class IIa). Once chest compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation.

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Rescuer fatigue may lead to inadequate compression rates or depth. When 2 or more rescuers are available it is reasonable to switch chest compressors approximately every 2 minutes (or after about 5 cycles of compressions and ventilations at a ratio of 30:2) to prevent decreases in the quality of compressions (Class IIa). Every effort should be made to accomplish this switch in 5 seconds.

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Managing the Airway A significant change in these guidelines is to recommend the initiation of chest compressions before ventilations (CAB rather than ABC). A healthcare provider should use the head tilt chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma . If healthcare providers suspect a cervical spine injury, they should open the airway using a jaw thrust without head extension (Class IIb).

Head tilt / chin lift and Jaw thrust

Adult Basic Life Support

Rescue Breathing
Deliver each rescue breath over 1 second (Class IIa). Give a sufficient tidal volume to produce visible chest rise (Class IIa) Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations (Class IIa).

AIRWAY

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Ventilation With Bag and Mask
Rescuers can provide bag-mask ventilation with room air or oxygen. This amount is usually sufficient to produce visible chest rise and maintain oxygenation and normocarbia in apneic patients (Class IIa). If the airway is open and a good, tight seal is established between face and mask.

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As long as the patient does not have an advanced airway in place, the rescuers should deliver cycles of 30 compressions and 2 breaths during CPR. The rescuer delivers ventilations during pauses in compressions and delivers each breath over 1 second (Class IIa). The healthcare provider should use supplementary oxygen (O2 concentration 40%, at a minimum flow rate of 10 to 12 L/min) when available.

Adult Basic Life Support

Ventilation With an Advanced Airway
When an advanced airway (ie, endotracheal tube, Combitube, or laryngeal mask airway [LMA]) is in place during 2-person CPR, give 1 breath every 6 to 8 seconds without attempting to synchronize breaths between compressions (this will result in delivery of 8 to 10 breaths/minute). There should be no pause in chest compressions for delivery of ventilations (Class IIb).

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Excessive ventilation is unnecessary and can cause gastric inflation and its resultant complications, such as regurgitation and aspiration (Class III). Rescuers should avoid excessive ventilation (too many breaths or too large a volume) during CPR (Class III).

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Cricoid Pressure
Cricoid pressure might be used in a few special circumstances (eg, to aid in viewing the vocal cords during tracheal intubation). Routine use of cricoid pressure in adult cardiac arrest is not recommended (Class III).

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Early Defibrillation With an AED

Adult Basic Life Support

All BLS providers should be trained to provide defibrillation because VF is a common and treatable initial rhythm in adults with witnessed cardiac arrest. For victims with VF, survival rates are highest when immediate bystander CPR is provided and defibrillation occurs within 3 to 5 minutes of collapse.

AED

AED

AED

Automated External Defribillator

T ogether
E verybody A chieves
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