The 2010 American Heart Association

Guidelines for Cardiopulmonary

Resuscitation (CPR)

Agus Harsoyo, MD
Cardiovascular Intervensionist and Electrophysiology Intervensionist

Department of Cardiology
Gatot Soebroto Army Center Hopital
Jakarta
2011

Chain of Survival
2010 Guidelines) Chain of Survival. For adults
they include:

Immediate recognition of cardiac arrest

and activation of the emergency response
system
Early
CPR
that
emphasizes
chest
compressions
Rapid defibrillation if indicated
Effective advanced life support
Integrated post cardiac arrest care
(Travers, et al. Circulation. 2010;122;S676-S684),
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Activation of Emergency Response

System
2010 Guidelines (New) The
healthcare provider should check for
response while looking at the patient to
determine if breathing is absent or not
normal. The provider should suspect
cardiac arrest if the victim is not
breathing or only gasping,

Change in CPR Sequence: C-A-B

Rather Than A-B-C

In CAB chest compression will initiated

sooner and ventilation only minimally
delayed
until completion of the first
cycle
of
chest
compression.
(30
compression should be accomplish in
approximately18 seconds).
Fewer than 50 % of person in Cardiac
Arrest receive bystander CPR. Starting
with Compressions might ensure that
more victim receive CPR and that recuers
who are unwilling to provide ventilations
will at least perform cheast compressions
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The vast majority of cardiac arrest occur in

adults with winessed arrest are patients
with VF (ventricular fibrillation) or pulsess
ventricular tachycardia (VT).
In these patients the critical initial
elements of CPR are chest compression and
early defibrilation,
In the ABC sequence chest compression are
often delayed when the responder give
mouth to mouth breaths or retrieves a
barrier
device
or
other
ventilation
equipment,
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Cricoid
Pressure
2010 Guidelines New: The routine
use of cricoid pressure in cardiac arrest
is not recommended

Emphasis on High-Quality
CPR
2010 Guidelines (New)
To provide effective chest compressions,
push hard and push fast.
compress the adult chest at a rate of at least 100
compressions per minute with a compression depth of at
least 2 inches/5 cm.
allow complete recoil
Not trained in CPR, the bystander should provide HandsOnly (compression-only)

For The HCP, chest compressions and rescue breaths

for cardiac arrest victims
(Berg, et al. Circulation. 2010;122;S685-S705)

Compression Hand
Position

Compression Hand Position (2010

Guidelines New) 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 verlapped and parallel
(Circulation. 2005; 112: IV19-IV34)

Compression Rate
Compression Rate (Guidelines 2010) compress the
adult chest at a rate of at least 100 compressions /mnt
compression depth of at least 2 inches (5 cm.),
Rationale For Change :
higher survival rates
with an increase in the number of
compressions provided per minute. (Berg, et al. Circulation.
2010;122;S685-S705)

Child/Infant Compression Rate (2010 Guidelines

New) Push fast; push at a rate of at least 100
compressions per minute,
for Compression Depth Push hard: push with sufficient
force to depress at least one third the anterior-posterior
(AP) diameter of the chest or approximately 1 inches (4
cm) in infants and 2 inches (5 cm) in children (Berg, et al.
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Breathing Assessment
(2010

Guidelines) After activation of the

emergency response system, all rescuers
should immediately begin CPR for adult
victims who are unresponsive with no
breathing or no normal breathing (only
gasping)
After delivery of 30 compressions, the lone
rescuer opens the victims airway and
delivers 2 breaths )(Berg, et al. Circulation. 2010;122;S685-S705).

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Use of an AED
2010 Guidelines have high specificity in
recognizing pediatric shockable rhythms, and
some are equipped to decrease (or attenuate)
the delivered energy to make them suitable
for infants and children < 8 years of age. For
infants an AED equipped with a pediatric
attenuator is preferred for infants. If neither is
available, an AED without a dose attenuator
may be used
(Link, et al. Circulation. 2010;122;S706-S719)

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Team Approach HCP

2010 Guidelines teams of providers who
should
perform
several
actions
simultaneously (e.g.: one rescuer activates
the emergency response system while
another begins chest compressions, and a
third either provides ventilations or retrieves
the bag-mask for rescue breathing, and a
fourth retrieves and sets up a defibrillator)
(Berg, et al. Circulation. 2010;122;S685-S705)

Highlights, Tasks can be performed

simultaneously,
Integrate
additional
rescuers as they arrive, Designate team
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leader with multiple rescuers

ACLS Cardiac Arrest Algorithm

(2010)

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Adult bradycardia
(2010)

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Thank you

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