CARDIAC ARREST & AHA

GUIDELINES 2015
DR. RAFIA TABASSUM
ASSISTANT PROFESSOR
DEPT: ANAESTHESIOLOGY, SICU & PAIN
MANAGEMENT CENTER
PUMHSW-SBA
CARDIAC ARREST
DEFINITION
• An international consensus
workshop classified cardiac
arrest as the “cessation of
cardiac mechanical activity, as
confirmed by the absence of
signs of circulation.”
 PEOPLE AT RISK ????
• People who have had a prior Sudden Cardiac
Arrest
• People with a family history of Sudden
Cardiac Arrest
• People who have had a heart attack
(Myocardial Infarction or MI)
• People with Congestive Heart Failure (HF)
• People with Ejection Fraction (EF) less than
35%
 HISTORY
• The first written account • . . . placed himself over
of a resuscitation
attempt is that of Elijah
the prophet.
• The story in the Bible
tells of a grief stricken
mother who brought her
lifeless child to Elijah
and begged for help.
the child. He put his
mouth on his mouth, his
eyes on his eyes, and his
hands on his hands, as he
bent over him. And the
body of the child became
warm. He stepped down,
walked once up and down
the room, then mounted
and bent over him.
Thereupon, the boy
sneezed seven times, and
the boy opened his eyes.
 KEY POINTS
• High quality CPR emphasizes adequate depth and
number of chest compressions.
• Position patient on hard surface in supine position
• Minimal interruptions for ventilation
• 18 seconds per cycle
• Adequate speed of compressions: >100/minute--- at
a rate of 100-120 per minute.
• Adequate depth of compressions: 2-2.4” (5-6cm)
• Allow complete recoil of chest
• Do not over ventilate
• Breathing devices include a ONE WAY VALVE FACE
MASK.
• Deliver breath over one second. Watch the chest
rise
 PULSELESS ALGORITHM

Shockable
 Ventricular fibrillation
 Ventricular tachycardia
Nonshockable
Pulseless electrical activity
Asystole
ANALYSING RHYTHM DO NOT TOUCH VICTIM
SHOCK INDICATED

• Stand clear
• Deliver shock
SHOCK DELIVERED FOLLOW AED
INSTRUCTIONS: CONTINUE CPR

30 2
 NO SHOCK ADVISED FOLLOW AED
INSTRUCTIONS---- CONTINUE CPR

30 2
 Monitoring
• Pulse check
 No more than 10 seconds
 No value during CPR
• ETCO2
 Intubated patients
 Quality of CPR (goal ≥10 mm Hg)
 ROSC (> 35-40 mm Hg)
• Arterial diastolic pressure
 Goal >20 mm Hg
Airway
 RESCUE BREATHS
• Pinch the nose
• Take a normal breath
VT= 500-600 mls
• Place lips over mouth
• Blow until the chest
rises
• Take about 1 second
• Allow chest to fall
• Repeat
BLS Dos & Don’ts of Adult high
quality CPR
 2015 Recommendations
• CHEST COMRESSION RATE = 100-
120/Min
• CHEST COMRESSION DEPTH = A
compression depth of at least 2
inches (5 cm) for an average adult
and avoid compression depths greater
than 2.4 inches (6 cm)
 2015 Recommendations
• NALAXONE IN OPIOD ASSOCIATED
LIFE THREATENING EMERGENCIES
Through 0.4 mg intramuscular or 2 mg
intranasal routes
• Shock First vs CPR First For
witnessed cardiac arrest when AED is
available, defibrillator should be used as
early as possible
 2015 Recommendations
• CHEST RECOIL = Avoid leaning on the
chest between compressions to allow
full chest wall recoil
• Minimizing interruptions in Chest
compressions = Minimize frequency &
duration of interruptions in
compressions to maximize the number
of compression delivered per minute
 2015 Recommendations
• Ventilation during CPR with an Advanced
Airway = During continuous chest
compression deliver 1 breath every 6 sec
(10 breaths/ min)
• Vasopressors for Resuscitation =
Administer Epinephrine as soon as feasible.
Vasopressin offers no advantage in
combination with Epinephrine
• Post Cardiac arrest drug therapy = Beta
blockers, Lidocaine
SUMMARY OF HIGH-QUALITY
CPR COMPONENTS
FOR BLS PROVIDER
 Alternative techniques &
Ancillary devices for CPR
• Impedance threshold devices
• Mechanical chest compression devices
• Extracorporeal techniques & invasive
perfusion devices