CARDIO - PULMO - (CEREBRAL) RESUSCITATION

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CARDIO - PULMO - (CEREBRAL) RESUSCITATION

• Jozef Firment
• Judita Capková
• Department ofAnaesthesiology Intensive
  MedicineŠafárik University Faculty of Medicine,
  Košice

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• Basic life support A,B,C - to buy time for
• Advanced life support A,B,C,D,E to restore
  circulation

1961 Peter Safar
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Most frequent causes of out-of-hospital cardiac
arrest CA
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Most common causes of cardiac arrest CA

• 1. place IHD...Myocardial infarction (80)

Ventricular fibrilation
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Most common causes of cardiac arrest CA

• 1. place IHD...Myocardial infarction
• Hypertension
• Valvular disease,..
• Trauma
• Poisoning
• Drowning
• Hypotermia...

Electrical defibrillation only effective
treatment for VF
Ventricular fibrilation
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Most common causes of cardiac arrest CA

• 1. place IHD...Myocardial infarction (80)
• Hypertension
• Valvular disease,..
• Trauma
• Poisoning
• Drowning
• Hypotermia...

Ventricular fibrilation
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Cause of CA in

• Trauma
• Drowning
• Drug overdose Asphyxia
• Children
• Rescue breaths are critical for resuscitation

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• In- hospital arrests are due tu PEA or asystole
  (60-70)
• - early recognition of pp at risk may prevent
  arrest Medical Emergency Teams
• Overall survival to hospital discharge is 10

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THE CHAIN OF SURVIVAL
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Open AirwayCervical spine injury

• Jaw thrust (no for lay rescuer) or chin lift
  with manual inline stabilisation of head and
  neck by an assistant

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AGONAL BREATHING

• Occurs shortly after the heart stops
• in up to 40 of cardiac arrests
• Described as barely, heavy, noisy or gasping
  breathing
• Recognise as a sign of cardiac arrest

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EXTERNAL CHEST COMPRESSIONS
one rescuer 302
f 100-120/min.
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The quality of cc is frequently suboptimal
Effective chest compressions
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Continous chest compression - only
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Only 1 in 4 patients in CA recieves bystander CPR

• transmission of infection - tuberculosis,
  SARS, H1N1 small number, - HIV never
  reported

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Protective devices
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Continous chest compression - only

• If layman is not able or is unwilling to perform
  mouth to mouth breathing
• Chest compressions f 100/min without stopping

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Basic life support C,A,B

• Continue chest compressions and rescue
  breathing
• - victim starts breathing normally (signs of
  life)- Medical emergency service arrives
• - you become exhausted

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• Basic life support C,A,B
• Advanced life supportC, A, B, Drugs, ECG,
  Fibrilation treatment - defibrilation...

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In hospital CPR- Advanced life support

• One person starts 302others call resuscitation
  team defibrillator, r. equipments (airway,
  ambu bag, adrenalin,..)
• only one person leaves the patient, calls
  resuscitation team starts 302

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VENTILATION MANAGEMENT ALS In-hospital CPR

• A and B
• Oral/nasal airway

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VENTILATION MANAGEMENT ALS In-hospital CPR

• A and B
• Oral/nasal airway
• Tracheal intubation f 10/min , Fi02 1,0
  (reservoir bag), VT(tidal volume) 6-7
  ml/kg,(chest compressions and ventilations
  continue uninterupted)

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Laryngeal mask, laryngeal tube Oe-Trach
Combitube
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BAG WITH OXYGEN SUPPLY
O2 FiO2 VT x f l/min adults
13 85-100 1000 x 15 - - 4 gt40
dtto children 5 85-100 300 x 20 - -
2 gt40 dtto
Campbell
B
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Advanced life support
Self-inflating bag-mask oropharyngeal airway
CCV 302
Hyperventilationreduces cerebral blood flow
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• The quality of chest compressions is frequently
  suboptimal
• team leader shouldchange CPR providers every 2
  minutes (5x ccv 302)

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Hearth rhytms associated with CA
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DEFIBRILLATION

• Paddle positions (sternum, apex), no over the
  breast tissue
• Self- adhesive pads (sparks!!)- the best
• Biphasic defibrilators1. 150-200J2.
  150-360J,....
• CPR for 2 min (5 x 302)after shock

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DEFIBRILLATION

• Check the rhythm(organised QRS
  complexesregular narrow- feeling for a
  pulse)
• After the third shock giveadrenalin 1mg every
  3-5 min. ivamiodaron 300mg iv
• Time between CC and shock delivery lt 5s
  coronary perfusion pressure falls substantially
• Signs of life return normal breathing,movement,
  coughing, puls

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A precordial thump

• Generates a small electrical shock
• In witnessed and monitored VF/VT arrests if a
  defibrillator is not immediately available
• The ulnar edge of fist the lower half of
  sternum from a height of 20 cm
• Converting VT to sinus rhytm

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LIFE-THREATENING CARDIAC RHYTHM DISTURBANCES

• Cardiac arrest (asystole)Fine VF will not be
  shocked successfully
• Pulseless electrical activity (PEA, EMD)-
  myocardial contractions are too weak to produce
  pulse or blood pressure

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POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)

• Hypoxia
• Hypovolemia
• Hypothermia
• Hyper/hypoKand metabolic disorders
• H ions (acidosis)

• Tension pneumothorax
• Tamponade
• Toxic/therap. disturbances
• Thrombosis coronary
• Thrombosis pulmonary

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POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)

• Hypoxia ventilation with 100 oxygen
• Hypovolemia (haemorrhage-trauma, GIT
  bleeding,rupture of an aortic aneurysm- fluid (
  saline or Hartmans solution urgent surgery)
• Hypothermia (in drowning incident)
• Hyper/hypoKand metabolic disorders(detected by
  biochemical tests, renal failure)
• H ions (acidosis) - bicarbonate

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POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)

• Tension pneumothorax- needle thoracocentesis and
  chest drain
• Tamponade needle pericardiocentesis
• Toxic substances appropriate antidotes
• Thrombosis coronary - thrombolysis
• Thrombosis pulmonary trombolytic drug

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Thoracocentesis
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Needle pericardiocentesis
Cardiac tamponade- difficult to diagnose-
penetrating chest trauma is suggestive
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Thrombosis pulmonary and coronary

• thrombolysis
• percutaneous coronary intervention -PCI

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DRUGS USED CPR

• 1. Adrenaline (EPINEPHRINE)
• 1 mg á 3- 5 (EVERY SECOND LOOP(5x CV 302) OF
  THE ALGORYTHM)
• alpha adrenergic actions cause vasoconstriction,
  increases myocardial and cerebral perfusion
  pressure
• 2. Bicarbonate 50ml 8,4
• -pH lt 7.1, BE lt -10-hyperkalaemia-tricyclic
  antidepressant overdose

• equipment
• (defibrilator)
• oxygen
• Ambu bag
• face mask
• F1/1
• infusion set
• plastic IV cannula

3. Amiodarone 300 mg after a third unsuccessful
defibrillation in VF/VT...150 mg (inf.
900mg/24h)lidocaine 1 mg/kg- alternative
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DRUG DELIVERY ROUTES

• Intravenous (central, peripheral 20 ml sol. F
  1/1 elevate 10-20 s)
• Intraosseal effective concentrations of drugs
  is achieved very quickly
• Tracheal (2-3x more dose 10 ml water)
  (adrenaline, lidocaine, atropine)
• NEVER IM nor SC !!!

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EZ-IO AD Proximal Tibial Access
Intraosseous Infusion System
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Automatický intraoseálny injektor
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Post resuscitation care

• Stable cardiac rhythm, normal haemodynamic
  function (thrombolysis, percutaneous coronary
  intervention)
• Intubation, ventilation, sedation
• Therapeutical hypothermia
• Comatose adults after out-of-hospital VF cardiac
  arrest were cooled to 32-34 oC for 12-24 h.
• Improved neurological outcome

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• www.erc.edu
• www.resus.org. uk
• Resuscitation (in october 2010)
• http//www.lf.upjs.sk/kaim/pregradualne_vzdelavani
  e.html

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Thank you!
jcapkova_at_capko.sk
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Open chest CPR

• better coronary perfusion
• Trauma, after cardiothoracic surgery, when chest
  or abdomen is already open

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PROTOCOL FOR CPCR INTERPRETATION Utstein
in-hospital

• TIME

• disaster call
• start CPCR
• emerg. team arrival
• onset of circulation
• living out
• provided activities...

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HODNOTENIE VÝSLEDKOVKPCR

• Kritériom krátkodobého výsledku KPCR je obnovenie
  krvného obehu
• Kritériom dlhodobého výsledku KPCR je návrat
  neurologických a psychických schopností pacienta

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Ectopic rhythm
Normal SR
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2
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Rhythm disorders at AMI
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Thrombus development
Acute MI
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LIFE-THREATENING CARDIAC RHYTHM DISTURBANCES

• 1. Ventricular fibrillation,pulseless
  ventricular tachycardia
• 2. Cardiac arrest (asystole)
• 3. Pulseless electrical activity (PEA, EMD)
• circulatoty arrest

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European resuscitation counscil

• Európske guidelines týkajúce sa resuscitácie boli
  publikované Európskou radou pre resuscitáciu
  (ERC) v International Journal Resuscitation
  v novembri 2010.
• www. erc.edu, www.resus.org.uk