Resuscitation guidelines what is new

Resuscitation Guidelines
2010
- What’s new?
C.N.E conducted at ATLAS
HOSPITAL, Muscat
Compiled by:
Dr.Rajesh.T.Eapen
Anaesthesiologist
Atlas Hospital, Ruwi 25, 2012
Friday, May

Emergency Response

Friday, May 25, 2012

LEARN CPR
You can do it!
2010 AHA Guidelines:
The ABCs of CPR
Rearranged to "CAB"

CAB – for life
• CPR is a technique used to save
anyone from breathing and
circulatory failure.
• CPR consists of Basic Life Support
(BLS) and Advanced Cardiac Life
Support (ACLS).


Emphasis on
High-Quality CPR
2010 Guidelines
“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 of the
chest after each compression, to allow the heart
to fill completely before the next compression.
… minimize the frequency and duration of
interruptions in compressions to maximize the
number of compressions delivered per minute.

(Berg, et al. Circulation. 2010;122;S685-S705)


Highlights
• This is a re-emphasis from 2005.
• For effective compressions:
– Push fast
– Push hard
– Allow chest to fully recoil
– Minimize any interruptions
• Applies to both lay and healthcare providers.


Rationale For Change
• High-quality chest compressions within CPR
continues to be a critical focal point.
• Well-performed compressions increase the
likelihood of survival.


Compression Hand
Position
2010 Guidelines
“The rescuer should place the heel of one hand
on the center (middle) of the victim‟s 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.”



Highlights
• Hands in center of the
chest.
• Lower half of
breastbone
• Second hand on top of
the first.
• Not on lowest part of
breastbone.
• Applies to both lay and
healthcare providers.

Rationale For
Change
• Use of the nipple line as a landmark for
hand placement was found to be unreliable.


Compression Rate
2010 Guidelines
“It is reasonable for laypersons and healthcare
providers to 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.)”



Highlights
• “At least” 100 times per minute.
• It is okay to be a little faster.


Rationale For
Change
• It has been found that higher survival rates are
associated with an increase in the number of
compressions provided per minute.


Compression Depth
2010 Guidelines
“It is reasonable for laypersons and healthcare
providers to 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.”



Highlights
• “At least” 2 inches on an adult.
• It is okay to compress a little deeper.
• Not enough information to define upper
limit.
• Applies to both lay and healthcare
providers.


Rationale For
Change
• Research indicates the tendency for CPR
providers to not compress deep enough, even
with the emphasis to "push hard."


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).”



Highlights
• No more look, listen, and feel.
• Quick “look” for no breathing or no normal
breathing.
• Agonal breaths remain a concern.


End-tidal CO2
• The use of end-tidal CO2 (ETCO2) monitoring is
a valuable adjunct for healthcare professionals.
• When patients have no spontaneous circulation,
the ETCO2 is generally ≤ 10 mm Hg.
• When spontaneous circulation returns, ETCO2
levels are expected to abruptly increase to at
least 35-40 mm Hg.
• By monitoring these levels, interruptions in
compressions for pulse checks become
unnecessary.

Rationale for Change
• Simplifying the breathing assessment is
intended to help laypersons respond more
quickly with chest compressions and CPR.
• There is a high likelihood of agonal, or irregular,
gasping breaths to occur early in cardiac arrest
and confuse rescuers.


CPR Sequence -
Lay
2010 Guidelines
For an unresponsive person, activate EMS,
then assess breathing. If the person is not
breathing or not breathing normally, begin CPR
with 30 compressions followed by opening the
airway and giving 2 rescue breaths. Repeat
cycles of 30:2 (CAB method).

(Summary from Berg, et al. Circulation.
2010;122;S685-S705)


Highlights
• Initial assessment steps:
– Assess responsiveness
– Activate EMS
– Assess breathing
– Perform CPR
• CAB – begin CPR cycles
with compressions,
followed by airway and
breathing.
• Guideline applies to adults,
children, and infants.


Rationale For
Change
• The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
• Early chest compression can immediately
circulate oxygen that is still in the bloodstream.


CHAIN
OF SURVIVAL


Chain of Survival
2010 Guidelines
“These actions are termed the links in the
„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)


Highlights

• Addition of fifth link in chain.
– Integrated post-cardiac arrest care.


Rationale For
Change
• Links in the “Chain of Survival” indicate the
individual actions that must be strong in
order for a person to survive a sudden
cardiac arrest.
• The addition of the fifth link, integrated post-
cardiac arrest care, further emphasizes the
additional dependence on longer-term care
for long-term survival.


Cricoid Pressure
2010 Guidelines
“The routine use of cricoid pressure in adult
cardiac arrest is not recommended.”



Highlights
• Cricoid may impede ventilation.
• Difficult to teach.
• May prevent advanced airway placement.
• Aspiration may still occur.


Rationale For
Change
• Regardless of expertise, rescuers cannot
effectively apply cricoid pressure.


Team Approach
2010 Guidelines
“The intent of the algorithm is to present the steps of BLS in a logical and
concise manner that is easy for all types of rescuers to learn, remember and
perform. These actions have traditionally been presented as a sequence of
distinct steps to help a single rescuer prioritize actions. However, many
workplaces and most EMS and in-hospital resuscitations involve 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).”



Highlights
• Tasks can be performed simultaneously.
• Integrate additional rescuers as they arrive.
• Designate team leader with multiple
rescuers.


Rationale For
Change
• Some resuscitations start with a lone rescuer
and builds to more, whereas other resuscitations
begin with several willing rescuers.
• Training should focus on building a team and
performing tasks simultaneously.


Major change in
drugs!!
• Atropine is no
longer
recommended for
routine use in
managing and
treating pulseless
electrical activity or
asystole.

Friday, May 25, 2012 .

BLS TRAINING
CLASSES


Reasons for this
change
• Most survivors of adult cardiac arrest have
an initial rhythm of ventricular fibrillation
(VF) or pulseless ventricular tachycardia
(VT)
• Best treated initially with chest
compressions and early defibrillation
rather than airway management.


Reasons for this
•
changedelay of
Airway management often results in a
initiation of good chest compressions.
• Airway management no longer recommended
until after the first cycle of chest compressions --
30 compressions in 18 seconds.
• The 30 compressions are now recommended to
precede the 2 ventilations, which previous
guidelines had recommended at the start of
resuscitation.


• Only a minority of cardiac arrest victims
receive bystander CPR.
• Significant obstacle to bystanders
performing CPR is their fear of doing
mouth-to-mouth breathing. By changing
the initial focus of resuscitation to chest
compressions rather than airway
maneuvers, more patients will receive
important bystander intervention, even if it
is limited to chest compressions.

Change…..
• Hands-only CPR (compressions only -- no
ventilations) is recommended for the
untrained lay rescuers to obviate their
fears of mouth-to-mouth ventilations and
to prevent delays/interruptions in
compressions.


Change…..
• Pulse checks by lay rescuers should not be
attempted because of the frequency of false-
positive findings.
• Recommended that lay rescuers should just
assume that an adult who suddenly collapses, is
unresponsive and not breathing normally (e.g.
gasping) has had a cardiac arrest, activate the
emergency response system, and begin
compressions.


Change…..
• If pulse checks are performed, healthcare
providers should take no longer than 10
seconds to determine if pulses are
present.
• If no pulse is found within 10 seconds,
compressions should resume immediately.


Electrical therapies
• Patients with VF or pulseless VT should
receive chest compressions until a
defibrillator is ready. Defibrillation should
then be performed immediately.
• Transcutaneous pacing of patients who
are in asystole has not been found to be
effective and is no longer recommended.


ACLS Changes…..
The recommendations for airway
management have undergone 2 major
changes:
(1) the use of quantitative waveform
capnography for confirmation and
monitoring of endotracheal tube placement
is now a class I recommendation in adults;
(2) the routine use of cricoid pressure during
airway management is no longer
recommended. Friday, May 25, 2012

Changes in
recommendations for
dysrhythmia management
• For symptomatic or unstable bradydysrhythmias,
intravenous infusion of chronotropic agents (e.g.
dopamine, epinephrine) is now recommended
when atropine fails;


Post-cardiac
arrest care.
• Induced hypothermia is generally
recommended for adult survivors of
cardiac arrest who remain unconscious,
regardless of presenting rhythm.
• Hypothermia should be initiated as soon
as possible after return of spontaneous
circulation with a target temperature of
32°C-34°C.

ACLS Changes…..
• Urgent cardiac catheterization and
percutaneous coronary intervention are
recommended for cardiac arrest survivors
who demonstrate ECG evidence of ST-
segment elevation acute myocardial
infarction regardless of neurologic status.


Post-arrest care
changes….
• Hemodynamic optimization to maintain
vital organ perfusion, avoidance of
hyperventilation, and maintenance of
euglycemia are also critical elements in
post-arrest care.


Now let us have a look at a video
on the Resuscitation guidelines
2010:


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