Basic Life Support 2020

1. CARDIOPULMONARY RESUSCITATION (CPR)
PRE-CPR,
BASIC LIFE SUPPORT
‫عملکردی‬ ‫اعصاب‬ ‫جراحی‬ ‫تحقیقات‬ ‫مرکز‬
‫بهشتی‬ ‫شهید‬ ‫پزشکی‬ ‫علوم‬ ‫دانشگاه‬

2. OBJECTIVES
• At the end of this course:
• Participants should be able to demonstrate:
• How to assess the collapsed victim
• How to perform chest compression and use AED
• How to approach to the pulseless arrest patients

6. These Highlights summarize the key issues
and changes in the 2020 American Heart
Association (AHA) Guidelines for
Cardiopulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC).
“Guidelines Highlights”

8. Figure 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies,
Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated May 2019)*

9. Distribution of COR and LOE as percent of 491 total recommendations in the
2020 AHA Guidelines for CPR and ECC.*a
Abbreviations: COR, Classes of Recommendation; EO, expert opinion; LD,
limited data; LOE, Level of Evidence; NR, nonrandomized; R, Randomized.

10. Adult Basic and Advanced Life Support

11. SUMMARY OF KEY ISSUES AND
MAJOR CHANGES
Adult Basic and Advanced Life Support

12. • Enhanced algorithms and visual aids provide easy-to-
remember guidance for BLS and ACLS resuscitation
scenarios.
• The importance of early initiation of CPR by lay rescuers
has been re-emphasized.
• Previous recommendations about epinephrine
administration have been reaffirm with emphasis on
early epinephrine administration.
•
Major new changes include the following:

13. • Use of real-time audiovisual feedback is suggested as a means to
maintain CPR quality.
• Continuously measuring arterial blood pressure and end-tidal
carbon dioxide (ETCO2) during ACLS resuscitation may be useful to
improve CPR quality.
• Routine use of double sequential defibrillation is not recommended.
• Intravenous (IV) access is the preferred route of medication
administration during ACLS resuscitation. Intraosseous (IO) access is
acceptable if IV access is not available.
Major new changes include the following:

14. Major new changes include the following:
• Care of the patient after return of spontaneous circulation (ROSC) requires
close attention to oxygenation, blood pressure control, evaluation for
percutaneous coronary intervention, targeted temperature management,
and multimodal neuro-prognostication.
• Because recovery from cardiac arrest continues long after the initial
hospitalization, patients should have formal assessment and support for
their physical, cognitive, and psychosocial needs.

15. Major new changes include the following:
• After a resuscitation, debriefing for lay rescuers, EMS
providers, and hospital-based healthcare workers may be
beneficial to support their mental health and well-being.
• Management of cardiac arrest in pregnancy focuses on
maternal resuscitation, with preparation for early perimortem
cesarean delivery if necessary to save the infant and improve
the chances of successful resuscitation of the mother

16. Taxonomy of Systems of Care: SPSO

17. 2015- AHA Chains of Survival for adult IHCA
and OHCA.

18. 2020- AHA Chains of Survival for adult IHCA
and OHCA.

19. CPR Training: Classes
• Routine: Training 1st hand learner or refreshment courses for lay
personnel
• Management: Training CPR managers
• Standardization: Developing local or provinential standards
• Guideline Development: Developing national, regional,
continental, or international guidelines

20. CPR Steps: Definitions
Progressive Vital Organ Detoriation
PreCPR
Cardiac Arrest
CPR
Return Of Spontaneous Circulation (ROSC)
Po st CPR
Vital Organ Function Stability

21. Special Thanks to Dr. Babak Foroutan
for the interesting insightful talk about PreCPR section

22. PreCPR: Rationale
• Preventing cardiac arrest, most effective compared to CPR or
PostCPR, in pts’ survival and post discharge condition.
• Preventing cardiac arrest, least costly compared to CPR or
PostCPR , in pts’ survival and post discharge condition.
• Cardiopulmonary arrest is frequently preceded by PreCPR
mismanagement, therefore is preventable.

23. Pre-CPR Goal:
To Prevent Cardiac
Arrest!

24. PreCPR: Steps
I. “Triage” Pts
I. Detect Pts “A t R i s k ” of cardiac arrest
II. Exclude “ D N R ” Pts
II. Define “Tracking” measures
I. Dz Oriented Monitors
II. Frequency of Evaluation
III. Define “ N o R e s p o n s e ”, “A l e r t ”, a n d “A c t i o n ” criteria for each monitor
III. Define “Triggering” responses
I. Determine “ I n C h a r g e ” Physician(s)
II. Define “ M E T ” activating criteria
III. Document “ P r o o f o f E f f e c t i v e n e s s ( P O E ) ” criteria
IV. Determine “ P e r i o d i c P O E ” interval

25. Vital Organ Failure +
I. Dz: Progressive
II. Pts Mental Status:
I. Frightened
II. Delirious
I. Agitated
II. Disconnected
III. Disorientated
I. Treatment:
I. Poorly or Not
Effective (Wrong
Rx?)
II. Vital
III. Fatal Complications
PreCPR: At Risk Criteria

26. BLS

27. Chain of Survival

28. Simplified BLS
Algorithm

29. Assessment & ERS Activation
1. Establish Unresponsiveness
Sudden Loss of Consciousness + Abn. Respiration
vs
Tap, Shake, Shout
2. Call for Help
2010 Step by step activation of ERS consequentially
2015 Simultaneous assessment of responsiveness, pulse, & breathing
before & while activating ERS

32. Chest Compression Depth -updated
2010
> 5 cm
2015
5 – 6 cm
Push Hard !
Class I, LOE C-LD

33. Chest Compression Rate -updated
2010
> 100
2015
100 – 120
Push Fast !
Class IIa, LOE C-LD

34. Fully Recoil !
do not leaning on chest
Class IIa, LOE C-LD

35. Audiovisual
Feedback
Devices
during CPR

36. Respiratory Rate (No advanced airway)
Avoid Hyperventilation !
30 : 2
Class IIa, LOE C-LD

37. Respiratory Rate (advanced airway) - updated
2010
> 8-10
2015-2020
10
Avoid Hyperventilation !
Class IIb, LOE C-LD

38. Team-Based Resuscitation

39. CPR (BLS): CPR vs CCCR
Essential Actions:
• Chest Wall Compression

41. CPR (BLS): CPR & AED
Essential Actions:
• Chest Wall Compression
• Early Defibrillation

42. CPR (BLS)
Essential Actions:
• Chest Wall Compression
• Early Defibrillation
• Cause Based Tailoring
2010 Chest compression + Rescue breaths for cardiac arrest
2015 Chest compression + Rescue breaths for cardiac arrest of
cardiac or non-cardiac cause. HCP can tailor CC,RB, & AED
sequence to cause

44. Adult Cardiac Arrest Algorithm.

45. Adult Post–Cardiac
Arrest Care
Algorithm

47. BLS Dos and Don’ts of
Adult High-Quality CPR

48. High Quality CPR Components for BLS

49. High Quality CPR Components for BLS