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					The New CPR 2009

Abbreviations
• • • • SCA - Sudden Cardiac Arrest CPR – Cardio Pulmonary Resuscitation CC CPR – Chest Compression CPR CCR – Cardio Cerebral Resuscitation

Alternatives to Traditional CPR
• Why are alternatives acceptable? • How are alternatives developed? • Were these piloted and where?

Why are alternatives acceptable?

Oxygen Supply in the Body

• Respiratory Arrest patients have depleted oxygen stores in their blood. • Sudden Cardiac Arrest patients have non circulating oxygen supply in their blood.

Phases of CPR
Phase 1 Phase Name Electrical phase Time from VF arrest Important intervention From time of arrest to about the first 5 min after arrest About 5 min to 10 or 15 min after arrest After about 10 to 15 min Electrical therapy

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Circulatory (hemodynamic) phase Metabolic phase

CPR before electrical therapy Possible therapeutic hypothermia or other new concepts

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CPR
• Cardio Pulmonary Resuscitation = heart, lung resuscitation • During traditional CPR, patients are given both chest compressions and ventilations during resuscitation attempts.

30 - 2
• Thirty Chest Compression to • 2 puffs ( quick puffs of air) you must see the chest rise and fall

Continuous Chest Compresssion CPR (CC CPR)
• This type of CPR is taught to lay people. (non health care providers) • CC CPR emphasizes on hard, fast chest compressions, minimizing interruptions. • During CC CPR, a patient receives chest compressions that circulates oxygenated blood. • Early defibrillation when a device is available.

CPR Jackhammer

Steve Berry

Cardio Cerebral Resuscitation (CCR)
• This type of CPR is taught to healthcare providers, with approval from medical direction. • CCR emphasizes on hard, fast chest compressions, minimizing interruptions, defibrillation, and administration of epinephrine and atropine.. • During CCR, a patient receives chest compressions that circulates oxygenated blood, vital defibrillations, and medications.

CCR
CCR is used on patient who have a sudden cardiac arrest DO NOT USE ON: Primary Respiratory Arrest Overdose Arrest Traumatic Arrest Drowning Any patient <8 years old

Why CCR?
• Oxygenated heart is critical to defibrillation • Sudden Cardiac Arrest patients have non circulating oxygen supply in their blood • The medications given help to increase a heart rate

What do we know we do wrong
• We interrupt CPR too frequently to perform other tasks, resulting, on average, in < 60 compressions/min • We don't compress the chest fast enough or deep enough, resulting in low coronary perfusion pressures. • We hyperventilate our pts, which inhibits VR by increasing intrathoracic pressures • Due to poor technique and/or rescuer fatigue, we don't allow the chest to recoil completely, leading to even higher intrathoracic pressures
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Decision to start CPR:
• Decision to start CPR is made if a victim is unresponsive and not breathing normally.
• Pulse check is no longer required, and is NOT recommended for lay persons. • Pulse check has been shown to be unreliable, with unacceptably high rates of false positives and negatives.
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Chest compressions
• Place hands on the center of the chest, rather than the ‘rib margin’ method. • 100/min for all victims (except newborns). • Allow chest to recoil to normal position after each compression. • Use equal compression and relaxation times. • Limit interruptions in chest compressions, even for rhythm check, shock delivery, advanced airway, or vascular access.
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Ventilation
• Breaths are given over 1sec rather than 2sec.

• During the first minutes of CPR, ventilation is probably not as important as compressions. • Ventilation, however, is important for victims of hypoxic arrest and after the first minutes of any arrest.

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Ventilation
• During CPR, blood flow to the lungs is much less than normal, so the victim needs less ventilation. • Hyperventilation is not necessary, and may be harmful. • Limit the time used to deliver breaths to reduce interruptions in chest compressions. • Ventilation during CPR increase intra-thoracic pressure, reducing VR and thus blood flow generated by chest compressions.
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Universal Compression-to-Ventilation Ratio for All Lone Rescuers
• Ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest.
• The 2 initial rescue breaths are omitted, with 30 compressions being given immediately after cardiac arrest is established. • During 2-rescuer CPR with an ETT in place, rescuers no longer stop compressions for ventilation (continuous compressions and 10 breaths/min).
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High-Frequency Chest Compressions
• >100/min chest compressions showed mixed results. One clinical trial of 9 pts showed that 120/min chest compressions improved hemodynamics over standard CPR.
• High-frequency chest compressions can be considered, but there is insufficient evidence to recommend for or against its use (Class Indeterminate).
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Interposed Abdominal Compression
• IAC-CPR uses a dedicated rescuer to provide manual compression of the abdomen during the relaxation phase of chest compression, to enhance venous return. • IAC-CPR may be considered for in-hospital resuscitation when sufficient trained personnel are available (Class IIb). • There is insufficient evidence to recommend for or against IAC-CPR in the out-of-hospital setting (Class Indeterminate).
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Summary
• Compression rate is 100/minute

• Ventilation rate is 10 breaths per minute .
• Once an advanced airway is in place, ratios cease to be used and chest compressions are performed nonstop at 100/minute, with breaths delivered at a rate of 10/min without pausing compressions to deliver the ventilations .
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Bottom Line
• Perfusion first, defibrillation second. Interruptions to CPR kept to a minimum • In witnessed arrest and AED is immediately available, shock. • Otherwise, CPR for 2 min • Shock-CPR-shock-CPR-shock, instead of shockshock-shock-CPR. • 30:2 for all but newborns • Avoid hyperventilation
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Pediatric basic life support
• Lone rescuers in pediatric cardiac arrest start with 5 rescue breaths and continue with the 30:2 ratio • Two rescuers will use the 15:2 ratio in a child up to the onset of puberty. • In an infant (<1yr) the compression technique remains the same: two-finger compression for single rescuers and two-thumb encircling technique for two or more rescuers. Above one yr of age, the one or two hands technique may be used according to rescuer preference.
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Summary of BLS for lay rescuers

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Summary of BLS for professional rescuers

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posted:6/22/2009
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