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CARDIO-PULMONARY-CEREBRALRESUSCITATION

(CPCR)با قلب زنده میمانیم و با مغز زندگی میکنیم

E AllahyaryAss. Prof.of anaesthesioilogy

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بسم اهللا الرحمن الرحیم

و من احیاھا فكانما احیا الناس جمیعا

٣٢سوره مائده آیھ



HISTORICAL REVIEW



CPCPCCR :R : A series of sequential assessments, maneuvers & techniques to restore spontaneous circulation:

1. chest compression to circulate blood 2. rescue breaths to oxygenate blood

1. Basic life support2. ACLS & ECC3. Post-resuscitation care4. Prolonged life support



CPCPCCR R

BLS1. Recognition of signs of sudden cardiac arrest

(SCA)2. Call EMS 3. Cardiopulmonary resuscitation (CPR)4. Defibrillation with an automated external

defibrillator (AED)



CPCPCCR R

Advanced CPCR (or ACLS)CPCR using “basic CPCR” plus advanced airway management, defibrillation, & medications ( IV / IO or via ET tube)



Causes of cardiac arrest

Cardiac

Extra- cardiac

majority of SCA VF

all cases accompanied with hypoxia



Diagnosis of cardiac arrest

Symptoms of cardiac arrest ?!3 absence of pulse on carotid arteries – a pathognomonic symptom

3 respiratory arrest – may be in 30 seconds after cardiac arrest

3 enlargement of pupils – may be in 90 seconds after cardiac arrest

Blood pressure measurement6

Taking the pulse on peripheral arteries6

Auscultation of cardiac tonesLoss of time !!!



Cardiac ArrestCardiac Arrest Cessation of cardiacCessation of cardiacmechanical activitymechanical activity

–No (un) responsiveness–No breathe (apnea, or agonal respiration) –No pulse



“Chain of Survival”



1. Early recognition of the emergency and activation EMS (phone 911)

2. Early bystander CPR 3. Early shock delivery: CPR plus

defibrillation within 3 to 5 minutes of collapse can produce survival rates as high as 49% to 75%

4. Early advanced life support followed by postresuscitation care



Start CPR Start CPR ImmediatelyImmediately

Ø Double or triple the survival from VF SCA

- Provides a small but critical amount of blood flow to the heart & brain

- Prolongs the time of VF present- Increases response to shock

Time interval from EMS call to its’ arrival is 7- 8 minso in the first min after collapse the victim’s chance of survival is in the hands of bystanders



Start CPR Start CPR ImmediatelyImmediately

What happens without CPCR0-4 min: breathing stops, Clinical death, brain damage unlikely 4-6 min: brain damage starts 6-10 min: brain damage probable > 10 min: Irreversible brain damage, Biological death



Universal Clinical ApproachA “unique system”

ðApproach all patients with this “system”



Survey the sceneSurvey the scene• Ensure that the

scene is safe

• RResponsiveness

––TapTap shoulder & ask “ Are you ok “



Activate EMS, Call for helpActivate EMS, Call for help

Ø Get an AEDAED (if available), and return to the victim to provide CPR and defibrillation

Ø In asphyxial arrest of any age, give 5 cycles (about 2 minutes) of CPR before leaving the victim to activate the EMS system

Ø If 2 rescuers: 1- Call EMS & get AED 2- Start CPR



Appropriate positioningAppropriate positioning

Position to supine or face up 1. All body parts at the same time2. Place the victim on a hard surface

ü Head & spinal cord injuries (2% of victims with blunt trauma & 6% with a craniofacial injury, a GCS <8, or both.)



BASIC BASIC LIFE LIFE SUPPORTSUPPORT

1. Assessment 2. Activate EMS & AED3. Proper positioning 4. Basic CPR

I. AirwayII. BreathingIII. CirculationIV. Defibrillation



ABCDA – AirwayqOpen the airwayüHead tilt chin lift

( lay rescuer--for both injured and noninjured victims)

üJaw thrust (no longer recommended for lay rescuers but for healthcare providers ,If suspicious of a cervical spine injury, jaw thrust without head extension)



ABCDB – Breathingü Look, listen and feel for breathingü (No longer than 10 sec)

Occasional gasps are not effective breathing

Difficult determination of the presence or absence of adequate breathing in

unresponsive victim



ABCDqBreathing• If the victim is not breathing,

Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise

• It applies to all forms of ventilations ( mouth to mouth, mouth to mask, bag mask & advanced airway ) with or without O2



ABCDq Mouth to Mouth

– Pinch the nose– Seal the mouth with

yours– If the first two don’t

go in, re-tilt and give two more breaths (if breaths still do not go in, suspect choking)



ABCDqBreathing

• Mouth To Nose (when to use)– Can’t open mouth– Can’t make a good seal– Severely injured mouth– Stomach distension

• Mouth to stoma (tracheotomy)– a pediatric face mask

Tidal vol= 500- 600 cc (6-7cc/kg)



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