update cpr 2015

7/24/2019 Update CPR 2015

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U P D A T E

C P

R 2 0

1 5

Prof. dr. Achsanuddin Hanae, Sp.An, !C,A"

Dep#. Anes#esio$o%i dan Terapi !n#ensif &'USU

7/24/2019 Update CPR 2015


(HAT !S CPR)

is an emergency procedure that is done when

someone’s breathing or heartbeat hasstopped. It performed in an eort tomanually preserve intact brain functionuntil further measures are taken to restorespontaneous blood circulation andbreathing.

7/24/2019 Update CPR 2015


HA*DS "*+ CPR

7/24/2019 Update CPR 2015


7/24/2019 Update CPR 2015


A'-'C CHA*E T" C'A'-

In 2010, the merican !eart ssociation "!# changed $%&’s

longstanding '('$ "irway, (reathing, $ompressions#se)uence to $''( "$ompressions, irway, (reathing#. *he old'('$ se)uence for $%& consisted of the following steps+

1. irways ' *ilt the victim’s head and lift his chin to open theairway

2. (reathing ' %inch the victim’s nose and breathe into themouth

. $ompressions - pply pressure to the victim’s chest

*he new $''( "$ompressions, irway, (reathing# se)uenceteaches rescuers to perform chest presses before anythingelse.

&eferensi+

arsch /, *schan , /emmer , 3obrist &, !un4iker %&, !un4iker /. ($ versus $( for cardiopulmonaryresuscitation+ a prospective, ran' domi4ed simulator'based trial. Swiss Med Wkly . 201516+w1789. doi+

10.6616:smw.201.1789.

;ink+

http+::www.ncbi.nlm.nih.gov:pubmed:260177<9

7/24/2019 Update CPR 2015


THE SC!E*CE -EH!*D THE DEC!S!"*

!n an adu$# /ho has een rea#hin%nora$$, #here is enou%h o3%en in #he$ood #o supp$ #he hear# and #he rain forse4era$ inu#es fo$$o/in% cardiac arres#.

Ches# copressions are needed, ho/e4er,#o circu$a#e #he o3%en and ensure #ha# i# isdis#riu#ed uic6$.

7/24/2019 Update CPR 2015


Rescue rea#hs are #hou%h# #o e harfu$ecause #he reuire #he rescuer #o s#op doin%ches# copressions for se4era$ seconds.Addi#iona$$, rescue rea#hs $o/er air pressure in

#he ches# ca4i#, /hich in #urn s$o/s do/ncircu$a#ion, a 6e fac#or in resusci#a#ion. !f #herescuer does ches# copressions rs#, #he 4ic#i%ains appro3ia#e$ 70 seconds of #ie in his

fa4or.

THE SC!E*CE -EH!*D THE DEC!S!"* 829

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THE SC!E*CE -EH!*D THE DEC!S!"* 879

(hen peop$e fo$$o/ #he A'-'C seuence #o perfor CPR,

#here is of#en a si%nican# de$a ecause #he spend souch #ie #rin% #o open #he air/a, a6e an air'#i%h#sea$ around #he ou#h, or %e# o4er #heir re$uc#ance #o doou#h'#o'ou#h resusci#a#ion. (i#h #he ne/ C'A'-seuence, peop$e ini#ia#e ches# copressions sooner and4en#i$a#ion is on$ s$i%h#$ de$aed. The AHA a$so predic#s#ha# #he nuer of peop$e /ho recei4e CPR /i$$ increaseecause of #his chan%e, since s#anders of#en a$6 a# #heidea of perforin% ou#h'#o'ou#h resusci#a#ion on a

#o#a$ s#ran%er.

7/24/2019 Update CPR 2015


Ho/e4er, #he chan%e fro A'-'C #o C'A'-on$ app$ies #o adu$# 4ic#is of suddencardiac arres#. &or chi$dren and in cases of

asph3ia$ arres#, dru% o4erdose, or near'dro/nin% aon% adu$#s, rescuers are s#i$$recoended #o fo$$o/ #he A'-'Cseuence.

THE SC!E*CE -EH!*D THE DEC!S!"* 8:9

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7/24/2019 Update CPR 2015


-+S AHA 2010

7/24/2019 Update CPR 2015


ERC2010

7/24/2019 Update CPR 2015


T"P CHA*ES T" CPR

2018 ! =uideline

$ompression &ate + 100 - 120

higher upper rate limit was added as $%& as )ualitydecreases with > 120 compressions per minute

?eep, but not too deep

n upper limit on the depth of chest compressions hasbeen added. *hey should be between 8cm "2’@# and 9cm"2.8@#. ?eeper can be harmful

7/24/2019 Update CPR 2015


ERC 2015

Hi%h'ua$i# CPR reains essen#ia$ #o ipro4in% ou#coes. The%uide$ines oncopression dep#h and ra#e ha4e no# chan%ed. CPR pro4idersshou$d ensure ches# copressions of adeua#e dep#h 8a# $eas# 5c u# no ore #han ; c9 /i#h a ra#e of 100<120 copressionsin=1. Af#er each copression a$$o/ #he ches# #o recoi$

cop$e#e$ and iniise in#errup#ions in copressions. (henpro4idin% rescue rea#hs>4en#i$a#ions spend appro3ia#e$ 1 sin?a#in% #he ches# /i#h su@cien# 4o$ue #o ensure #he ches# rises4isi$. The ra#io of ches# copressions #o 4en#i$a#ions reains702. Do no# in#errup# ches# copressions for ore #han 10 s #opro4ide 4en#i$a#ions.

ERC U!DE+!*E 2015 p.1

7/24/2019 Update CPR 2015


CHEST C"BPRESS!"* RATE

2018 "Apdated# +

In adult victims of cardiac arrest, it is reasonable forrescuers to perform chest compressions at a rate of100 to 120:min

2010 "Bld#+

It is reasonable for lay rescuers and !$%s to performchest compressions at a rate of at least 100:min

&eference +

Idris, .!., =uey, ?., %epe, %.C. et al, $hest compression rates and survivalfollowing out'of'hospital cardiac arrest. Crit Care Med . 201856+760-767.

;ink +

http+::www.ncbi.nlm.nih.gov:pubmed:2889868D

http://www.ncbi.nlm.nih.gov/pubmed/25565457

http://www.ncbi.nlm.nih.gov/pubmed/25565457

7/24/2019 Update CPR 2015


7/24/2019 Update CPR 2015


CHEST C"BPRESS!"* DEPTH

2018 "Apdated# +

?uring manual $%&, rescuers should performchest compressions to a depth of at least 2inches "8cm# for an average adult, whileavoiding eEcessive chest compressiondepths "greater than 2.6 inches F9 cmG#

2010 "Bld# +

*he adult sternum should be depressed atleast 2 inches "8 cm#

&eference +

/teill, (rown, ichol et al "2016# $irculation

;ink +

http+::circ.ahaHournals.org:content:10:22:1<92.long

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7/24/2019 Update CPR 2015


CARD!AC ARREST !* PRE*A*C

%riorities for the pregnant woman in cardiac

arrest are provision of high')uality $%& andrelief of aortocaval compression. If the fundusheight is at or above the level of the umbilicus,manual left uterine displacement can bebenecial in relieving aortocaval compression

during chest compressions.

7/24/2019 Update CPR 2015


+UD

anual ;eft Aterine ?isplacement ";A?#

eectively relieves aortocaval pressure inpatients with !ypotension."$yna,ndrew,Cmmett&/,iddleton%,/immons/J.*echni)ues forpreventing hypotension during spinal anaesthesia for caesarean sec'tion.Cochrane Database Syst Rev . 2009+$?002281.#

o cardiac arrest outcome studies have beenpublished eEamining the eect of ;A? or otherstrategies to relieve aortocaval compressionduring resuscitation. "2018 ! =uideline Apdate for

$%& and C$$, /802#

7/24/2019 Update CPR 2015


7/24/2019 Update CPR 2015


*hank youK.

update cpr 2015

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