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Cpr 2015

2015 AHA Guidelines Highlights

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Cpr 2015

  1. 1. LOGO Paleerat Jariyakanjana, MD Emergency physician 26/1/59 CPR 2015
  2. 2. Contents Systems of care and continuous quality improvement Adult BLS & CPR quality: HCP BLS Adult advanced cardiovascular life support Post-cardiac arrest care
  3. 3. Systems of care and continuous quality improvement
  4. 4. Components of a system of care
  5. 5. Adult BLS & CPR quality: HCP BLS
  6. 6. Immediated recognition and activation of emergency response system
  7. 7. Chest Compression Depth -updated 2010 > 5 cm 2015 5 – 6 cm Push Hard ! Class I, LOE C-LD
  8. 8. Chest Compression Rate -updated 2010 > 100 2015 100 – 120 Push Fast ! Class IIa, LOE C-LD
  9. 9. Fully Recoil ! do not leaning on chest Class IIa, LOE C-LD
  10. 10. Minimizing Interruptions ! -updated Achieve chest compression fraction (CCF) unprotected airway ≥60% 0 9030 60 120 CCF = 105 120 = 87.5
  11. 11. Audiovisual Feedback Devices during CPR
  12. 12. Delayed ventilation witnessed OHCA with a shockable rhythm + EMS  3 cycles of 200 continuous compressions + passive oxygen insufflation & airway adjuncts Class IIb, LOE C-LD
  13. 13. Respiratory Rate (No advanced airway) Avoid Hyperventilation ! 30 : 2 Class IIa, LOE C-LD
  14. 14. Respiratory Rate (advanced airway) - updated 2010 > 8-10 2015 10 Avoid Hyperventilation ! Class IIb, LOE C-LD
  15. 15. Team-Based Resuscitation
  16. 16. Adult advanced cardiovascular life support
  17. 17. Vasopressors for resuscitation Vasopressin No advantage Removed from the Adult Cardiac Arrest Algorithm Epinephrine ASAP
  18. 18. ETCO2 for prediction of fail resuscitation Failure to achieve an ETCO2 of >10 mm Hg by waveform capnography after 20 min of CPR may be considered as one component of a multimodal approach to decide when to end resuscitative efforts
  19. 19. Post-cardiac arrest drug therapy Lidocaine Inadequate evidence to support the routine use may be considered immediately after ROSC from cardiac arrest due to VF/pVT ẞ-blockers Inadequate evidence to support the routine use may be considered early after hospitalization from cardiac arrest due to VF/pVT
  20. 20. Post-cardiac arrest care
  21. 21. Coronary angiography should be performed emergently for OHCA pt c suspected cardiac etiology of arrest & ST elevation on ECG Emergency coronary angiography is reasonable for select adult pt who comatose after OHCA of suspected cardiac origin but without ST elevation on ECG
  22. 22. Targeted temperature management All comatose adult pt with ROSC after cardiac arrest should have TTM, with a target temperature between 32-36 ◦C selected and achieved, then maintained constantly for at least 24 hr
  23. 23. Continuing temperature management beyond 24 hr Actively preventing fever in comatose pt after TTM Out-of-hospital cooling not recommend
  24. 24. Hemodynamics goals after resuscitation Avoid and immediately correct hypotension (SBP <90 mm HG, MAP <65 mm Hg)
  25. 25. Prognostication after cardiac arrest pt not treated with TTM: 72 hr after cardiac arrest pt treated with TTM: 72 hr after return to normothermia
  26. 26. Organ donation All pt who are resuscitated from cardiac arrest but who subsequently progress to death or brain death should be evaluated as potential organ donors.
  27. 27. THANK YOU

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