2015 AHA Guidelines Highlights

1. LOGO
Paleerat Jariyakanjana, MD
Emergency physician
26/1/59
CPR 2015

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. Systems of care
and continuous
quality
improvement

4. Components of a system of care

6. Adult BLS & CPR
quality: HCP BLS

7. Immediated recognition and activation of
emergency response system

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

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

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

11. Minimizing Interruptions ! -updated
Achieve chest compression fraction
(CCF)
unprotected airway ≥60%
0 9030 60 120
CCF =
105
120
= 87.5

12. Audiovisual
Feedback
Devices
during CPR

13. 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

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

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

16. Team-Based
Resuscitation

24. Adult advanced
cardiovascular
life support

25. Vasopressors for resuscitation
Vasopressin
No advantage
Removed from the Adult Cardiac
Arrest Algorithm
Epinephrine
ASAP

26. 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

28. 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

34. Post-cardiac
arrest care

35. 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

36. 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

38. Continuing temperature management
beyond 24 hr
Actively preventing fever in
comatose pt after TTM
Out-of-hospital cooling
not recommend

39. Hemodynamics goals after
resuscitation
Avoid and immediately correct
hypotension (SBP <90 mm HG, MAP
<65 mm Hg)

40. Prognostication after cardiac
arrest
pt not treated with TTM: 72 hr after
cardiac arrest
pt treated with TTM: 72 hr after
return to normothermia

42. 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.

44. THANK YOU