Advance

Cardiac Arrest Life Support

in Covid-19 Pandemic & AHA 2020
Oleh :
Yudi Elyas
Disampaikan Pada Webinar Keperawatan
13 Desember 2020
 Curiculum Vitae
Nama : Ns. Yudi Elyas, S.Kep
NIRA : 31730118302
Lama Bekerja : 16 Tahun
Riwayat Jabatan : 1. Ka. Ruang ICU bedah Jantung PJT RSCM
2. Supv. ICCU,ICU bedah jantung, RR PJT RSCM
Jabatan Saat ini : PJ Pelayanan Ruang Intensif RSCM Jakarta
Tlp / Instagram : 081316006831 / @YUDI ELYAS

Pendidikan :
• Ners Keperawatan FIK UI
• Pendidikan ICU Bedah Jantung (CCNP) Institute Jantung Negara (IJN) Malaysia

Pelatihan : Trainer :
Organisasi :
• BLS & ACLS Certified by AHA
• Kardiologi Dasar • PPNI
• Basic Trauma Cardiac Life Support
• Intensive Care Unit (ICU) • HIPERCCI DKI (Pengurus)
(BTCLS)
• INKAVIN (Anggota)
• BLS & ACLS AHA 2015 • Pelatihan ICU (RSCM & HIPERCCI)
• Provider BTCLS
• TOT BLS & ACLS AHA • Pelatihan Code Blue system di RS
• Asesor Keperawatan • Pelatihan Interpretasi EKG
• Seminar & Workshop Keperawatan
• TOT Keperawatan
 Lingkup Bahasan

Tachicardia &
Cardiovascular Cardiac Arrest
Review BLS ACLS Bradycardia
& Covid-19 Management
Management
 Cardiovascular
& Covid-19

Sumber :
European Society of cardiology. (2020). ESC Guidance for the Diagnosis and
Management of CV Disease during the COVID-19 Pandemic. European Heart
Journal, 1–115.
 Cardiovascular & Covid-19

Bansal, M. (2020). Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel
coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and information. 14(3), 247–250.
The most common clinical symptom :
- Fever (88.7%)
- Cough (67.8%)
- Shortness of breath (18.7%)
- Myalgia or arthralgia (14.9%)
- Headache (13.6%)
- Diarrhea (3.8%)
- Sore throat (13.9%)
- Sputum production (33.7%)
- Fatigue (38.1%).
- Acute respiratory distress (15.6%), which
requires invasive mechanical ventilation
(14.5%) and extracorporeal membrane
oxygenation (2.9%)
 Advance Cardiac Life Support

Cardiac Arrest

Takicardia

Bradicardia

Post Cardiac Arrest Care

Ns. Yudi Elyas, S.Kep
PJT RSUPN. Dr Cipto Mangunkusumo
 Intra Hospital
Cardiac Arrest Management
BLS & ACLS
In Covid-19.. ???

Edelson, D. P., Sasson,Topjian, A. A. (2020). Interim Guidance for Basic and Advanced Life
Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From
the Emergency Cardiovascular Care Committee and Get with the Guidelines-Resuscitation
Adult and Pediatric Task Forces of the American Heart Association. Circulation, E933–E943.
https://doi.org/10.1161/CIRCULATIONAHA.120.047463
 Chain Of Survival AHA 2020

Dalam
Rumah Sakit

Luar
Rumah Sakit
 Henti Jantung
Keadaan terhentinya aliran darah dalam sistem sirkulasi tubuh akibat
terganggunya efektivitas kontraksi jantung
 Cardiac Arrest / Henti Jantung

1. Pasien tidak sadar

2. Tidak ada nafas dan tidak teraba nadi
3. EKG:
Ventricular Fibrillation (VF)

Pulseless Ventricular Tachycardia (VT)

Pulseless electrical activity (PEA)

Asistole

Gbr EKG pada saat terjadi serangan jantung , sekitar 60%-70% adalah irama Ventricular Fibrilasi (VF)
 CPR in COVID-19 patients has a low
survival rate
• The overall 30-day survival rate for COVID-19 patients receiving CPR was 4 (2.9%)
patients, but only 1 (0.7%) had a favorable neurologic outcome at 30 days and just 18
(13.2%) patients achieved return of spontaneous circulation (ROSC). These figures are
from a study of 136 COVID-19 patients who received CPR at a hospital in Wuhan,
China.
• As is true in most studies of COVID-19, two-thirds of the patients were male, and 105
(77%) were greater than 60 years old. The arrest was due to respiratory issues in 119
patients, cardiac in 10, and other in 7.
• A rapid response team responded to all resuscitations—23 (17%) occurring in
intensive care units. In all, 132 had witnessed cardiac arrests. The initial rhythm
detected was asystole in 122 patients, ventricular fibrillation/tachycardia in 8, and
pulseless electrical activity (PEA) in 6;
• ROSC occurred in 11 (9%) with asystole, 6 (75%) with V fib/tach, and 1 (16.7%) with
PEA.
https://www.physiciansweekly.com/cpr-in-covid-19-patients-has-a-low-survival-rate/
HIGH QUALITY CPR
2020
The History Of CPR
1800s
 ANJURAN & LARANGAN
UNTUK CPR BERKUALITAS TINGGI

Anjuran Larangan
1. Kompresi dada dengan 1. Kompresi dada dengan
kecepatan 100 – 120x/ kecepatan < 100 x / mnt atau
menit
> 120 x/ menit
2. Kompresi dada dengan 2. Kompresi dada dengan
kedalaman minimal 2 inchi
(5 cm) kedalaman kurang dari 5 cm atau
lebih dari 6 cm
3. Dada rekoil penuh setelah 3. Bertumpu di atas dada di antara
setiap kali kompresi
kompresi yang dilakukan
4. Minimalkan jeda dalam 4. Kompresi berhenti lebih dari 10
kompresi
detik
5. Memberikan ventilasi yang 5. Memberikan ventilasi berlebihan
cukup (2 nafas buatan
setelah 30 kompresi, setiap (mis: terlalu banyak nafas buatan
1 nafas buatan (diberikan atau memberikan nafas buatan
dalam 1 detik inspirasi dan dengan kekuatan berlebihan)
1 detik ekspirasi ) cukup
sampai dada terangkat

Sumber: http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf
Evaluasi High Quality CPR
Saat CPR Berlangsung...
1. Melihat kedalaman dan kecepatan kompresi
2. Perabaan nadi di arteri dorsalis pedis
3. Gelombang saturasi (Pulse Oximetry)
4. Gelombang arteri line (invasive Monitoring)

 .
Pulse Oximetry Waveform
X

Arterial waveform Probe saturasi

 Kapan RJP di Hentikan
• Adanya denyut nadi dan penderita telah bernafas
• Bantuan telah datang
• Tanda kematian telah jelas
• Penolong kehabisan tenaga
• Bila dilanjutkan akan membahayakan penolong
Cth. Kebakaran di dekat penolong
• Henti jantung lebih dari 30 menit
Kontroversial
Basic Life Support (BLS)
CPR In Covid-19 Patient
With Mask
In Prone Position… How To Do CPR..??
 CPR in Prone Position

• 2010 AHA Guidelines (2015 AHA Not

Reviewed)
When the patient cannot be placed in the
supine position, it may be reasonable for
rescuers to provide CPR with the patient in
the prone position, particularly in
hospitalized patients with an advanced
airway in place
(Class IIb, LOE C).
 CPR in Prone Position
CPR
• 2 hands Together
• Put Hands on T 7 from scapula
• While performing a prone CPR, it is important to ensure high-
quality CPR

Defibrilator
• Defibrillator should be applied using maximum energy
discharge and should be shocked at the end of expiration
with the lowest positive end expiratory pressure to minimize
the chest impedance.
• One of which is the one electrode technique placed to the left
lower sternal border and the other posteriorly below the
scapula.
• Successful electrical defibrillation has been reported in
patients having spinal surgery in the prone position
Bantuan Hidup Lanjut
 Henti Jantung
Shockable
DC Shock 360 J Not shockable
monofasik/200J bifasik Do chest compression
Chest compression

CPR
CPR
 SHOCK THERAPY
(Recommendation AHA 2015)

Patient Defibrilasi
(Asycronise)
Adult Bi phasic = 200 J
Monophasic = 360 J

Pediatrik 1st = 2 J/kg

2nd = 4 J / kg
Maks = 10 J/kg
Aba –aba saat akan melakukan
defibrilasi..Wajib.
 Shock First VS CPR First
 Henti jantung dewasa yang disaksikan / diketahui  Defibrillator
(AED) digunakan sesegera mungkin
 Henti jantung yang tidak diketahui / Defibrillator (AED)
belum siap Mulai CPR, jika indikasi dan alat sudah siap
maka lakukan defibrilasi sesegera mungkin
(Sumber: http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf)

(Guidelines Update for Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care. Part 5-Circulation. 2015;132(suppl 2):S414–S435)
 Penatalaksanaan Lanjutan
Henti Nafas & Henti Jantung di RS
tidak dapat dilakukan oleh 1 atau 2 orang

“Call For Help”

Aktifkan Code Blue...!!!
MISSION IMPOSIBLE
Bellomo R GD, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical emergency
team. MJA. 2003;179:283-7.
Chen J, Ou L, Hillman K, Flabouris A, Bellomo R, Hollis SJ Assareh H. Cardiopulmoary arrest and mortality trends and their
association with rapid response system expansion. MJA 2014; 201: 167-170
• Tetap bersama korban, gunakan handphone untuk
panggil bantuan, aktifkan speaker untuk
berkomunikasi dan mendengarkan instruksi tenaga
kesehatan.
Atau
• Jika sendirian tanpa handphone, berteriak meminta
tolong dan ambil AED (jika dapat tersedia segera)
sebelum memulai RJP.
Jelaskan lokasi penderita, kondisi penderita, serta bantuan yang sudah diberikan kepada penderita.

Code Blue,..!!!

Intra Hospital
Aktifkan “CODE BLUE SYSTEM”
 Sistem Komunikasi & Koordinasi

Komunikasi antar ruangan

Komunikasi Gedung (Sentral)
• Operator mengumumkan
“Code Blue di lantai ….
kamar ….” (2x)
Saat kode diaktifkan tim menuju ruangan di mana pasien berada
& melakukan tindakan resusitasi jantung paru
Uncoordinated Cardiac Arrest Team
Code Blue Team Positions
 DEFIBRILASI
Defibrilasi harus dilakukan dengan segera
dengan alasan:
1. Irama yang terjadi pada henti jantung
umumnya adalah VF
2. VF cenderung berubah menjadi asistol
dalam waktu beberapa menit
3. Pengobatan yang efektif untuk VF adalah
defibrilasi
4. Makin lambat defibrilasi dilakukan, makin
kurang kemungkinan keberhasilannya
DEFIBRILATION POSITION
SHOCK THERAPY
(AHA Recommendation )

Patient Defibrilasi
(Asyncronise)
Adult • Bi phasic = 200 J
• Monophasic = 360 J

Pediatrik • 1st = 2 J/kg

• 2nd = 4 J / kg
• Maks = 10 J/kg
 • Siapkan defibrilator
• Siapkan paddle
Langkah-Langkah • berikan Jelly
• Isi energi: CHARGE
• Stop CPR
• Tempel paddle
• I’m clear, you’re clear,
everybody’s clear
• Lakukan shock:
DISCHARGE
• Angkat paddle
• Lanjutkan CPR
• Evaluasi monitor
Tachicardias Rhythm
Contoh ….

VT

SVT

AF RR
 Kesimpulan
• Covid-19 dapat menyebabkan gangguan pada sistem Kardiovaskuler dan menyebabkan kondisi
pasien memburuk dan terjadi kematian
• Pencegahan dan deteksi dini gangguan sistem kardiovaskuler merupakan hal penting untuk
mengurangi angka kejadian henti jantung di Rumah Sakit
• BHD merupakan tatalaksana awal dari kondisi henti jantung
• BHD yang baik dengan melakukan tindakan dengan high quality CPR
• Keberhasilan menolong pasien yang henti jantung dilanjutkan dengan bantuan hidup lanjut
(BHL)
• RS harus memiliki system untuk melakukan tatalaksana kegawatan di RS yaitu dengan sistem
Code Blue
• Dalam tatalaksana kegawatan pada pasien dengan PDP & Positif Covid-19 diperlukan
kewaspadaan tinggi dan APD yang sesuai
Daftar Pustaka

Circulation. 2020;141:e933–e943. DOI:10.1161/CIRCULATIONAHA.120.047463

 Daftar Pustaka
1. Bansal, M. (2020). Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin
on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and
information. 14(3), 247–250
2. Bellomo R GD, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical emergency team.
MJA. 2003;179:283-7.
3. Chen J, Ou L, Hillman K, Flabouris A, Bellomo R, Hollis SJ Assareh H. Cardiopulmoary arrest and mortality trends and their association
with rapid response system expansion. MJA 2014; 201: 167-170
4. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
5. Edelson, D. P., Sasson,Topjian, A. A. (2020). Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates
with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with the Guidelines-
Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation, E933–E943.
https://doi.org/10.1161/CIRCULATIONAHA.120.04746
6. European Society of cardiology. (2020). ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19
Pandemic. European Heart Journal, 1–115.
7. Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 5-Circulation. 2015;132 (suppl
2):S414–S435
8. http://ecgguidelines.heart.org/wp-content/upload/2015-AHA-Guidelines-Highlights-Indonesia.pdf
9. https://www.physiciansweekly.com/cpr-in-covid-19-patients-has-a-low-survival-rate/
10. M. SenthilVelou, E. Ahila (2020). Happy hypoxemia: What has been forgotten.IAIM, 2020; 7(8): 75-79.,
11. Tobin, M. J., Laghi, F., & Jubran, A. (2020). Why COVID-19 silent hypoxemia is baffling to physicians. American Journal of Respiratory
and Critical Care Medicine, 202(3), 356–360. https://doi.org/10.1164/rccm.202006-2157CP
TERIMAKASIH