CARDIAC ARREST

Dr . SUHAEMI, SpPD,Finasim

HISTORICAL REVIEW
5000 - first artificial mouth to mouth
3000
BC
ventilation
1780 first attempt of newborn
resuscitation by blowing
1874 first experimental direct cardiac
massage
1901 first successful direct cardiac massage
in man
1946 first experimental indirect cardiac
massage and defibrillation
1960 indirect cardiac massage
1980 development of cardiopulmonary
resuscitation due to the works of Peter
Safar
2

all cases accompanied

with hypoxia

extracardiac

Causes of cardiac
arrest
cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
3
disorders, mechanical factors

Causes of circulation
arrest
Cardiac
Ischemic heart disease
(myocardial infarction,
stenocardia)
Arrhythmias of different
origin and character
Electrolytic disorders
Valvular disease
Cardiac tamponade
Pulmonary artery
thromboembolism
Ruptured aneurysm of
aorta

Extracardiac
airway obstruction
acute respiratory failure
shock
reflector cardiac arrest
embolisms of different
origin
drug overdose
electrocution
poisoning 4

arrest
Blood pressure measurement

Taking the pulse on peripheral

arteries

Auscultation of cardiac tones

Loss of
time !!!

Symptoms of cardiac
arrest
absence
of pulse on carotid arteries a

pathognomonic symptom
respiration arrest may be in 30 seconds after
cardiac arrest
enlargement of pupils may be in 90 seconds after
5
cardiac arrest

Is cardiac arrest different from a

heart attack?
Sudden cardiac arrest is not the
same as a heart attack!!
Sudden cardiac arrest occurs when electrical
impulses in the heart become rapid or
chaotic, which causes the heart to suddenly
stop beating.
A heart attack occurs when the blood supply
to part of the heart muscle is blocked. A
heart attack may cause cardiac arrest.

Underlying Arrhythmia of
Sudden Cardiac Arrest
Primary
VF
8% Torsades
de Pointes
13%
VT
62%

Adapted from Bays de Luna A. Am Heart J. 1989;117:151-159.

Bradycardia
17%

Coronary Heart Disease

An estimated 13 million people had CHD in the U.S. in 2002. 1
Sudden death was the first manifestation of coronary heart disease in
50% of men and 63% of women. 1
CHD accounts for at least 80% of sudden cardiac deaths in Western
cultures.3

Etiology of Sudden Cardiac Death2,3

5% Other*
15%
Cardiomyopathy
American Heart Association. Heart Disease and Stroke Statistics2003 Update. Dallas, Tex.:
American Heart Association; 2002.
2
Adapted from Heikki et al. N Engl J Med, Vol. 345, No. 20, 2001.
3
Myerberg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. P. 895.
1

80%
Coronary
Heart
* ion-channel abnormalities,
valvular or
Disease
congenital heart disease, other causes

ISCHEMIA AND SCD

CHEST PAIN
SOB
DEMAND > SUPPLY ISCHEMIA
PERFORMANCE
NON-LETHAL ARRYTHMIA
LETHAL ARRHYTHMIA

Sudden Cardiac Arrest

Out of hospital cardiac arrest:

overview
Initial rhythm in primary cardiac arrest
50% VF
30% Asystole
18% PEA
2% VT

Overall 20% reach hospital and 8% survive

Outcomes are very rhythm dependent
Rhythm % Reach Hospital
VT 80% 70%
VF 40% 20%
PEA 10% 1%
Asystole 5% 1%

% Survival

Otak
tidak dapat O2

Jantung
3 8 menit

mati

Keterlambatan BHD
Keterlambatan
BHD
1 menit
3 menit
10 menit

Kemungkinan
berhasil
98 dari 100
50 dari 100
1 dari 100

Indikasi BHD

Tenggelam, stroke, benda asing di

sal nafas, inhalasi asap, epiglotitis,
overdosis obat, cedera, infark
miokard akut, tersengat listrik,
koma

DANGEROUS
Kita Jangan Menjadi Korban Berikut

Proteksi Diri
Pertolongan Pertama, Jangan
Menambah Cedera Tambahan

PERIKSA KEMBALI KEADAAN KORBAN DENGAN

CARA MENGGONCANGKAN BAHU KORBAN

SEGERA BERTERIAK MINTA

PERTOLONGAN

AKTIFKAN EMS
No telephone sistem emergency
Prosedur EMS yang baku
lokasi , no telp dari mana panggilan
dilakukan, apa yang terjadi, jumlah
korban, keadaan korban,
pertolongan apa yang sedang
dilakukan, informasi lain

PEMERIKSAAN JALAN NAFAS

MEMBUKA JALAN NAFAS

Head Tilt

Chin Lift

JAW THRUST

BREATHING

Nilai Pernafasan
Lihat (look)
Dengar (listen)
Rasakan (feel)
Waktu : 10 DETIK
Henti Nafas - Nafas Tidak Adekuat

NAFAS BUATAN 2 X

Bila pernafasan dan sirkulasi

kembali normal dan korban tidak
diduga memiliki cedera cervikal

POSISI SISI MANTAP

Bila pernafasan dan sirkulasi

kembali normal dan korban tidak
diduga memiliki cedera cervikal

POSISI SISI MANTAP

apnea, nafas abnormal, nafas tidak adekuat

NAFAS BUATAN
Mouth to mouth
Mouth to nose
Mouth to stoma
Mouth to mask
Bag-valve-mask device

BREATHING

Mulut - mulut

Mulut - Masker

BREATHING

"Bagging" : lebih baik berdua

NILAI SIRKULASI
Nadi carotis < 10 det
Ada / tidak
(+)

(-)

Nafas Buatan

Nafas Buatan

Tanpa PJL

+ PJL

Nilai Sirkulasi

Meraba Denyut Nadi

PIJAT JANTUNG LUAR

pada 1/2 bawah
sternum,
diantara 2
putting susu
4 - 5 cm
(Dewasa)
2,5 3 cm (Anakanak/ 1 tangan)
Rasio Pijat
Jantung Luar /
Nafas Bantu 30 :

 Sebelum intubasi
Dewasa (>8 th) = Rasio 30 : 2 (utk 1 &
2 penolong)
Anak (1-8 th)
30 : 2 (1 penolong)
Bayi (<1 th )15 : 2 (2 penolong)
Neonatus 3 : 1 (15 siklus = 30 detik)

5 x siklus 30 : 2 (= 2mnt) nilai

ulang sirkulasi

Setelah 5 x siklus 30 :2
nilai ulang sirkulasi
Sirkulasi ( - ) : teruskan PJL
Sirk (+)Nafas (-) : nafas buatan
10 12 X/Menit
Sirk (+) Nafas (+) : posisi sisi
mantap
jaga jalan
nafas

RJP DIHENTIKAN
Kembalinya ventilasi & sirkulasi
spontan
Ada yang lebih bertanggung
jawab
Penolong lelah
Adanya DNAR
Tanda kematian yang irreversibel

RJP TIDAK DILAKUKAN

DNAR (Do Not Attempt
Resuscitation)
Tanda kematian : rigor mortis
(kaku mayat), lebam mayat
Sebelumnya dengan fungsi vital
yang sudah sangat jelek dengan
terapi maksimal
Bila menolong korban akan
membahayakan penolong

KOMPLIKASI RJP
Nafas buatan :
regurgitasi
mengurangi volume paru

KOMPLIKASI RJP
PJL
Fraktur iga & sternum
Pneumothorax
Hemothorax
Kontusio paru
Laserasi hati dan limpa
Emboli lemak

Are You
Alright?

What to do:
3
Cs
Check
Shake & Shout
Call 911 &
Send Someone for an
A.E.D.
Compress Chest at
100 Per Minute
Use an A.E.D. When it
Arrives

How to Do Chest Compression Only

CPR
With the victim on the floor:
1.
2.
3.
4.
5.
6.

Kneel beside them

Place one hand on top of the other
Lock your elbows
Aim for the middle of the chest (on the sternum between the nipples)
Push hard and fast (try for 100/min.)
Take turns with another person when tired.

Why Might Rescue Breathing be

Harmful?
Any interruption of chest compressions
stops blood flow to the brain
Increased pressure in the chest decreases
blood return to the heart

Why Might Rescue Breathing be

Harmful?
Any interruption of chest compressions
stops blood flow to the brain
Increased pressure in the chest decreases
blood return to the heart

Hands Only CPR

American Heart
Association

Why Might Rescue Breathing be

Harmful?
Any interruption of chest compressions
stops blood flow to the brain
Increased pressure in the chest decreases
blood return to the heart

Chest Compressions Only

Blood Flowing
To The Brain

Compressions + Breaths (30:2)

Pausing for
breaths means
No Blood Flow

Blood Flowing
To The Brain

Ewy GA, et al. Circulation.

2007;116(22):2525-30.

Is cardiac arrest different from a

heart attack?
Sudden cardiac arrest is not the
same as a heart attack!!
Sudden cardiac arrest occurs when electrical
impulses in the heart become rapid or
chaotic, which causes the heart to suddenly
stop beating.
A heart attack occurs when the blood supply
to part of the heart muscle is blocked. A
heart attack may cause cardiac arrest.

AEDs

They may look different, but they all function the Same!

Open and Follow Instructions

Turn AED ON
Apply Pads to Bare Chest
Plug in Pads (if necessary)
Analyze Patient (CLEAR!)
Push Shock to defibrillate,
if directed (CLEAR!)
Immediately resume CPR

The Universal Symbol

Safe
Easy
Voice Prompted

The ICD System

Ventricle
VT prevention
Antitachycardia

pacing
Cardioversion
Defibrillation

How it Works

Atrium &
Ventricle
Bradycardia

sensing
Bradycardia
pacing
Antitachycardia
pacing

The IMPLANTIBLE CARDIAC

DEFIBRILLATOR (ICD)

Defibrillation
Manual defibrillators are $15,000$20,000
AEDs are $3000-$5000
In clinics I would recommend an AED
rather than a manual defibrillator
All clinical staff should know how to use
it