Cardiopulmonary Cerebral

Resuscitation (CPCR)
Mrs. Anusha Thomas
ORIGIN OF THE CONCEPT OF
•CPR
The first city to teach and promote resuscitation was
Amsterdam in Europe
• In August 1767, a few wealthy citizens formed the
“society for recovery of drowned persons”
and provided mouth to mouth ventilation, head
low position and warming techniques
• 0 James Elam together with Dr. Peter Safar
In 1954, Dr.
(anesthetists) demonstrated CPR for
the first time
• 03 Peter Safar wrote the book ‘ABC of re-
In 1957,Dr.
suscitation’
• In 1970’s CPR was promoted as a technique for the
public 04
• 1979 Advanced Cardiovascular Life Support (ACLS)
is developed
 DEFINITION
 CPCR
Cardio Pulmonary Cerebral Resuscitation is a technique of basic
life support to restore normal cardio pulmonary cerebral function
that involves breathing for the victim and applying external chest
compression to make the heart pump.

 CARDIAC ARREST
Cardiac arrest is sudden cessation of all cardiac mechanical and
electrical activities.
 Cardiac arrest rhythm
There are four cardiac arrest rhythms
Can be classified as shockable and non-shockable
rhythm
1. Shockable rhythm
Pulseless ventricular tachycardia (VT)
Ventricular fibrillation (VF)
2. Non-shockable rhythm
Pulseless electrical activity(pea)
Asystole
Monitoring
– ECG
 Asystole
 Pulseless electrical activity
 Sinus bradycardia
 Ventricular fibrillation
 Asystole

• No rhythm on ECG
• Survival rate in people nearly 0%
• Treatment options
– Atropine
– Epinephrine
– Vasopressin
Pulseless Electrical Activity (PEA)

• Aka Electromechanical dissociation

• Human survival 1-4%
• Treatment options:
– Epinephrine
– Atropine
– Vasopressin
– Treat underlying cause
Ventricular tachycardia
 Ventricular Fibrillation

– 30% response rate

– SVT or sinus rhythm common when converted
• Predisposing causes
– Hypokalemia
– Hypomagenesemia
 Causes
-Cardiac diseases like coronary heart disease, heart at-
tack, cardiomyopathy, congenital heart disease,
myocardial infarction and acute myocarditis
-Severe hemorrhage
-Drug overdose
-Electrolyte imbalance like hypokalaemia, hyper-
kalaemia, hypomagnesemia
- Previous history of cardiac arrest
-Atelectasis
-COPD
-Drowning
 - Unresponsiveness
- Absence of detectable pulse
Signs - Apnoea or agonal respiration
&
Symptoms
 Goals of CPCR
• Provide artificial respiration and cardiovascular support until Re-
turn of Spontaneous Circulation (ROSC)
– Coronary perfusion pressure
– Cerebral perfusion pressure
• Identify cause and treat immediately
Goals: Coronary Perfusion Pressure
• = Aortic diastolic pressure – right atrial pressure
Goals:
Cerebral Perfusion Pressure = Mean Arterial Pressure (MAP) – In-
tracranial Pressure (ICP)
BLOOD FLOW MECHANISM
DURING CPR
1. Cardiac pump theory (Pediatrics)
2. Thoracic pump theory (Adults)
CPR PRACTICE
 Single rescuer
 Two rescuer
 Team of experts
AMERICAN HEART ASSOCIA
(AHA)
GUIDELINES FOR CPR
CHANGE IN CPR SE-
QUENCE!!
CPR SEQUENCE
 STEPS IN RESUSCITATION (DRS C-A-B-D )
 Check for Danger
 Check for Response- Check responsiveness of the patient by shake and shout method. Tap the
patient vigorously while shout “Uncle are you alright”
 ‘S’ has been added for Send for help
• If you are alone activate the emergency medical system. While informing cardiac arrest team
tell the exact ward location and age of the patient correctly to avoid unnecessary confusion. If
two rescuers are there tell one person to activate cardiac arrest team. In VBCH dial
_____from any landline to activate cardiac arrest team.
• Check for Pulse (carotid pulse )
 ‘C’ directs rescuers to perform 30 Compressions to patients who are unresponsive and not
breathing normally, followed by 2 rescue breaths.
 ‘A’ directs rescuers to open the Airway
 ‘B’ directs rescuers to check Breathing

 Basic Life Support (BLS)
CIRCULATION
– Check for heart beat/pulse
– Do not assume there is no heart beat or pulse just because they are not breathing
– If no heart beat or pulse begin chest compressions
– Begin cycles of 30 compressions and 2 breaths

CIRCULATION/CHEST COMPRESSIONS
Goal
• Maximize blood to the heart and brain
• Restore pulmonary CO2 elimination and O2 uptake by providing pulmonary blood flow
 PLACEMENT OF HANDS
1.
(ADULT)
Locate the xiphoid process, 2 fingers above it place the heel of one hand on the lower half
of the sternum (sterno-xiphoid junction).
2. Place the other hand directly on top of the first hand and try to keep your fingers off the
chest by interlacing them or holding them upward.
3. Keep arms straight and lock elbows so as to compress the chest fully while conserving
energy.
 PEDIATRIC
2 thumb-encircling hand technique and 2 finger technique
Circulation/Chest compressions
– Minimize interruptions to <10 seconds

– How hard (Push Hard Push Fast)

• Rescuers should perform chest compressions to a depth of at least 2 inches (5
cm) for an average adult, while avoiding excessive chest compression depths
(greater than 2.4 inches [6 cm]).

– What rate
• At least 100-120 compressions/minutes
AIRWAY
METHODS TO OPEN THE AIRWAY
Head –tilt –chin –lift method
Jaw thrust
method
BREATHING
Breathing techniques
 Mouth to mouth breathing
 Mouth to mask breathing
 Bag-mask breathing
 Early defibrillation with AED
Defibrillation is a medical emergency procedure in which an external device used to give
electric current to entire myocardium to depolarize the heart.
Single greatest advance in CPR
The survival rate is 90% if the patient is defibrillated within 1 min. and only 10%, if it is
delayed till 10mins
AED-Automated external defibrillation
-joules used 200 biphasic
-contra indicated for less than one year infant
-apply both paddles appropriately.
-Shout I clear, u clear and we all clear
-Then press the paddle button to release the energy.
CPR
 TWO RESCUER ADULT CPR
Rescuer -1
 At the victim’s side
 Perform chest compressions
 Give 30 compressions(count loud)
 Allow complete chest recoil
Rescuer 2
 At the victim’s head
 Open airway
 Head-tilt chin- lift/ Jaw thrust
 Give 2 breaths, watch for chest rise
 Switch duties after every 5 cycles
Advanced Life Support
 Airway
Definitive airway should be secured as soon as possible
• Endo Tracheal intubation using cricoid pressure
Acceptable Alternatives
• Laryngeal Mask Airway (LMA)
• Cricothyrotomy to be performed in an emergency
 Breathing
Once definitive airway secured ventilation rate will be 8 to 10 per minute without
synchronization
 Circulation
- Secure broad IV line
- Give cardiac arrest injections according to the rhythm
- After injection always push 20 ml of normal saline and raise the extremity
- Emergency medication like Inj. Lidocaine, Inj. Epinephrine, Inj. Atropine, Inj. Naloxone and
Inj. Vasopressin (LEANV) can be given thro tracheal route and it should be 2- 3 times of nor-
mal dose.
 DRUG ADMINISTRATION
– Intravenous
• Ideal mode
• Central large bore catheter best
• Peripheral typically easier during arrest
• Consider venous cut down early
• If peripheral catheter, flush with 5-50 ml flush to reach the heart
 Common drugs
– Epinephrine
– Atropine
– Vasopressin
– Dextrose
– Sodium bicarbonate
– Calcium gluconate
– Reversal agents: Naloxone,
Flumazenil
 CARDIAC ARREST DRUGS
Epinephrine
 Indicated in all cardiac arrest rhythms

i.e. VF, Pulse less VT, Asystole and PEA

 Adrenaline - 1mg administered every 3-5 minutes
Vasopressin
 Vasopressin Dose - 40 IU (INSTEAD of 1st and 2nd adren-
aline)
Amiodarone
 Persistent or recurrent VF or VT
 Dose is 300 mg IV push (150 mg may be repeated after 3-5 minutes )
may be followed by a 24 hour infusion
 Sodium Bicarbonate
Specific indications are as follows

 pre-existing hyperkalemia
 after prolonged resuscitation with
effective ventilation
 acidosis
The dose is 1 meq/kg bolus, repeat half this dose every 10 minutes
thereafter
 Post Resuscitation Support
• Adequate oxygenation
• Provide side lying position [recovery]
• Continuous monitoring
• Life saving drugs
• Maintenance of cerebral perfusion
• Seizure treatment and supportive care
• Stable vital signs
• Maintain blood oxygen levels and blood chemistry
• Blood sugar maintenance
 SIGNS OF SUCCESSFUL CPR

 Lung expansion
 Pupil will react to light / will appear normal
 Normal heart beat will return
 A spontaneous gasp/breathing will occur
 May move legs / arms and color may improve.
COMPLICATIONS
Faulty techniques of CPR can result in
 Local blunt trauma
 Bruising or fracture of the sternum or ribs compression at the xiphoid process causes lac-
eration of liver.
 Cardiac tamponade
 Pneumothorax
 Hemopericardium
 Lung laceration
LEGAL AND ETHICAL CONSID-
ERATIONS
• CPR can be given without fear of any legal actions
• The lay rescuers should not be afraid of any harm if the patient dies after the CPR at-
tempt.
• Avoid CPR in conditions where there is DO NOT ATTEMPT RESUSCITATION (D-
NAR OR DNR) order, because we have to respect patient’s wish
Thank you