ADJUNCTS FOR RESUSCITATION

DR. Med. dr. Untung Widodo, SpAn.KIC. Bagian Anestesiologi & Reanimasi Fakultas Kedokteran UGM, Yogyakarta 2010

I. Pendahuluan

CPR Guidelines 2005 (update from 2000) (ILCOR, International Liaison Committee on Resuscitation.
Agreed in Int. consensus confe-rence on CPR and emergency cardiovascular care science )

- No assessing pulse - Chest compression- ventilation = 30:2 - Compression rate : 100 x/minute - No mouth to mouth breath w/o chest comp. (for lay rescuer)
1. "Adult Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-19 2. Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-156. 3. Adult Basic Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5 4."Pediatric Basic and Advanced Life Support". American Heart Association. http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-73

Device example :

For healthcare provider

5 cycles of CPR before DC-shock Check pulse after 5 cycles of CPR Minimize CPR interruption for insert A device, reassessment or drugs ad. 1 DC shock only, then CPR Reaffirmation of tPA i.v. for stroke, & should be administered by physician Increased emphasis on ventilation, & deemphasis on using high conc. O2 for new born

Circulation 2005;112;IV-1-IV-5; originally published online Nov 28, 2005; part 1 : Introduction

Compression only CPR

(= cardiocerebral resuscitation, CCR)

A study by the University of Arizona, claimed that CCR had a 300% greater success rate over standard CPR ( The exceptions were in the case of drowning or drug overdose )

1. 2.

Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study". Lancet 69(9565): 9206. March 17, 2007. Heart Association: Hands-only CPR works

to improve survival of CPR

Immediate CPR followed by defibrillation within 35 minutes of sudden VF cardiac arrest improve survival. Widespread CPR training. (In cities such as Seattle where CPR training is widespread
and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York City, without those advantages, the survival rate is only 12 percent )

II. Adjuncts for Airway control & Ventilation

Bag-Mask Ventilation, (with sufficient Vt to produce chest arise, 6-7 ml/kg b.w. or 500-600 ml over 1 second) 2 x vent. then 30 chest compression If ET/Combitube/LMA in place, give breath 8-10 x/minute, chest compression rate 100 x/minute Dont attempt to syncronize

Circulation 2005;112;IV-51-IV-57; originally published online Nov 28, 2005; Part 7.1 : Adjuncts for Airway Control and Ventilation

Aduncts for Airway

Oropharyngeal airway Nasopharyngeal airway Advances airway : Esophageal-tracheal Combitube Laryngeal Mask Endotracheal tube (dont >10sec. for insertion)

Oropharyngeal tube

Nasopharyngeal tube

LMA

Esophageal-tracheal combiyube

Endotracheal tube

Bag-mask

III. Adjuncts for CPR

To date no adjunct has consistently been shown to be superior to standard manual CPR for out-ofhospital basic life support, and no device other than a defibrillator has consistently improved long-term survival from out-of-hospital cardiac arrest.

Circulation 2005;112;IV-47-IV-50; originally published online Nov 28, 2005;

techniques

High-Frequency Chest Compressions (100 x/minute ) Open-Chest CPR (during cardiac surgery) Interposed Abdominal Compression to improve cardiac preload) Cough CPR (during awake monitored VT/VF

devices

Automatic and Mechanical Transport Ventilators Active Compression-Decompression CPR Impedance Threshold Device Mechanical Piston Device Load-Distributing Band CPR or Vest CPR Phased Thoracic-Abdominal CompressionDecompression CPR With a Hand-Held Device Extracorporeal Techniques and Invasive Perfusion Devices

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