Tài liệu lớp học châu âu - chiaseykhoa.com

1. Cardiopulmonary Resuscitation
(Basic and Advanced Cardiac Life
Support)
David Maldonado MD
Mayo Clinic
Rochester, MN, USA

2. Agenda
• Cardiac Arrest
• Basic Life Support
• Advanced Cardiac Life Support for
Pulseless Arrest
• Ventricular Fibrillation (VF)
• Pulseless Ventricular Tachycardia (VT)
• Asystole
• Pulseless Electrical Activity (PEA)
• Algorithms

3. Cardiac Arrest
• Sudden loss of heart function
• With or without prior history of heart
disease
• May lead to death within minutes
• In U.S. up to 750,000 cardiac arrests with
attempted resuscitation every year
• 225,000 deaths

4. Causes of Cardiac Arrest
• Most commonly coronary artery disease
• Electrical impulses become too rapid
(ventricular tachycardia) or chaotic
(ventricular fibrillation)
• Also from profound bradycardia,
respiratory arrest/choking/drowning,
electrocution, trauma and other causes
• May also occur without any known cause
Americanheart.org

5. • Brain death begins within 4-6 minutes
• Cardiac arrest can be reversed within
minutes
• Chances of survival decrease 7-10% every
minute without CPR or defibrillation (not
including cold-water drowning)
• Early & effective CPR and early &
appropriate defibrillation are keys to
management
Americanheart.org

6. Cardiopulmonary Resuscitation (CPR)
Basic Life Support (BLS)
• Chest Compressions and Rescue
Breathing for person felt to be in cardiac
arrest
• To provide blood flow to brain and heart
• Maintain end-organ perfusion during arrest
• May still likely require defibrillation or
definitive treatment of ACLS
(anti-arrhythmic medications, fluid
resuscitation, electrolyte restoration, etc.)

7. BLS Healthcare Provider Algorithm
No movement or response
Open AIRWAY, check BREATHING
If not breathing, give 2 BREATHS that make chest rise
• Give 1 breath every 5 to 6
seconds
• Recheck pulse every 2
minutes
If no response, check pulse:
Definite pulse
Give cycles of 30 COMPRESSIONS and 2 BREATHS
Push hard and fast (100/min) and release completely
Minimize interruptions in compression
No pulse
AED/defibrillator ARRIVES
Check rhythm
Shockable rhythm?
Give 1 shock
Resume CPR immediately
for 5 cycles
Resume CPR immediately
For 5 cycles
Check rhythm every
5 cycles; continue until ALS
Providers take over or
victim starts to move
Shockable
(VF/VT)
Non Shockable
Adapted from Circulation;112 (24 Supplement): IV-19.
(2005)

8. ABCD’s of BLS
Step 1: Airway
• Head-tilt, Chin-lift maneuver
• Open airway

9. Step 2: Breathing
Look, listen, and feel
• Look for chest rise
• Listen for normal breath sounds
• Feel air flow with cheek or hand
• If not detected within 10 seconds, give 2
rescue breaths, then proceed to next step
• Each breath for 1 second
• Visible chest rise
• Bag-mask, mouth-to-mask, mouth-to-
mouth

10. Smurd.com

11. Step 3: Circulation
Check Pulse
• Pulse present: give 1 breath every 5-6
seconds
• Pulse absent: deliver effective chest
compressions
• “Push hard and fast”
• 100 compressions/minute
• 4-5 cm depth
• Complete chest recoil
• 30 compressions : 2 breaths = 1 cycle

12. Chest Compression Technique
Smurd.com

13. 100 compressions/minute
Abella et al. Circulation. 2005;111:428-434.

14. Compression Depth
4-5 cm
Edelson et al. Resuscitation. 2006; 71:136-145.

15. Step 4: Defibrillation
Advanced Cardiac Life Support (ACLS)
• Oxygen, monitor/defibrillator, IV
• Assess rhythm
• Shockable rhythm
• Ventricular fibrillation
• Pulseless Ventricular Tachycardia
• Non-shockable rhythm
• Asystole
• Pulseless Electrical Activity

16. Shockable Rhythms
VF and pulseless VT

17. • Deliver single shock (360 J Monophasic or
200 J Biphasic)
• Immediate 5 cycles of CPR
• Assess rhythm – Still shockable rhythm?
• Repeat defibrillation, 5 cycles of CPR, and
either epinephrine 1mg every 3-5 minutes
or Vasopression 40 Units IV x 1
• Assess rhythm – Still shockable rhythm?
• Repeat defibrillation, 5 cycles of CPR, and
consider antiarrhythmics
• Amiodarone 300mg IV push or
• Lidocaine 1-1.5mg/kg

18. Non-Shockable Rhythms
Asystole and PEA

19. • Immediate 5 cycles of CPR
• Epinephrine 1mg IV every 3-5 minutes or
Vasopressin 40 Units IV x 1
• Atropine 1mg IV for asystole or slow PEA
• Reassess rhythm – Still non-shockable?
• Repeat pattern and consider differential

20. Differential/Management
6 H’s and 5 T’s
• Hypovolemia Fluid resuscitation
• Hypoxia Supplemental O2
• Hydrogen (Acidosis) Treat cause, ?bicarbonate
• Hypo-/Hyperkalemia Correct imbalance
• Hypoglycemia Check/replace glucose
• Hypothermia Rewarming
• Toxins Toxin-specific Rx
• Tamponade Pericardiocentesis
• Tension Pneumothorax Needle decompress
• Thrombosis (MI or PE) MI/PE Rx
• Trauma Surgical evaluation

21. Post-resuscitative Care
• Supportive, multi-organ care
• ?Hypothermia, ?Glucose control
• Predictors of poor outcome at 24 hrs
• Absent corneal reflex
• Absent pupillary response
• Absent withdrawl response to pain