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Prof. dr. Achsanuddin Hanafie, Sp.An, KIC,

KAO
Dept. Anestesiologi dan Terapi Intensif FKUSU

WHAT IS CPR?
is an emergency procedure that is done when
someones breathing or heartbeat has
stopped. It performed in an effort to
manually preserve intact brain function
until further measures are taken to restore
spontaneous blood circulation and
breathing.

HANDS ONLY CPR

A-B-C CHANGE TO C-A-B

In 2010, the American Heart Association (AHA) changed CPRs
longstanding A-B-C (Airway, Breathing, Compressions)
sequence to C-A-B (Compressions, Airway, Breathing). The old
A-B-C sequence for CPR consisted of the following steps:
1. Airways - Tilt the victims head and lift his chin to open the
airway
2. Breathing - Pinch the victims nose and breathe into the
mouth
3. Compressions Apply pressure to the victims chest
The new C-A-B (Compressions, Airway, Breathing) sequence
teaches rescuers to perform chest presses before anything
else.

Referensi:
Marsch S, Tschan F, Semmer NK, Zobrist R, Hunziker PR, Hunziker S. ABC versus CAB for cardiopulmonary
resuscitation: a prospective, ran- domized simulator-based trial. Swiss Med Wkly. 2013;143:w13856. doi:
10.4414/smw.2013.13856.
Link:
http://www.ncbi.nlm.nih.gov/pubmed/24018896

THE SCIENCE BEHIND THE DECISION

In an adult who has been breathing

normally, there is enough oxygen in the
blood to supply the heart and the brain for
several minutes following cardiac arrest.
Chest compressions are needed, however,
to circulate the oxygen and ensure that it is
distributed quickly.

THE SCIENCE BEHIND THE DECISION (2)

Rescue breaths are thought to be harmful
because they require the rescuer to stop doing
chest
compressions
for
several
seconds.
Additionally, rescue breaths lower air pressure in
the chest cavity, which in turn slows down
circulation, a key factor in resuscitation. If the
rescuer does chest compressions first, the victim
gains approximately 30 seconds of time in his
favor.

THE SCIENCE BEHIND THE DECISION (3)

When people follow the A-B-C sequence to perform CPR,
there is often a significant delay because they spend so
much time trying to open the airway, make an air-tight
seal around the mouth, or get over their reluctance to do
mouth-to-mouth resuscitation. With the new C-A-B
sequence, people initiate chest compressions sooner and
ventilation is only slightly delayed. The AHA also predicts
that the number of people who receive CPR will increase
because of this change, since bystanders often balk at the
idea of performing mouth-to-mouth resuscitation on a
total stranger.

THE SCIENCE BEHIND THE DECISION (4)

However, the change from A-B-C to C-A-B

only applies to adult victims of sudden
cardiac arrest. For children and in cases of
asphyxial arrest, drug overdose, or neardrowning among adults, rescuers are still
recommended
to
follow
the
A-B-C
sequence.

BLS AHA 2010

ERC
2010

TOP CHANGES TO CPR

2015 AHA Guideline
Compression Rate : 100 120
A higher upper rate limit was added as CPR as quality
decreases with > 120 compressions per minute
Deep, but not too deep
An upper limit on the depth of chest compressions has
been
added. They should be between 5cm (2) and 6cm
(2.5). Deeper can be harmful

ERC 2015
High-quality CPR remains essential to improving outcomes. The
guidelines on
compression depth and rate have not changed. CPR providers
should ensure chest compressions of adequate depth (at least 5
cm but no more than 6 cm) with a rate of 100120 compressions
min1. After each compression allow the chest to recoil
completely and minimise interruptions in compressions. When
providing rescue breaths/ventilations spend approximately 1 s
inflating the chest with sufficient volume to ensure the chest rises
visibly. The ratio of chest compressions to ventilations remains
30:2. Do not interrupt chest compressions for more than 10 s to
provide ventilations.

ERC GUIDELINE 2015 p.1

CHEST COMPRESSION RATE

2015 (Updated) :
In adult victims of cardiac arrest, it is reasonable for
rescuers to perform chest compressions at a rate of
100 to 120/min
2010 (Old):
It is reasonable for lay rescuers and HCPs to perform
chest compressions at a rate of at least 100/min

Reference :
Idris, A.H., Guffey, D., Pepe, P.E. et al, Chest compression rates and survival
following out-of-hospital cardiac arrest. Crit Care Med. 2015;43:840848.
Link :
http://www.ncbi.nlm.nih.gov/pubmed/25565457

CHEST COMPRESSION DEPTH

2015 (Updated) :
During manual CPR, rescuers should perform
chest compressions to a depth of at least 2
inches (5cm) for an average adult, while
avoiding excessive chest compression
depths (greater than 2.4 inches [6 cm])
2010 (Old) :
The adult sternum should be depressed at
least 2 inches
(5 cm)

Reference :
Steill, Brown, Nichol et al (2014) Circulation
Link :
http://circ.ahajournals.org/content/130/22/1962.long

CARDIAC ARREST IN PREGNANCY

Priorities for the pregnant woman in cardiac
arrest are provision of high-quality CPR and
relief of aortocaval compression. If the fundus
height is at or above the level of the umbilicus,
manual left uterine displacement can be
beneficial in relieving aortocaval compression
during chest compressions.

LUD
Manual Left Uterine Displacement (LUD)
effectively relieves aortocaval pressure in
patients with Hypotension.
(CynaAM,AndrewM,EmmettRS,MiddletonP,SimmonsSW.Techniques for
preventing hypotension
during spinal anaesthesia for caesarean sec-tion.
Cochrane Database Syst Rev. 2006:CD002251.)

No cardiac arrest outcome studies have been

published examining the effect of LUD or other
strategies to relieve aortocaval compression
during resuscitation.
(2015 AHA Guideline Update for
CPR and ECC, S502)

Thank you.