AHA 2010

Guidlines for CPR

dr Buyung SpAn
 HISTORICAL REVIEW

 5000 - first artificial mouth to mouth 3000 BC

ventilation
 1780 – first attempt to rescucitate a newborn by
blowing
 1874 – first experimental direct cardiac massage
 1901 – first successful direct human cardiac
massage
 1946 – first experimental indirect cardiac
massage and defibrillation
 1960 – indirect cardiac massage
 1980 – development of cardiopulmonary
resuscitation arrising from the works of Peter
Safar

2
 all cases accompanied by
hypoxia
extracardiac

Causes of cardiac arrest

cardiac
Primary lesion of cardiac muscle leading to the progressive
decline of contractility, conductivity disorders, mechanical
factors 3
 Causes of circulation arrest
Cardiac Extracardiac
• Ischemic heart disease
(myocardial infarction, • airway obstruction
stenocardia) • acute respiratory failure
• Arrhythmias of different
origin and character • shock
• Electrolytic disorders
• reflector cardiac arrest
• Valvular disease
• Cardiac tamponade • embolisms of different
• Pulmonary artery origin
thromboembolism
• drug overdose
• Ruptured aneurysm of aorta
• poisoning 4
 ABC  CAB
• 2005 : 2 rescue breaths followed by 30 chest
compressions and then 2 breaths
• 2010 : initial chest compression before ventilation
• Reasons :
– Chest compression deliveres blood to heart and brain
– Early compression had good outcome


 Elimination Look, Listen, Feel
• 2005 : Look, listen and feel used to assess
breathing after opening airway
• 2010 : After 30 compressions the lone rescuer
opened victim’s airway and delivered 2
breaths
• Reasons :
– With the new chest compression, first sequence
CPR is performed if the adult is unresponsive and
not breathing or not breathing normaly (C-A-B
sequence)
Chest compression at least 100 per minute

• 2005 : Compress at a rate 100 per minute

• 2010 : reasonable for a lay and healthcare
provider to perform chest compression at
least 100 per minute
• Reasons :
– Push hard and fast
– Compression delivered per minute is an important
determinant of ROSC
– More compressions are associated with higher
survival rates
 Chest compression Depth
• 2005 : The adult sternum should be depressed
approximately 1,5 to 2 inches (4-5cm)
• 2010 : sternum should be depressed at least 2
inches (5cm)
• Reasons :
Compression creates blood flow primarily by
increasing intrathoracic pressure and directly
compressing the heart. Compressions generate
critical blood flow, oxygen and energy delivery to
the heart and brain
 Shock first vs CPR First
• 2010 (Reaffirmed 2005)
When any rescuer witnessing an out-of-
hospital arrest and AED,and who is immedietly
available on site, should start CPR with chest
compressions and use the AED as soon as
possible
 1-shock vs 3 shock sequence
2010 (no change from 2005)
• If 1 shock fails to eliminate VF, the incremental
benefit of another shock is low treatment of
VF cardiac arrest
Defibrilation waveforms and energy Levels

2010 (no change from 2005)

• Data shows that biphasic waveform shock at
energy settings comparable to or lower than
200-J monophasic shock have equivalent or
higher success in terminating VF
• Defibrilator at the maximum dose may be
considered
 Supraventricular Tachyarrhytmia
• 2005 : The recommended initial monophasic
energy dose for cardioversion of AF is 100 to
200 J
• 2010 : recommended initial biphasic energy
dose for cardioversion of AF is 120-200 J, And
monophasic is 200 J
 Ventricular Tachycardia
• 2010 :
o Adult stable monomorphic VT responds
well to monophasic or biphasic cardioversion
shock at initial energies of 100 J
o Cardioversion should also not be used for
pulseless VT or polymorphic VT (irregular VT)
 New Medication Protocols
• 2010 : Atropine is not recommended for
routine use in the management of
PEA/Asystole and has been romoved from the
ACLS Cardiac Arrest Algorithm
• Adenosine is recomended in the initial
diagnosis and treatment of stable,
monophormic wide complex tachycardia
• Atropine unlikely have therapeutic benefits
during PEA or asystole
Tapering of inspired Oxygen Concentration After ROCS
based on monitored Oxyhemoglobin Saturation

• 2005 : No Specific information about weaning

was provided
• 2010 :
Once the circulation is restored, monitor
arterial oxyhemoglobin saturation
Titrate oxygen administration to maintain the
arterial oxyhemoglobin saturation ≥ 94%
 Cont.......
Why :
• An Oxygen saturation of 100% may
correspond to a PaO2 anywhere between
approximately 80 and 500 mmHg
• A recent study has documented the harmful
effects of hyperoxia after ROSC
Organized Post Cardiac Arrest Care
• Optimizing cardiopulmonary function and vital organ
perfusion after ROSC
• Transportation to an appropriate hospital or critical
care unit with comprehensive post cardiac arrest
treatment system of care
• Identification and intervention for acute coronary
syndrome (ACS)
• Temperature control to optimize neurological
recovery
• Anticipation, treatment, and prevention of multiple
organ dysfunction