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BLS & ACLS 2015

• First CPR guidelines were published in 1966 by


ad hoc comitee.
• AHA guidelines published in 1974, 1980, 1986,
1992, 2000, 2005, 2010, and now 2015.
• 250 evidence reviewers from 39 countries.
• 166 scientific reviews.
• Update to 2010 guidelines.
• New updates will be published as needed.
Class (Strength) of recommendation
• 315 classified recommendations
• 78 Class I recommendations(25%), 217 Class II
recommendations (68%), and 20 Class III
recommendations (7%).
• Overall, 3 (1%) are based on Level of Evidence (LOE) A,
50 (15%) are based on LOE B-R (randomized studies), 46
(15%) are based on LOE B-NR (nonrandomized studies).
• 145 (46%) are based on LOE C-LD (limited data), and 73
(23%) are based on LOE C-EO (consensus of expert
opinion).
15-25%
success
rate.
May
increase
with rapid
response
teams

10-15%
success
rate.
May
increase to
40-50%
New recommendations - OHCA
• Activation of emergency response without leaving patient
(mobile phone…)
• Emphasis on Public Access Defibrillation.
• Dispatch guided CPR.
• C-A-B – compressions first, 30:2 ratio.
• Compression-only CPR by lay people.
Compression/ventilation by trained people
• High Quality CPR:
– Rate 100-120.
– Depth 5-6 cm.
– Minimal interruptions
Health Care provider BLS
• Simultaneous activation of system with evaluation of patient.
• 10 seconds pulse check.
• May change order of actions based on situation.
• Team work
• High quality CPR:
– 30:2 compressions/ventilations.
– At least 60% CPR time.
• Defibrillate as soon as possible
• With advanced airway – 10 un-synchronized,
ventilations/minute.
PEA – Pulseless Electrical Activity
:‫טיפול‬
‫ איכותי‬CPR •
‫• אדרנלין‬
T’s H’s

Tension Pneumothorax Hypovolemia


Tamponade (cardiac) Hypoxia
Toxins Hydrogen ion (Acidosis)
Thrombosis (pulmonary) Hyper/Hypokalemia
Thrombosis (coronary) Hypothermia
Adult advanced cardiovascular life
support - changes
• No benefit from vasopressin.
• Amiodarone for resistant VF, Lidocaine
possible alternative
• Early administration of adrenalin – within first
3 minutes.
• ETCO2<10mmHg till 20 minutes resuscitation
– bad prognostic sign.
Extracorporal CPR
• 5 articles
• Common inclusion criteria:
– Witnessed cardiac arrest.
– No ROSC within 10,15,20 minutes of CPR.
– Age 16-75.
– No other severe illness.
Post resuscitation care
• Coronary angiography to patients with ST elevation
or suspected cardiac origin for arrest.
• Targeted temperature management to all comatose
patients after CPR
– 32-36 degrees, 24 hours, prevention of fever afterwards.
• Correct hypotension – SBP>90, MAP>65 mmHg
Special situations
• IV lipid emulsion for local anesthetic toxicity.
(and possibly other drugs).
• Manual left uterine displacement while
patient on her back in rescucitation during
pregnancy.
• Consider peri- mortem cesarean delivery at 4
minutes after arrest.
Pediatric life support
• C-A-B, but ventilation is important.