BASIC LIFE SUPPORT

Risa Herlianita
ADULT BASIC LIFE SUPPORT
AND CARDIOPULMONARY
RESUSCITATION
(CPR) QUALITY
 OVERVIEW
• Part – 1 : Executive Summary (ringkasan dari semua part)
• Part – 2 : Evidence evaluation and management of conflict of interest
• Part – 3 : Ethical issues (Kapan perlu dan tidak di mulai CPR)
• Part – 4 : Systems of care and continous quality improvement (SPGDT & Chain Survaival)
• Part – 5 : Adult Basic Life Support and Cardiopulmonary Resuscitation Quality
• Part – 6 : Alternative techniques and ancillary devices for cardiopulmonary resuscitations
• Part – 7 : Adult advanced cardiovascular life support
• Part – 8 : Post cardiac arrest care
• Part – 9 : Acute coronary syndromes
• Part – 10 : Special circumstances of resuscitation (naloxon for antidotum opiat)
• Part – 11 : Pediatric basic life support and cardiopulmonary resuscitation quality
• Part – 12 : Pediatric advanced life support
• Part – 13 : Neonatal resuscitation
• Part – 14 : Education ( Standar & Managent Training, CPR feed Back peningkatan HQ CPR)
• Part – 15 : First Aid
 BACKGROUND
• Sudden cardiac arrest : leading cause of death in USA

• 70 % OHCA occur in the home, 50 % are unwitnessed

• Outcome from OHCA remains poor: only 10.8% of adult patients with nontraumatic cardiac arrest who have
received resuscitative efforts from emergency medical services (EMS) survive to hospital discharge.

• In-hospital cardiac arrest (IHCA) has a better outcome, with 22.3% to 25.5% of adults surviving to discharge.

• BLS is the foundation for saving lives after cardiac arrest.

• Fundamental aspects of adult BLS include immediate recognition of sudden cardiac arrest and activation of the
emergency response system, early CPR, and rapid defibrillation with an automated external defibrillator (AED).
 CARDIAC ARREST
Penyebab: 5

> Penyakit Jantung:

- IMA ( terbanyak) - Miokarditis
- Kardiomiopati - Trauma/tamponade
- Gagal Jantung
> Respirasi :
- Hipoksia - Hiperkapnea
> Metabolisme
- hiperkalsemia - hiper/hipokalemi
- hipotermi
> Sengatan listrik
> Refleks vagal
Ventricular Tachycardia

Ventricular Fibrillation
PULSELESS ELECTRICAL ACTIVITY (PEA)
SYSTEMS OF CARE AND CONTINOUS QUALITY
IMPROVEMENT
 CHAIN OF SURVIVAL

• Immediate recognition of cardiac arrest and activation of emergency

respone system
• Early CPR with an emphasis on chest compressions
• Rapid defibrillation
• Effective advance life support
• Intrgrated post- cardiac arest care
(AHA, 2010)
CHAINS OF SURVIVAL
 CHAIN OF SURVIVAL
Mempunyai jalur perawatan yang berbeda antara OHCA
dan IHCA
OHCA Masyarakat sebagai penolong
Mampu mengenali serangan, meminta
bantuan, memulai CPR, memberikan
defibrilasi
IHCA Pengawasan untuk mencegah serangan
Pelayanan terintegrasi yang
profesional dan multidisipliner
OUTCOME CHAIN SURVIVAL - IHCA
 BLS/RJP
BERDASAR AHA 2010-2015
 15

KEY CHANGES FOR 2010 & 2015

• Immediate recognition of sudden cardiac arrest
• Unresponsiveness
• Absence of normal breathing/ only gasping
• ‘Look Listen & Feel’ removed from algorithm
• ‘Hands-Only’ CPR for untrained lay-rescuer
• Sequence change from ABC to CAB
• Increased focus on chest compression
• De-emphasis on pulse check for HCP
• Recommendation of choreographed approach for CAB, rhythm detection and
shock for highly trained rescuers in appropriate setting
16
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Designed to simplify lay rescuer training and to emphasize

the need for early chest compressions for victims of sudden
cardiac arrest
ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Immediate recognition of unresponsiveness

Activate an emergency response without

leaving the victim’s side (use of a mobile
telephone)

Initiation of CPR if the lay rescuer find an

unresponsive victim is not breathing / not
breathing normally (gasping)
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Rapid identification of
potential cardiac
arrest
Dispatchers
Immediate provision of
CPR instructions to the
caller (dispatch –
guided CPR)
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

To help bystanders recognize cardiac arrest,

dispatchers should inquire about a victim’s absence
of responsiveness and quality of breathing (normal
versus not normal). If the victim is unresponsive with
Dispatchers absent or abnormal breathing, the rescuer and the
dispatcher should assume that the victim is in cardiac
arrest.
Dispatchers should be educated to identify
unresponsiveness with abnormal and agonal gasps
across a range of clinical presentations and
descriptions.
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR
Single rescuer

Initiate chest compressions before giving rescue breaths

(C-A-B rather than A-B-C)
30 chest compressions : 2 breaths

To delay to first compression

ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

• Untrained lay rescuers

Hand Only CPR with or without dispatcher
guidance for adult victims of cardiac arrest
• Trained lay rescuer
30 compressions : 2 breaths

Continue CPR until an AED arrives and is ready for use, EMS
providers take over care the victim or the victim starts to
move
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Adequa 100 – 120

te rate x/mnt

Avoiding Adequa
excessive 5 – 6 cm (2
ventilatio te – 2,4
n depth inches)
High quality CPR

Minimizing Complete
interruptions chest recoil
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Rate : influence the number of chest compressions

Adequat The number of chest compressions : important determinant of

ROSC and survival with good neurologic function
e rate
100 -120
Excessive compression rate adversely affect outcomes
x/mnt

Study : associating extremely rapid compression rates (> 140 x/mnt)

with inadequate compression depth
 ADULT BASIC LIFE SUPPORT :
LAY RESCUER CPR

Compressions : create blood flow primarily by increasing

intrathoracic pressure and directly compressing the heart, which in
turn results in critical blood flow and oxygen delivery to the heart and
brain

Adequate
depth Study : reported an association between excessive compression
depth and injuries that were not life threatening
2 – 2,4
inches (5 – 6
cm)
CPR feedback : more often too shallow than they are too deep
 COMMUNITY LAY RESCUER
AED PROGRAMS

Recommended that PAD programs for patients with OHCA be implemented in

public locations where there is a relatively high likelihood of witnessed cardiac
arrest (eg, airports, casinos, sports facilities)

Improved survival from cardiac arrest when a bystander perform CPR and
rapidly uses an AED
 ADULT BASIC LIFE SUPPORT :
HEALTHCARE PROVIDER

•Flexibility for activation of the emergency response system to better match the
HCP clinical setting
Issues

•Trained rescuers are encouraged to simultaneously perform some steps (ie,

checking for breathing and pulse at the same time), in an effort to reduce the
Issues time to first chest compression.

•Integrated teams of highly trained rescuers may use a choreographed

approach that accomplishes multiple steps and assessments simultaneously
Issues rather than the sequential manner used by individual rescuers
 ADULT BASIC LIFE SUPPORT :
HEALTHCARE PROVIDER

• Increased emphasis has been placed on high-quality CPR using

performance targets (compressions of adequate rate and depth,
allowing complete chest recoil between compressions, minimizing
Issues
interruptions in compressions, and avoiding excessive ventilation).

• Compression rate is modified to a range of 100 to 120/min.

• Compression depth for adults is modified to at least 2 inches (5 cm) but
Issues should not exceed 2.4 inches (6 cm).

• To allow full chest wall recoil after each compression, rescuers must avoid
leaning on the chest between compressions.
Issues
 ADULT BASIC LIFE SUPPORT :
HEALTHCARE PROVIDER

• Criteria for minimizing interruptions is clarified with a goal of chest

compression fraction as high as possible, with a target of at least 60%.
Issues

• Where EMS systems have adopted bundles of care involving continuous

chest compressions, the use of passive ventilation techniques may be
Issues considered as part of that bundle for victims of OHCA.

• For patients with ongoing CPR and an advanced airway in place, a

simplified ventilation rate of 1 breath every 6 seconds (10 breaths per
Issues minute) is recommended.
CPR QUALITY