Setyo Utomo

RSUD Dr. Harjono S

Ponorogo
The 2015 AHA Guidelines Update for CPR and
ECC is based on an international evidence
evaluation process that involved 250 evidence
reviewers from 39 countries and is very different
from previous editions of the AHA Guidelines for
CPR and ECC
Components of a System of Care
Universal elements of a system of care have been identified
to provide stakeholders with a common framework with
which to assemble an integrated resuscitation system

Chains of Survival
Separate Chains of Survival have been recommended that
identify the different pathways of car for patients who
experience cardiac arrest in the hospital as distinct from out
of hospital settings
Use of Social Media to Summon Rescuers
It maybe reasonable for communities to incorporate social
media technologies that summon rescuers who are in close
proximity to a victim of suspected OHCA (out of hospital
cardiac arrest) and are willing and able to perform CPR

Team Resuscitations: Early Warning Sign

Systems, RRT and MET Systems
Rapid Response Team (RRT) or Medical Emergency Team
(MET) systems can be effective in reducing the incidence
of cardiac arrest
Continous Quality Improvement for
Resuscitations Programs
Resuscitation systems should establish on going assessment
and improvement of systems of care

Regionalization of Care
A regionalized approach to OHCA resuscitation that includes
the use of cardiac resuscitation center may be considered
Community Lay Rescuer AED Programs
It is recommended that PAD (Public Access Defibrilation) programs
for patients with OHCA be implemented in public locations

Dispatcher Identification of Agonal Gasps

Cardiac arrest victims sometimes present with seizure-like activity
or agonal gasps that can confuse potential rescuer.
Emphasis on Chest Compressions*
Untrained lay rescuers should provide
compression-only (Hands-Only) CPR.
The rescuer should continue compression-only
until the arrival of an AED or rescuers with
additional training
In addition, the trained lay rescuer perform CPR
in a ratio of 30 compreession to 2 breaths

*Similar for Lay Rescuers and

HCPs
 Chest Compression Rate*
Adult victims of cardiac arrest, its reasonable for
rescuers to perform chest compressions at a rate of
100 to 120/min.

Chest Compression Depth*

Rescuer should perform chest compressions to a
depth of at least 2 inches (5 cm), while avoiding
excessive depths greater than 2.4 inches (6 cm).

*Similar for Lay Rescuers and

HCPs
Immediate Recognition and Activation of
Emergency Response System
HCPs must call for help upon finding the victim
unresponsive
HCPs continue to access breathing and pulse
simultaneously
Fully activating the emergency response system or
calling for backup
 Emphasis on Chest Compressions*
It is reasonable for HCPs to provide chest
compressions and ventilation for all adult patient
in cardiac arrest
HCPs to tailor the sequences of rescue actions
to the most likely cause of arrest

*Similar for Lay Rescuers and

HCPs
BLS Dos and Donts of Adult High-Quality CPR
Shock First vs CPR First
For witnessed adult cardiac arrest when AED
immidiately available, it is reasonable that the
defibrilator be used as soon as possible
Adult with unmonitored cardiac arrest or an AED
is not immidiately available it is reasonable that
CPR be initiated while the defibrilator being
retrieved and applied and that defibrilation if
indicated
 Chest Compression Rate*
Adult victim of cardiac arrest perform chest
compression at a rate 100 to 120/min

Chest Compression Depth*

Rescuer should perform chest compressions to a
depth of at least 2 inches (5 cm), while avoiding
excessive depths greater than 2.4 inches (6 cm).

*Similar for Lay Rescuers and

HCPs
 Chest Recoil*
Rescuer to avoid leaning in the chest between
compressions to allow full chest wall recoil for adult
cardiac arrest

Minimizing Interruptions in Chest

Compressions*
Rescuer should attempt to minimize the frequency
and duration of interuption to maximize the number
of compressions delivered per minute

*Similar for Lay Rescuers and

HCPs
BLS Healthcare
Provider Adult Cardiac
Arrest Algorithm
2015 Update
Vasopressors for Resuscitation:
Vasopresssin
Vasopressin in combination with epinephrine offers no
advantages as a substitute for standard dose epinephrine in
cardiac arrest
Epinephrine
It may be reasonable to administer epinephrine as soon as
visible after the onset of cardiac arrest due to an initial non
shockable rhythm
Post-Cardiac Arrest Drug Therapy:
Lidocaine
There is inadequate evidence to support the routine use
of lidocaine after cardiac arrest

- Blockers
There is inadequate evidence to support the routine use
of blockers after cardiac arrest
 Coronary Angiography
Should be perform emergently for OHCA patients
with suspected cardiac etiology of arrest and ST
elevation on ECG

Targeted Temperature Management

All comatose adult patients with ROSC after cardiac
arrest should have TTM between 32oC and 36oC
selected and achieved, maintain constantly for at
least 24 hours
 Out of Hospital Cooling
The routine prehospital cooling of patients with
rapid infusion of cold IV fluids after ROSC is not
recommended

Hemodynamic Goals After Resuscitation

Avoid and immidiately correct hypotension (SBP <
90 mmHg, MAP < 65 mmHg)
THANK YOU