American Heart Association

Guidelines for CPR 2015

Wanida Chongarunngamsang, MD.

Faculty of Srinakarinwirot University
 American Heart Association
Guidelines for CPR 2015
• BLS
• ACLS
– Pulseless Arrest
– Bradycardia
– Tachycardia
• Post cardiac arrest care
 Chains of Survival
2015 (New): Separate Chains of Survival (Figure 4) have
been recommended that identify the different pathways
of care for patients who experience cardiac arrest in the
hospital as distinct from out-of-hospital settings
 “Chain of Survival”
in-hospital cardiac arrest (IHCA)
• Surveillance for cardiac arrest
• Activate code (multidisciplinary team)
• Initiate CPR by professional providers
• Early defibrillation
• Integrated post cardiac arrest care
 “Chain of Survival”
out-of-hospital cardiac arrest (OHCA)
• Immediate recognition of cardiac arrest and
activation of the emergency response system
• Early CPR that emphasizes chest compressions
• Rapid defibrillation if indicated
• Effective advanced life support
• Integrated post cardiac arrest care
Adult Basic Life Support
(BLS)
 Basic Life Support

– Used for patients with life-threatening illness or

injury before the patient can be given full medical
care.
– Generally used in the pre-hospital setting, and can
be provided without medical equipment.
– Generally does not include the use of drugs or
invasive skills.
.
30:2 x 5 cycle unresponsesive

CallPulse :breathing
for help and AED
Breathing 5-6 sec
and pulse

No pulse : CPR
The BLS Survey includes four steps:
The BLS survey is the starting point for all
ACLS management
• Check for a response
• Call for help and to bring an AED
• Check circulation
• Check rhythm
 The Primary Assessment
The Primary Assessment uses the ABCDE model
• Airway – Use the least advanced airway possible to maintain
the airway and oxygenation
• Breathing – Monitor tube placement and oxygenation using
waveform capnography
• Circulation – Medications, CPR, fluids and defibrillation
• Differential Diagnosis –treat reversible causes
• Disability- neurological assessment “AVPU”(Alert, Voice,
Painful, Unresponsive)
• Exposure - looking for signs of trauma, bleeding,
burns, or medical alert bracelets
 The Secondary Assessment
• The secondary assessment includes a search for
underlying causes for the emergency and if possible
a focused medical history “SAMPLE’
• (S)Signs and symptoms
• (A)Allergies
• (M)Medications
• (P)Past Illnesses
• (L)Last Oral Intake
• (E)Events Leading Up To Present Illness
 Check pulse :carotid artery

 Start Chest compression if no definite

pulse within 10 seconds
Chest compression

Push hard, Put fast

กดลึก-- ปล่อยสุด -- อย่า

หยุด-- กดบ่อย
Chest compression
Chest compression
 Chest compression

กดลึก 5 cm (2 Full chest recoid

inches)
 Minimal interruption
• หลัง defibrillation หรือ shock ให ้กดหน้าอกต่อ
ไม่ต ้องคลาชีพจร
• minimize the frequency and duration of
interruptions in compressions
• CPR without an advanced airway, goal of a chest
compression fraction as high as possible, with a
target of at least 60%.
Chest compression

กดต่อเนื่ องด ้วย

ความเร็ว
100-120 ครงต่ ้ั อนาที
Airway

Head tilt
Chin lift
Jaw thrust ถ้าสงสัย C-spine
injury
Breathing
 BLS Dos and Don’ts of Adult High-Quality CPR

Rescuers Should Rescuers Should Not

perform chest compressions at a Compress at a rate slower than 100/min or

rate of 100-120/min faster than 120/min
Compress to a depth of at least 2 inches (5 Compress to a depth of less than 2 inches (5
cm) cm) or greater than 2.4 inches (6 cm)

Allow full recoil after each compression Lean on the chest between compressions

Minimize pauses in compressions Interrupt compressions for greater than 10

seconds
Ventilate adequately (2 breaths after 30 Provide excessive ventilation
compressions, each breath (ie, too many breaths or breaths with
delivered over 1 second, each causing chest excessive force)
rise)
AED (Automated External Defibrillator)

1. เปิ ดเครือง่ AED

2. ติด paddle ตามรูป
่
3. เครืองจะท าการ
วิเคราะห ์ว่าให ้ shock
ได ้หรือไม่
่
4. ถ ้าเครืองให ้ shock ได ้
ให ้กดปุ่ มshock ที่
เครือง ่
AED (Automated External Defibrillator)

AED ON

่
กดปุ่ มเครืองเปิ ด และหมุนปุ่ ม
AED on
AED (Automated External Defibrillator)

ติด pad ที่ sternum

/apex
AED (Automated External Defibrillator)

ต่อสาย electrode pad ต่อ

เข้ากับelectrode cable ของ
่
ตวั เครือง
AED (Automated External Defibrillator)

่ เคราะห ์คลืนไฟฟ้
• เครืองวิ ่ ่
าหัวใจเมือเครื ่ เคราะห ์จะ
องวิ
้
รายงานขึนบนจอภาพว่ ่
าเป็ นคลืนไฟฟ้ าหัวใจแบบไหน
และจะแนะนาว่าให ้ทา defibrillation ถ ้าคลืนไฟฟ้ ่ า
หัวใจเป็ นชนิ ดVF หรือVT
• ห ้ามสัมผัสผูป้ ่ วยเนื่ องจากเครืองจะอ่
่ าน EKG ผิด
• ถ ้า EKG เป็ นชนิ ดVF หรือVT เครืองจะให ่ ้ charge
พลังงาน
่
• ถ ้า EKG เป็ นชนิ ด asystole เครืองจะให ้ CPR ต่อไป 2
นาทีแล ้วจะ analyze EKG ใหม่
AED (Automated External Defibrillator)

่ า
กดเพือท
การ shock
Advanced Cardiovascular
Life Support: ACLS
Advanced Cardiovascular Life
Support: ACLS
• Pulseless Arrest
• Bradycardia with Pulse
• Tachycardia with Pulse
Pulseless Arrest
 shock

 Hypovolemia  Toxins
 Hypoxia  Tamponade
  Tension PTX
Hydrogen ions (acidosis)
 Hyper/hypokalemia Thrombosis (coronary)
 Hypothermia  Thrombosis (pulmonary)

Amiodarone 5 Hs, 5Ts

300 mg----150 mg
Pulse/BP
EtCO2>40 mmHg
A-line wave form
Bradycardia with Pulse
 Unstable
bradycardia
Tachycardia with Pulse
 Narrow regular
50-100 j

Narrow irregular
120-200 j
(mono 200j)
Unstable
Tachycardia
Wide regular
100 j

Wide irregular
DF
Quantitative Waveform Capnography
• Confirmation and monitoring ETT placement
• Evaluating the effectiveness of chest compressions
ETCO2 value is at least 10-20 mmHg.
• Identification of ROSC
• Failure to achieve an ETCO2of greater than 10 mm Hg
by waveform capnography after 20 minutes of CPR
decide to end resuscitative efforts but should not be
used in isolation
Capnography Recommendation
 CPR Quality

• Quantitative waveform capnography

– If Petco2<10 mm Hg, attempt to improve
CPR quality
• Intra-arterial pressure
– If relaxation phase (diastolic) pressure <20
mm Hg, attempt to improve CPR quality
Defibrillator
Defibrillator
SBP >90 mmHg
MAP>65 mmHg

BT 32C-36C
at least 24 hr
Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity(PEA)

NO PULSE
Supraventricular tachycardia
New and Updated Recommendations
CPR Guideline 2015
• Separate Chain of Survival

• Chest compressions at a rate of 100 to 120/min :

extremely rapid compression rates with inadequate compression depth

• Chest compressions at a depth of at least 2 inches or

5 cm for an average adult, while avoiding excessive
chest compression depths (greater than 2.4 inches [6
cm])
New and Updated Recommendations
CPR Guideline 2015
• Delivery 1 breath every 6 seconds (10 /min) while
continuous chest compression with advance airway
• Vasopressin was removed from the ACLS Cardiac
Arrest Algorithm
• Nonshockable rhythm ,administer epinephrine as
soon as feasible (IV/IO/ET)
• Targeted temperature management 32C to 36C in 24
hr
• The routine prehospital cooling of patients with rapid infusion
of cold IV fluids after ROSC is not recommended
Thank you