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Curriculum Vitae

Bambang Irawan SpPD [K], SpJP [K],


FIHA, FASCC, FInaSIM

 Internist [SpPD] 1981


 Cardiologist [SpJP] 2004
 Fellow Indonsian Heart Association [FIHA] 2004
 Cardiologist Consultant [K] 2005
 Professor in Cardiology [ Prof ] 2006
 Fellow Asean College Cardiology [FAsCC] 2008
What should you do in
SUDDEN CARDIAC ARREST ?

PROF DR BAMBANG IRAWAN SpPD [K] SpJP [K]


FIHA FASCC FINASIM
Department of Cardiology and Vascular Medicine
Faculty of Medicine GadjahMada University
CAUSES of CARDIAC ARREST

CARDIAC NON CARDIAC

MYOCARDIAL INFARCTION PULMONARY EMBOLIS


CARDIOMYOPATHY BLEEDING
VALVULAR DISEASES LUNG DISEASES
CONGENITAL HEART DEFECT STROKE
ELECTROPHY ABNORMANITIES METABOLIC / ELECTROLYTE
ABNORMALITY
TRAUMA & INTOXICATION
The vulnerable atherosclerotic
plaque

Lipid core

Adventitia
Plaque rupture
The main releasing factors
The Grip of Angina
.
.
• .
CARDIAC ARREST

STATE OF WHOLE-BODY ISCHAEMIA

BRAIN INJURY

MYOCARDIAL DYSFUNCTION

SYSTEMIC COAGULATION & INFLAMMATION


WHOLE BODY ISCHAEMIA

CESSATION OF CARDIAC PUMP FUNCTION


RAPID DECLINE BLOOD PRESSURE
BLOOD FLOW NEGATIVE
OXYGEN & GLUKOSE NEGATIVE

ELIMINATION CO2 NEGATIVE


NEURONAL DEATH after CARDIAC
ARREST
3 – 6 S AFTER ARREST PATIENT
UNCONSIOUSNESS
IN 2 MNT O2 TENSION ZERO
ATP DEPLETED ADENOSINE LACTATE
HYDROGEN IONS ACCUMULATE
ION PUMP ZERO
ACCUMULATION OF Ca
CELLULER TOXICITY
PROLONG ISCHAEMIA

NEURONAL NECROSIS PROGRESS

CPR & ROSC : NEURONAL ENERGY RECOVER


BUT STILL SEQUELY: IMPAIRED OF
MEMORY ATTENTION & EXECUTIVE
FUNCTIONING [ 50% ]
MYOCARDIAL DYSFUNCTION after
CARDIAC ARREST

MARKED REDUCTION of MYOCARDIAL


FUNCTION
PRONOUNCED HEMODYNAMIC INSTABILITY
CARDIAC DAMAGE : DEFIBRILLATION
ADRENALIN

SELF LIMITING in 72 HOURS


INFLAMATION & COAGULATION
after CARDIAC ARREST

CYTOKINES : INTERLEUKINS / TNF SYSTEMIC /


LOCAL IN BRAIN

SYSTEMIC INFLAMMATORY RESPONES


SYNDROME [ SIRS ]

COAGULATION DISORDERS : NO REFLOW


PHENOMENON
.

WHAT SHOULD WE DO
MECHANICAL CPR

CHEST COMPRESSIONS

VENTILATION

COMPRESSION / VENTILATION RATIO

ELECTRICAL DEFIBRILLATION
CHEST COMPRESSION

MEAN ARTERIAL BLOOD PRESSURE 30 – 50


MMHG
CRITICAL AMOUNT OF CORONARY &
CEREBRAL BLOOD FLOW
ERC GUIDELINES 100 – 120 / MINUTE
INTERUPTIONS BY DC SHOCK AIR WAY &
DRUG IMPAIRED SUCCESFULLY
PERSON CHANGED EVERY 2 MINUTES
VENTILATION

BAG – MASK VENTILATION

TRACHEAL INTUBATION

100% O2 if AVAILABLE

ROSC O2 SHOULD BE TITRATED


Cek for breathing
.
.
COMPRESSION / VENTILATION
RATIO

30 : 2

50 : 2

3 CYCLES OF 200 PRIOR TO


TRACHEAL INTUBATION
.
ELECTRICAL DEFIBRILLATION

CAUSAL THERAPI :
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION

NOT INDICATED IN :
ASYSTOLE
PULSELESS ELECTRICAL ACTIVITY
DRUGS DURING CPR

ADRENALIN

AMIODARON

MAGNESIUM
BICARBONATE
THROMBOLYTICS
ALGORITHMS for CPR

BASIC CARDIAC LIFE SUPPORT

ADVANCED CARDIAC LIFE SUPPORT

SHOCKABLE RHYTHMS
NON SHOCKABLE RHYTHMS
CRITICAL CARE after ROSC

NORMOTENSION

NORMOGLYCAEMIA

NORMOCAPNIA

NORMOXAEMIA
THERAPEUTIC HYPOTHERMIA

CORONARY REVASCULARIZATION

PROGNOSTICATION
CONCLUSION

OCT 2010 new CPR GUIDELINES BY ERC

CONTINUOUS & EFFECTIVE CHEST


COMPRESSIONS DURING CPR

PUSHING HARD & FAST with MINIMIZED


INTERRUPTIONS is the KEY to SAVE PATIENTS’
LIVES