CPR , Basic Life Support 2020

Basic Life Support 2020

1. CARDIOPULMONARY RESUSCITATION (CPR)    Pre-CPR, Basic Life Support مرکز تحقیقات جراحی اعصاب عملکردی دانشگاه علوم پزشکی شهید بهشتی

2. OBJECTIVES At the end of this course: P articipants should be able to demonstrate: How to assess the collapsed victim How to perform chest compression and use AED How to approach to the pulseless arrest patients

3. These Highlights summarize the key issues and changes in the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). “Guidelines Highlights”

4. Figure 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated May 2019)*

5. Distribution of COR and LOE as percent of 491 total recommendations in the 2020 AHA Guidelines for CPR and ECC .*a Abbreviations: COR, Classes of Recommendation; EO, expert opinion; LD, limited data; LOE, Level of Evidence; NR, nonrandomized; R, Randomized.

6. Adult B a sic a nd Adv a nced L ife S upport

7. Summary of Key Issues and Major Changes Adult Basic and Advanced Life Support

8. Enhanced algorithms and visual aids provide easy-to-remember guidance for BLS and ACLS resuscitation scenarios . The importance of early initiation of CPR by lay rescuers has been re-emphasized . Previous recommendations about epinephrine administration have been reaffirm with emphasis on early epinephrine administration . Major new changes include the following:

9. Use of real-time audiovisual feedback is suggested as a means to maintain CPR quality . Continuously measuring arterial blood pressure and end-tidal carbon dioxide (ETCO2) during ACLS resuscitation may be useful to improve CPR quality . Routine use of double sequential defibrillation is not recommended . Intravenous (IV) access is the preferred route of medication administration during ACLS resuscitation. Intraosseous (IO) access is acceptable if IV access is not available. Major new changes include the following:

10. Major new changes include the following: Care of the patient after return of spontaneous circulation (ROSC) requires close attention to oxygenation, blood pressure control, evaluation for percutaneous coronary intervention , targeted temperature management , and multimodal neuro-prognostication . Because recovery from cardiac arrest continues long after the initial hospitalization, patients should have formal assessment and support for their physical, cognitive, and psychosocial needs .

11. Major new changes include the following: After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers may be beneficial to support their mental health and well-being. Management of cardiac arrest in pregnancy focuses on maternal resuscitation , with preparation for early perimortem cesarean delivery if necessary to save the infant and improve the chances of successful resuscitation of the mother

12. Taxonomy of Systems of Care: SPSO

13. 2015- AHA Chains of Survival for adult IHCA and OHCA.

14. 2020- AHA Chains of Survival for adult IHCA and OHCA.

15. CPR Training: Classes Routine: Training 1st hand learner or refreshment courses for lay personnel Management: Training CPR managers Standardization: Developing local or provinential standards Guideline Development: Developing national, regional, continental, or international guidelines

16. CPR Steps: Definitions Progressive Vital Organ Detoriation PreCPR Cardiac Arrest CPR Return Of Spontaneous Circulation (ROSC) PostCPR Vital Organ Function Stability

17. Special Thanks to Dr. Babak Foroutan for the interesting insightful talk about PreCPR section Pre CPR

18. PreCPR: Rationale Preventing cardiac arrest, most effective compared to CPR or PostCPR, in pts’ survival and post discharge condition . Preventing cardiac arrest, least costly compared to CPR or PostCPR , in pts’ survival and post discharge condition . Cardiopulmonary arrest is frequently preceded by PreCPR mismanagement , therefore is preventable.

19. Pre-CPR Goal: To Prevent Cardiac Arrest!

20. PreCPR: Steps “Triage” Pts Detect Pts “At Risk” of cardiac arrest Exclude “DNR” Pts Define “Tracking” measures Dz Oriented Monitors Frequency of Evaluation Define “ No Response ”, “Alert”, and “Action ” criteria for each monitor Define “Triggering” responses Determine “ In Charge ” Physician(s) Define “ MET ” activating criteria Document “ Proof of Effectiveness (POE)” criteria Determine “Periodic POE” interval

21. Vital Organ Failure + Dz : Progressive Pts Mental Status: Frightened Delirious Agitated Disconnected Disorientated Treatment: Poorly or Not Effective (Wrong Rx?) Vital Fatal Complications PreCPR: At Risk Criteria

22. BLS CPR

23. Chain of Survival

24. Simplified BLS Algorithm

25. Assessment & ERS Activation Establish Unresponsiveness Sudden Loss of Consciousness + Abn . Respiration vs Tap, Shake, Shout Call for Help 2010 Step by step activation of ERS consequentially 2015 Simultaneous assessment of responsiveness, pulse, & breathing before & while activating ERS

26. Chest Compression Depth -updated 2010 > 5 cm 2015 5 – 6 cm Push Hard ! Class I, LOE C-LD

27. Chest Compression Rate -updated 2010 > 100 2015 100 – 120 Push Fast ! Class IIa , LOE C-LD

28. Fully Recoil ! do not leaning on chest Class IIa , LOE C-LD

29. Audiovisual Feedback Devices during CPR

30. Respiratory Rate (No advanced airway) Avoid Hyperventilation ! 30 : 2 Class IIa , LOE C-LD

31. Respiratory Rate (advanced airway) - updated 2010 > 8-10 2015-2020 10 Avoid Hyperventilation ! Class IIb , LOE C-LD

32. Team-Based Resuscitation

33. CPR (BLS): CPR vs CCCR Essential Actions: Chest Wall Compression

34. CPR (BLS): CPR & AED Essential Actions: Chest Wall Compression Early Defibrillation

35. CPR (BLS ) Essential Actions: Chest Wall Compression Early Defibrillation Cause Based Tailoring 2010 Chest compression + Rescue breaths for cardiac arrest 2015 Chest compression + Rescue breaths for cardiac arrest of cardiac or non-cardiac cause. HCP can tailor CC,RB, & AED sequence to cause

36. Adult Cardiac Arrest Algorithm.

37. Adult Post–Cardiac Arrest Care Algorithm

38. BLS Dos and Don’ts of Adult High-Quality CPR

39. High Quality CPR Components for BLS

40. High Quality CPR Components for BLS