New Approach in Basic Life SupportBasic Life Support

Departemen Ilmu Penyakit DalamFK – UI/RS Cipto Mangunkusumo

IntroductionIntroduction

• The 2005 AHA Guidelines for CPR and ECCThe 2005 AHA Guidelines for CPR and ECC emphasized the importance of high‐quality chest compressions (compressing at anchest compressions (compressing at an adequate rate and depth, allowing complete chest recoil after each compression andchest recoil after each compression, and minimizing interruptions in chest compressions)compressions).

Continued Emphasis on High‐Quality CPR (adult)

The 2010 AHA Guidelines for CPR and ECC once again emphasize the need for high‐quality CPR, including :

1. A compression rate of at least 100/min (a change from “approximately” 100/min)from approximately 100/min)

2. A compression depth of at least 2 inches (5 cm) in adults Note : the range of 1½ to 2 inches is no longer used

for adultsfor adults.

Continued Emphasis on High‐Quality CPR (adult)

3. Allowing for complete chest recoil after each compressioncompression

h4. Minimizing interruptions in chest compressions

5. Avoiding excessive ventilationg

Continued Emphasis on High‐Quality CPR (adult)

• There has been no change in the recommendation for a compression‐to‐ventilation ratio of 30:2 for single rescuers of adults.

Th 2010 AHA G id li f CPR d ECC ti t d• The 2010 AHA Guidelines for CPR and ECC continue to recommend that rescue breaths be given in approximately 1 second.

• Once an advanced airway is in place chest compressions can be• Once an advanced airway is in place, chest compressions can be continuous (at a rate of at least 100/min) and no longer cycled with ventilations.

• Rescue breaths can then be provided at about 1 breath every 6 to 8 seconds (about 8 to 10 breaths per minute).

• Excessive ventilation should be avoided.

Highlights of the 2010 GuidelinesHighlights of the 2010 Guidelines

A Change From A‐B‐C to C‐A‐BA Change From A B C to C A B

h 20 0 G id li f C d CC• The 2010 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of

f A B C (Ai B hi Chsteps from A‐B‐C (Airway, Breathing, Chest compressions) to C‐A‐B (Chest compressions, Ai B hi ) f d l hild dAirway, Breathing) for adults, children, and infants.

A Change From A‐B‐C to C‐A‐B

Why :

• The vast majority of cardiac arrests occur in d lt d th hi h t i l t f diadults, and the highest survival rates from cardiac

arrest are reported among patients of all ages who have a witnessed arrest and an initial rhythm yof ventricular fibrillation (VF) or pulselessventricular tachycardia (VT).

• In these patients, the critical initial elements of BLS are chest compressions and early p ydefibrillation.

A Change From A‐B‐C to C‐A‐B

Why :

• In the A‐B‐C sequence, chest compressions are often delayed while the responder opens the airway to give mouth‐to‐mouth breaths, retrieves a barrier device, or gathers and assembles ventilation equipment.g q p

• By changing the sequence to C‐A‐B, chest compressions will be initiated sooner and the delay in ventilation should be minimal (ie, only the time required to deliver the first cycle of 30 chestrequired to deliver the first cycle of 30 chest compressions, or approximately 18 seconds

A Change From A‐B‐C to C‐A‐BA Change From A B C to C A B

The difference between 2010 BLS AHA with 2005

Activation of Emergency Response System f g y p y

• 2010 (New):

Check for response while looking at the patient to determine if breathing is absent or not normal. Suspect cardiac arrest if the victim is not breathing or only gaspingvictim is not breathing or only gasping.

• 2005 (Old):2005 (Old):

Activated the emergency response system after finding an unresponsive victim, then returned to the victim and opened the

d h k d f b h b l b hairway and checked for breathing or abnormal breathing.

The difference between 2010 BLS AHA with 2005

Activation of Emergency Response System

Why :

Should not delay activation of the emergency response system but should obtain 2 pieces of information simultaneously: the provider should check the victim for

d h k f b thi lresponse and check for no breathing or no normal breathing.

The difference between 2010 BLS AHA with 2005

Change in CPR Sequence: C‐A‐B Rather Than A‐B‐C

• 2010 (New):

A change in the 2010 AHA Guidelines for CPR and ECC is toA change in the 2010 AHA Guidelines for CPR and ECC is to recommend the initiation of chest compressions before ventilations.

• 2005 (Old):

Th f d lt CPR b ith i f th iThe sequence of adult CPR began with opening of the airway, checking for normal breathing, and then delivering 2 rescue breaths followed by cycles of 30 chest compressions and 2 breaths.

The difference between 2010 BLS AHA with 2005

Change in CPR Sequence: C‐A‐B Rather Than A‐B‐C

• Why:

Survival was higher when bystanders provided chest compressions rather than no chest compressions.

Delays or interruptions in chest compressions reduce survival.

Chest compressions can be started almost immediately, whereas positioning the head and achieving a seal for mouth‐to‐mouth or bag‐mask rescue breathing all take timetime.

The difference between 2010 BLS AHA with 2005

Elimination of “Look, Listen, and Feel for Breathing”

• 2010 (New):

“Look, listen, and feel for breathing” was removed from the f f b h f hsequence for assessment of breathing after opening the

airway. The healthcare provider briefly checks for breathing when checking responsiveness to detect signs of cardiac g p garrest. After delivery of 30 compressions, the lone rescuer opens the victim’s airway and delivers 2 breaths.

• 2005 (Old):

“Look listen and feel for breathing” was used to assessLook, listen, and feel for breathing was used to assess breathing after the airway was opened.

The difference between 2010 BLS AHA with 2005

Eli i i f “L k Li d F l f B hi ”Elimination of “Look, Listen, and Feel for Breathing”

• Why:

CPR is performed if the victim is unresponsive and b hi b hi ll d b inot breathing or not breathing normally and begins

with compressions (C‐A‐B sequence). Breathing is briefly checked as part of a check for cardiac arrestbriefly checked as part of a check for cardiac arrest. After the first set of chest compressions, the airway is opened and the rescuer delivers 2 breaths.p

The difference between 2010 BLS AHA with 2005The difference between 2010 BLS AHA with 2005

Chest Compression Rate: At Least 100 / MinuteChest Compression Rate: At Least 100 / Minute

• 2010 (New):

i bl f l d h l hIt is reasonable for lay rescuers and healthcare providers to perform chest compressions at a

f l 100/ irate of at least 100/min.

• 2005 (Old):

Compress at a rate of about 100/minCompress at a rate of about 100/min.

The difference between 2010 BLS AHA with 2005The difference between 2010 BLS AHA with 2005

Chest Compression Rate: At Least 100 / Minute

• Why:

Delivery of more compressions during resuscitation is associated with better survival, and delivery of fewer compressions is associated with lower survival.

An inadequate compression rate or frequent interruptions (or both) will reduce the total number of compressions delivered per minute.

The difference between 2010 BLS AHA with 2005

Chest Compression DepthChest Compression Depth

• 2010 (New):

The adult sternum should be depressed at least 2 inches (5 cm).

• 2005 (Old):2005 (Old):

The adult sternum should be depressed 1½ to 2 inches (approximately 4 to 5 cm)2 inches (approximately 4 to 5 cm).

The difference between 2010 BLS AHA with 2005

Ch C i D hChest Compression Depth

• Why:

Compressions create blood flow primarily by increasing intrathoracic pressure and directly compressing the heartcompressing the heart.

Compressions generate critical blood flow and oxygen and energy delivery to the heart and brainoxygen and energy delivery to the heart and brain.

Compressions of at least 2 inches are more effective than compressions of 1½ inchesthan compressions of 1½ inches.

The difference between 2010 BLS AHA with 2005

Cricoid Pressure

• 2010 (New):

The routine use of cricoid pressure in cardiac arrest is f pnot recommended.

• 2005 (Old):

Cricoid pressure should be used only if the victim is p y fdeeply unconscious, and it usually requires a third rescuer not involved in rescue breaths or compressions.

The difference between 2010 BLS AHA with 2005The difference between 2010 BLS AHA with 2005

Cricoid PressureCricoid Pressure

Why:

Seven randomized studies showed that cricoidpressure can delay or prevent the placement of anpressure can delay or prevent the placement of an advanced airway and that some aspiration can still occur despite application of cricoid pressure.

In addition, it is difficult to appropriately train rescuers in use of the maneuver.

The difference between 2010 BLS AHA with 2005

The difference between 2010 BLS AHA with 2005

CPR TechniquesCPR Techniques

• 2010 (New):2010 (New):

The precordial thump should not be used for unwitnessed out‐of‐hospital cardiac arrest. The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery.y , y y

• 2005 (Old):

No recommendation was provided previously.

The difference between 2010 BLS AHA with 2005

CPR Techniques

• Why:

A precordial thump has been reported to convert ventricular t h h th i i t ditachyarrhythmias in some studies.

Two larger case series found that the precordial thump did not result in ROSC for cases of VF.

Reported complications associated with precordial thump include sternal fracture, osteomyelitis, stroke, and triggering

f li t h th i i d lt d hildof malignant arrhythmias in adults and children.

The precordial thump should not delay initiation of CPR or defibrillation.defibrillation.

Take Home Messageg

Take Home MessageTake Home Message

Take Home Message

TERIMA KASIHTERIMA KASIH