2010 American Heart Association Guidelines for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care

Robert A. Berg, Chair; Robin Hemphill; Benjamin S. Abella; Tom P. Aufderheide; Diana M. Cave; Mary Fran Hazinski; E. Brooke Lerner; Thomas D. Rea; Michael R.

Sayre; Robert A. Swor

BLS Guidelines 2010

Fundamental aspects of BLS :◦immediate recognition of SCA◦activation ERS◦early CPR◦rapid defibrillation

BLS Guidelines 2010

Key changed and continued points :◦ Immediate recognition of SCA unresponsiveness & normal

breathing◦ “look, listen, feel” removed◦ Hands only CPR untrained lay rescuer◦ ABC CAB◦ CPR continued ROSC/termination of effort◦ High quality CPR :

Compression rate & depth Full chest recoil Interruption Avoid overventilation

BLS Guidelines 2010 (cont’d)

Key changed & contiued points :◦De-emphasis of pulse check◦Simplified algorithm of BLS◦Simultaneous & choreographed approach for

resuscitation by integrated trained rescuers

BLS Guidelines 2010

SCA leading cause of Etiologies, circumstances, settingsSingle approach to resusc isn’t practical ?

universal strategy“Chain of Survival”

◦Immediate recogniton & activation of ERS◦Early CPR chest compression◦Rapid defibrilation (indicated)◦Effective ALS◦Integrated post-SCA care

BLS Guidelines 2010

Isn’t always straightforward laypersons

Confusion delay/failure to start CPRUnresponsive victim immediately

activate the ERS begin CPR

Immediate recognition of

SCA

BLS Guidelines 2010

Early CPR survival Often not provided until the arrival of

professional rescuersThe highest priority CHEST

COMPRESSIONChest compression perfusion during

CPR“push hard & push fast”High quality CPR !!!

Early CPR

BLS Guidelines 2010

Rapid defibrillation predictor of successful resusc following VF SCA

Reduce interval bw collaps to defibrillationDepending on the setting & circumstancesUse of AEDAED heart rhythm & lifesaving shock

Rapid Defibrillatio

n

BLS Guidelines 2010

Call local emergency numberDispatcher CPR instruction Misinterpret victim’s breathing failureInquire consciousness & breathingUnresponsive victim CPR

immediately !!!Provide “hands-only” CPRInclude rescue breathing likelihood of

asphyxial (eg, drowning)

Activating ERS

BLS Guidelines 2010

Sequential assessments & actionsEasy for any type of rescuers to learn,

remember, and performHelp a single rescuer to prioritizeEMS/in hospital simultaneously

BLS Sequence

BLS Guidelines 2010BLS

Sequence

BLS Guidelines 2010

Immediate Recognition & Activation of ERS

Unresposive victim activate the ERS Absent/abnormal breathing arrestDispatcher guide lay-rescuer check

breathing & steps of CPR !!!ERS activated begin CPR !!!911 location, the events, number,

condition BLS Sequence

BLS Guidelines 2010

Pulse CheckDifficult to detectTake too long time to check for a pulseLay rescuer unresponsive victim

don’t check for a pulse !!Trained no more than 10sec

BLS Sequence

BLS Guidelines 2010

Early CPRChest CompressionLower half of the sternumIntrathoracic pressure & direct compression to

heart blood flow & oxygen deliveryEffective CC providing blood flow during CPR PUSH HARD & PUSH FAST ~ 2inches/5cm ~

100c/minComplete Recoil Minimize frequency & duration of interruptionCompression : Ventilation = 30 : 2

BLS Sequence

BLS Guidelines 2010

Early CPRRescue BreathsCC started rescue breath m-2-m/bag-

mask oxygenation & ventilationDeliver it over 1 secGive sufficient tidal volume visible chest

riseCompression : ventilation = 30 : 2

BLS Sequence

BLS Guidelines 2010

Early Defibrillation with an AEDActivating ERS retrieve AED (if nearby &

accessible) return to the victim

Defibrillation sequence :◦Turn the AED on◦Follow the AED prompts◦Resume compression immediately after the shock

(minimize interuption) BLS Sequence

• 1 begin chest compression

• 1 activating ERS & get AED

2 rescuers

BLS Guidelines 2010

Rescuer Spesific CPR Strategies : Putting It All Together

Untrained Lay-RescuerProvide “hands-only” CPR PUSH HARD & PUSH

FAST !!!Follow the directions of dispatcherContinuously AED arrives/EMS take over care

BLS Sequence

BLS Guidelines 2010

Trained Lay-RescuerProvide chest compression & rescue

breathRatio 30 : 2Continuously AED arrives/EMS

take over care

BLS Sequence

BLS Guidelines 2010

Healthcare ProviderProvide chest compression & rescue breathRatio 30 : 2 advance airway placed

ventilation per 6 to 8 secMINIMIZE INTERRUPTION !!!Suddenly collapse assume as SCA call AED

(if nearby) victim attach&use AED CPRDrowning/foreign body obs give 5 cycle (± 2

min) CPR activate ERS

BLS Sequence

BLS Guidelines 2010BLS Skills

BLS Guidelines 2010

Recognition of Arrest (Box 1)check vic’s response unresponsive

activate ERS (lays)/check for breath (trained)

Normal breathing SCA ERSDeemphasize of checking breathOccasional gasps Deemphasize of pulse checkMinimize delays in chest compression

BLS Skills

BLS Guidelines 2010

Technique : Chest Compression (Box 4)Firm surface CPRKneeling beside the vic’s chest / standing

beside the bedHospital beds backboardAvoid : delays, interruption, displacement Heel to heel lower half of sternum Depth 2 inches (5 cm)Compression time ~ recoil time

BLS Skills

BLS Guidelines 2010

Technique : Chest Compression (Box 4)Fatigue incomplete recoilincomplete recoil hemodynamics Actual no. of CC CC rate + interruptionInterruption : open the airway, rescue breath,

AED analysisNo. of CC/min ROSC In-hospital : 80c/min; out-hospital : 68-89c/minSurvival 120c/minRecommended 100c/min

BLS Skills

BLS Guidelines 2010

Technique : Chest Compression (Box 4)Fatigue inadequate comp.rate/depth>>> after 1min of CPR2/more rescuers switch/2min (5 cycles)Switch < 5 secLay rescuers do not check for

ROSC !!!Interruption < 10sec (adv

airway/defibrillator)

BLS Skills

BLS Guidelines 2010

Compression-Ventilation Ratio (Box 4)Ratio 30 : 2 Adv. airway don’t pause

compression for ventilation !!Ventilation per 6-8sec (8-10 breaths/min)

BLS Skills

BLS Guidelines 2010

Hands-Only CPRBystander CPR (20-30%) survival Reluctance to perform m-2-m ventilationPANIC ATTACK !!CC > breath O2 level & gas exchange

BLS Skills

BLS Guidelines 2010

Managing AirwayOpen the Airway : Lay RescuersHead tilt - chin lift

Open the Airway : Healthcare ProviderHead/neck trauma Head tilt - chin liftSpinal injury manual spinal motion restrictionSpinal immobilization transport

BLS Skills

To be continued …