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Developed by the University of Arizona Sarver Heart Center
Resuscitation Research Group
• Are the most common cause of death in the United States
• Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often cardiac arrest
• Since most occur out of the hospital
• Out-of-hospital cardiac arrest is a major public health problem
• Blockage in coronary artery
• Person usually conscious
• Upper body discomfortor pain
• Electrical issue, heart stops pumping
• Person is unconscious
• Often no previous symptoms
Heart Attack vs. Cardiac Arrest
Heart Attack vs. Cardiac Arrest
Heart Attack: Cardiac Arrest:
Primary vs. Secondary Cardiac Arrest
Primary vs. Secondary Cardiac Arrest
• Heart stops pumping
• Blood in arteries full of oxygen
• Unexpected witnessed collapse
Secondary
• Heart stops pumping due to lack of oxygen
• Drowning, Drug Overdose, Lung Failure (severe asthma or emphysema)
Primary
Out-of-Hospital Cardiac Arrest
Out-of-Hospital Cardiac Arrest
The majority of all out of hospital cardiac arrests are Primary Cardiac Arrest
Unexpected, witnesses (seen or heard) collapse in an individual who is not responsive
Chest Compression Only CPRAnn Emerg Med. 1997 Jul;30(1):69-75.
What is Chest Compression Only
CPR?
What is Chest Compression Only
CPR?• A new method of resuscitation developed
through extensive research at The University of Arizona Sarver Heart Center for primary cardiac arrest
• Continuous forceful chest compressions to circulate the person’s blood to their brain and heart
• Mouth-to-mouth breaths may actually be harmful
Why isn’tRescue Breathing
Necessary?
Why isn’tRescue Breathing
Necessary?
–Lungs are full of airLungs are full of air
–Blood is full of oxygenBlood is full of oxygen
–Circulating the oxygenated blood is the key Circulating the oxygenated blood is the key
During Cardiac Arrest:During Cardiac Arrest:
Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest?
Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest?
• People less likely to perform
• Causes interruption of chest compressions: stops blood flow to the brain
• Increased pressure in the lungs and chest decreasing blood return to the heart
Aufderheide TP et al.., Death by hyperventilation: a common and life-threatening problem during CPR. Crit Care Med 2004;32:S345-51
Aufderheide TP et al.., Hyperventilation induced hypotension during CPR Circulation 2004;109:1960-5
Why Chest Compression Only
CPR?
Why Chest Compression Only
CPR?
• It saves more lives
• More likely to survive over:
– Doing nothing
– Traditional CPR
Bobrow, et al. JAMA October 2010
What Stops People from Doing CPR?
What Stops People from Doing CPR?
Coons SJ, et al. Resuscitation 80;334-340:2009 This study was designed and funded by the Sarver Heart CenterThe University of Arizona College of Medicine and SHARE
Mouth-to-Mouth
Harming the Person
Legal Consequences
Won’t Perform Properly
Physically Unable
Chest Compressions Only
Better than dead
Good Samaritan Law
Easier to Do
Do Your Best / Call For Help
Fear / Concern
Solution
40%
30%
25%
20%
15%
10%
5%
0%
17.6% 17.7%
33.7%
Surv
ival to
Hosp
ital D
isch
arg
e
NoCPR
TraditionalCPR
CCOCPR
Bystander CPR in Arizona (2005 to 2010)
Witnessed & Shockable Out of Hospital Cardiac Arrest
Bystander CPR in Arizona (2005 to 2010)
Witnessed & Shockable Out of Hospital Cardiac Arrest
Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010
When to useChest Compression Only
CPR?
When to useChest Compression Only
CPR?
• Obvious Breathing Problems:– Drowning – Drug overdoses
• Someone who unexpectedly collapses, and is unresponsive.
TraditionalCPR
Chest CompressionOnly CPR
• Vast Majority• Vast Majority
What to do:What to do:
Compress: Chest compressions at 100 Per Minute
Call: 911 & send someone for an A.E.D. (if available)
Are You Alright? Check: Shake & Shout
Are They Breathing?Are They Breathing?
• Gasping is a sign of cardiac arrest
• Majority of people with cardiac arrest gasp
• Can be a sign of minimal but adequate blood flow to the brain.
• DODO NOTNOT stop chest compressions if they gasp
How to Do Chest Compression Only CPR
How to Do Chest Compression Only CPRWith the victim on the floor:
1. Kneel beside them2. Place the heel of one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum between the nipples)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.
Chest Compressions:Rate and Depth
Chest Compressions:Rate and Depth
• Allows the heart to refill
• Beat of “Staying Alive!!”
• After each compression, take all weight off the chest
100100Compressions per MinuteCompressions per Minute
2 inches2 inchesin depthin depth
Bystander CCO CPR Improves Chance Bystander CCO CPR Improves Chance ofof
Survival from Cardiac ArrestSurvival from Cardiac Arrest
Bystander CCO CPR Improves Chance Bystander CCO CPR Improves Chance ofof
Survival from Cardiac ArrestSurvival from Cardiac Arrest100%
80%
60%
40%
20%
0%
Time between collapse and defibrillation (min)0 1 2 3 4 5 6 7 8 9
Surv
ival (%
)
Nagao, K Current Opinions in Critical Care 2009EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008.
EMS Arrival
No CPRNo CPR
CPRCPR
CCO CPRCCO CPR
What to do:What to do:
COMPRESSChest Compressions at 100 Per Minute
CALL 911
Are You Alright? CHECK Shake & Shout “Are
you all right?”
If available; Send for an A.E.D.
AEDsAEDsThey may look different, but they all function the Same!
Open and Follow Instructions
• Turn AED ON• Apply Pads to Bare Chest• Plug in Pads (if necessary)• Analyze Patient (CLEAR!)• Push Shock to defibrillate,
if directed (CLEAR!)• Immediately resume CPR
The Universal SymbolThe Universal Symbol
•Safe
•Easy
•Voice Prompted
Save your Breath…Save a Life
How to Do Chest Compression Only CPR
How to Do Chest Compression Only CPRWith the victim’s back on the floor:
1. Kneel beside them2. Place one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum between the nipples)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.
Ewy GA, et al. Circulation. 2007;116(22):2525-30.
Blood FlowingTo The Brain
Blood FlowingTo The Brain
Chest Compressions Only
Compressions + Breaths (30:2)
Pausing forbreaths meansNo Blood Flow
Three-Phase Model of Resuscitation
Three-Phase Model of Resuscitation
Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8
0 2 4 6 8 10 12 14 16 18 20
Arrest Time (min)
0
100
Myocardial ATP
Per
cen
t
SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.
25%
20%
15%
10%
5%
0%5.2%
7.8% 13.3%
Surv
ival to
Hosp
ital D
isch
arg
e
NoCPR
TraditionalCPR
CCOCPR
150/2,900
52/666
113/849
Bystander CPR in Arizona (2005 to 2010)
All out-of-hospital cardiac arrests
Bystander CPR in Arizona (2005 to 2010)
All out-of-hospital cardiac arrests
Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010