Cardiopulmonary Resuscitation

CARDIOPULMONARY
RESUSCITATION
1
HISTORICAL REVIEW
 5000 - first artificial mouth to mouth
3000 BC ventilation
 1780 – first attempt of newborn
resuscitation by blowing
 1874 – first experimental direct cardiac
massage
 1901 – first successful direct cardiac massage
in man
 1946 – first experimental indirect cardiac
massage and defibrillation
 1960 – indirect cardiac massage
 1980 – development of cardiopulmonary
resuscitation due to the works of Peter
Safar 2
all cases accompanied
with hypoxia
extracardiac
Causes of cardiac
arrest
cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors 3
Causes of circulation arrest
Cardiac Extracardiac
• Ischemic heart disease • airway obstruction
(myocardial infarction,
stenocardia) • acute respiratory failure
• Arrhythmias of different • shock
origin and character
• Electrolytic disorders • reflector cardiac arrest
• Valvular disease • embolisms of different
• Cardiac tamponade origin
• Pulmonary artery • drug overdose
thromboembolism
• electrocution
• Ruptured aneurysm of
aorta • poisoning 4
Diagnosis of cardiac arrest
Blood pressure measurement

Taking the pulse on peripheral
arteries

Auscultation of cardiac tones
Loss of time !!!
Symptoms of cardiac arrest

 absence of pulse on carotid arteries – a
pathognomonic symptom
 respiration arrest – may be in 30 seconds after
cardiac arrest
 enlargement of pupils – may be in 90 seconds after
5
cardiac arrest
Sequence of operations
 Check responsiveness
 Call for help
 Correctly place the victim and ensure
the open airway
 Check the presence of spontaneous
respiration
 Check pulse
 Start external cardiac massage and
artificial ventilation 6
In case of unconsciousness it
is necessary to estimate
quickly
 the open airway

 respiration
 hemodynamics
7
Main stages of resuscitation
A (Airway) – ensure open airway by preventing
the falling back of tongue, tracheal
intubation if possible
B (Breathing) – start artificial ventilation of
lungs
C (Circulation) – restore the circulation by
external cardiac massage
D (Differentiation, Drugs, Defibrilation) –
quickly perform differential diagnosis of
cardiac arrest, use different medication and
electric defibrillation in case of ventricular
fibrillation 8
A (Airway)
ensure open
airway
9
Open the airway using a head
tilt lifting of chin. Do not tilt the
head too far back
Check the pulse on

carotid artery using
fingers of the other hand
10
B (Breathing)
Tilt the head back

and listen for. If
not breathing
normally, pinch
nose and cover
the mouth with
yours and blow
until you see the
chest rise.
11
Algorithm
for artificial ventilation
mouth to mouth or mouth ventilation by a face mask and a
to nose respiration self-inflating bag with oxygen
2 initial subsequent breaths

wait for the end of expiration
10-12 breaths per minute with a volume of app.

800 ml, each breath should take 1,5-2 seconds
Control over the ventilation
check chest movements during ventilation
check the air return 12

C. Circulation
Restore the circulation, that is
start external cardiac massage
13
2 mechanisms explaining the
restoration of circulation by
external cardiac massage
Cardiac Thoracic
pump pump
14
Cardiac pump during the cardiac
massage
Blood pumping is
assured by the
compression of heart
between sternum and
spine
Between
compressions
thoracic cage is
expanding and heart
is filled with blood
15
Thoracic pump at the cardiac massage
Blood circulation is
restored due to the change
in intra thoracic pressure
and jugular and subclavian
vein valves
During the chest
compression blood is
directed from the
pulmonary circulation to
the systemic circulation.
Cardiac valves function as
in normal cardiac cycle.
16
ALGORITHM of Cardiopulmonary resuscitation
2 breaths (durationa 1 – 1.5 sec.)
palpation of pulse on carotid arteries (5 – 10 sec.)
1 in case of absence of pulse initiate 2

person external cardiac massage persons
a
compression rate 80 – 100/min. compression rate 80 – 100/min
compression/breath = 15 : 2 compression/breath = 5 : 1
2 breathsa in 4 – 7 sec. breath during 1 – 1.5 sec. after

each 5th compression
4 cycles: 15 compression 10 cycles: 5 compression

and 2 breaths and 1 breath
check the pulse on carotid arteries (5 sec)
in case of absence of pulse continue resuscitation 17

VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA
Witnessed Unwitnessed
Precordial thump
Check pulse, if none:
Begin CPR
Defibrillate with 200 joules
Defibrillate with 200-300 joules
Establish IV access, intubate
Adrenaline 1 mg push
Lidocaine 1 mg/kg IV, ET
18
Possible arrhythmias after
cardiac defibrillation
ventricular tachycardia
bradyarrythmia including
electromechanical dissociation and
asystole
supraventricular arrhythmia
accompanied with tachycardia
supraventricular arrhythmia with
normal blood pressure and pulse
rate 19
Operations in case of asystole
Asystole
•Start CPR
• IV line
• Adrenaline:IV 1 mg, each 3-5 min.
-or
- intratracheal 2 - 2.5 mg
- in the absence of effect increase
the dose
-Atropine 1 mg push (repeated once
in 5 min)
•Na Bicarbonate 1 Eq/kg IV

•Consider pacing 20
Drugs used in CPR
• Atropine – can be injected bolus, max 3 mg to
block vagal tone, which plays significant role in
some cases of cardiac arrest
• Adrenaline – large doses have been
withdrawn from the algorithm. The
recommended dose is 1 mg in each 3-5 min.
• Vasopresine – in some cases 40 U can
replace adrenaline
• Amiodarone - should be included in algorithm
• Lidocaine – should be used only in ventricular
fibrillation 21

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CARDIOPULMONARY

Symptoms of cardiac arrest

 the open airway

Check the pulse on

Tilt the head back

2 initial subsequent breaths

10-12 breaths per minute with a volume of app.

Control over the ventilation

check chest movements during ventilation

check the air return 12

palpation of pulse on carotid arteries (5 – 10 sec.)

1 in case of absence of pulse initiate 2

2 breathsa in 4 – 7 sec. breath during 1 – 1.5 sec. after

4 cycles: 15 compression 10 cycles: 5 compression

check the pulse on carotid arteries (5 sec)

in case of absence of pulse continue resuscitation 17

Check pulse, if none:

•Na Bicarbonate 1 Eq/kg IV

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