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    Adult Cardiopulmonary Practice

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    Dinda Radeta
    1) Sudden cardiac arrest is a major cause of death in both Europe and the United States, causing over 700,000 deaths per year in Europe and over 330,000 out-of-hospital deaths per year in the US. 2) In Indonesia, diseases of the circulatory system are the leading cause of death, accounting for 26.4% of total deaths, with heart disease being the cause of 18.9% of circulatory system deaths. 3) Early defibrillation through the use of automated external defibrillators (AEDs) by security officers in casinos resulted in a 53% survival rate to discharge for patients experiencing sudden cardiac arrest in casinos.

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    Adult Cardiopulmonary Practice

    Uploaded by

    Dinda Radeta
    11 views41 pages
    1) Sudden cardiac arrest is a major cause of death in both Europe and the United States, causing over 700,000 deaths per year in Europe and over 330,000 out-of-hospital deaths per year in the US. 2) In Indonesia, diseases of the circulatory system are the leading cause of death, accounting for 26.4% of total deaths, with heart disease being the cause of 18.9% of circulatory system deaths. 3) Early defibrillation through the use of automated external defibrillators (AEDs) by security officers in casinos resulted in a 53% survival rate to discharge for patients experiencing sudden cardiac arrest in casinos.

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    CPR PONEK

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    1) Sudden cardiac arrest is a major cause of death in both Europe and the United States, causing over 700,000 deaths per year in Europe and over 330,000 out-of-hospital deaths per year in the US. 2) In Indonesia, diseases of the circulatory system are the leading cause of death, accounting for 26.4% of total deaths, with heart disease being the cause of 18.9% of circulatory system deaths. 3) Early defibrillation through the use of automated external defibrillators (AEDs) by security officers in casinos resulted in a 53% survival rate to discharge for patients experiencing sudden cardiac arrest in casinos.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    11 views41 pages

    Adult Cardiopulmonary Practice

    Uploaded by

    Dinda Radeta
    1) Sudden cardiac arrest is a major cause of death in both Europe and the United States, causing over 700,000 deaths per year in Europe and over 330,000 out-of-hospital deaths per year in the US. 2) In Indonesia, diseases of the circulatory system are the leading cause of death, accounting for 26.4% of total deaths, with heart disease being the cause of 18.9% of circulatory system deaths. 3) Early defibrillation through the use of automated external defibrillators (AEDs) by security officers in casinos resulted in a 53% survival rate to discharge for patients experiencing sudden cardiac arrest in casinos.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 41

    ADULT

    CARDIOPULMONARY
    PRACTICE
    Presented in “Pelatihan Program PONEK”
    RSUP. Dr. Moh. Hoesin Palembang, Saturday August 25th 2018
    HENTI JANTUNG MENDADAK
    (SUDDEN CARDIAC ARREST)
    Eropa (ESC)
    700.000 kematian/tahun
    40% Fibrilasi ventrikel

    Amerika (CDC)
    kematian CAD/thn
    • 330.000 di luar RS / UGD
    • 250.000 di luar RS
    Insidens
    0,55 kematian/1000 pop/thn

    Indonesia (Depkes)
    Penyebab kematian utama 
    sistem sirkulasi (26,4%)
    PENYAKIT PENYEBAB KEMATIAN
    UMUM DI INDONESIA

    26,4%

    Sistem sirkulasi
    18,9% = henti jantung

    16%

    Profil Kesehatan
    Indonesia 2001 Depkes Courtesy of Arif Mansjoer
    “…the true number of premature
    deaths associated with preventable
    harm to patients was estimated at
    more than 400,000 per year.”
    ETIOLOGY OF SUDDEN CARDIAC ARREST

    • Etiologi

    Nolan J. ERC Guidelines for


    Resuscitation 2005-
    introduction. Resuscitation.
    2005; 67 (suppl 1):S3-S6
    N Engl J Med 2012; 367:1912-20
    What we have been learned for 15 years
    Check and assess -
    “hands-off time” =
    time without chest
    compression  reduce
    survival
    OUTCOME OF RAPID DEFIBRILLATION BY SECURITY
    OFFICER AFTER CARDIAC ARREST IN CASINOS

    • Prospective study for sudden cardiac arrest in


    casinos n=105
    • Survival to discharge 53%
    • 90 patients (86%) witnessed
    • Collapse to AED 3.5+2.9
    • Collapse to defibrillation 4.4 + 2.9 min
    • Collapse to defibrillation ≤ 3 min
    • Survival to discharge 74%
    • Collapse to defibrillation ≥ 3 min
    • Survival to discharge 49%

    NEJM 2000
    TRIPLING SURVIVAL FROM SUDDEN CARDIAC ARREST VIA
    EARLY DEFIBRILLATION WITHOUT TRADITIONAL EDUCATION
    IN CARDIOPULMONARY RESUSCITATION

    • Result ;
    • 354 sudden cardiac arrest in Italy

    Control AED P-value


    Survival to 3.3% 10.5% 0.006
    discharge
    Survival of 4.3% 15.5% 0.002
    witnessed
    Shockable 21.2% 44.1% 0.046
    rhythm
    Neurological 2.4% 8.4% 0.009
    intact

    Circulation 2002;106
    DELAYING DEFIBRILLATION TO GIVE BASIC CPR
    TO PATIENTS WITH OUT-OF-HOSPITAL VF
    • Randomized trial, n=200
    • Defibrillation at once (group A) vs. 3 min of CPR before
    defibrillation (group B)
    A(n=96) B(n=104 P

    ROSC 46% 56% 0.1

     Response time < 5 min (n=81)


     No difference between group A and B
     Response time > 5 in (n=119)

    A(n=64) B(n=55) P-value


    ROSC 38% 58% P<0.03
    Survival to discharge 4% 22% P<0.003
    1-yr survival 4% 20% P<0.003
    JAMA 2003
    Aufderheide TP, Sigurdsson G, Pirrallo
    R, Yannopoulos D, McKnite S, von- Percobaan 3 kelompok hewan  hiperventilasi
    Briesen C, et al Hyperventilation- Tekanan intra toraks rata-rata

    induced hypotension during CPR


    Circulation. 2004;109:1960-5

    Tekanan perfusi koroner

    Observasi pada penolong terlatih dalam


    memberikan pernapasan buatan

    Kelompok pasien Kecepatan ventilasi


    yang ditolong (napas/menit)

    Kelompok1 (n=7) 37 + 4*
    Kelompok2 (n=6) 22 + 3*
    Kelompok3 (n=13) 30 + 3.2
    Tidak ada korban yang selamat

    Penolong profesional  pemberian ventilasi berlebih pada tindakan RJP.


    Hiperventilasi (pada hewan)  tekanan intratorakal meningkat, tekanan perfusi koroner
    menurun, dan angka ketahanan hidup menurun
    THE OLD (2005) ALGORITHM

    AED
    AUTOMATED EXTERNAL DEFIBRILATOR
    Meta-analysis
    UNIVERSAL ALGORITHM CPR 2010
    UPDATE IN CPR 2015?
    UPDATES IN CPR
    • A change in CPR since 2010 Guidelines is:
    • To initiate of compressions before ventilations
    • Begins CPR with 30 compressions rather than 2
    ventilations leads to a shorter delay to first
    compression
    For adults patients, RRT or MET
    systems can be affective in
    reducing the incidence of cardiac
    arrest, particularly in general
    wards (Class IIa, LOE C)
    CPR BEFORE DEFIB
    • TREATMENT RECOMMENDATION
    • During an unmonitored cardiac arrest, we suggest a
    short period of CPR until the defibrillator is ready for
    analysis and, if indicated, defibrillation. The task force
    notes that these recommendations apply to
    unmonitored victims in cardiac arrest.
    • In witnessed, monitored VT/VF arrest where a patient is
    attached to a defibrillator, shock delivery should not be
    delayed.
    HIGH-QUALITY CPR

    • Appropriate Depth at least 5-6 cm and rate of 100-120/min.


    • Upper limits of Depth and Rate are: 6 cm & 120/min

    • Allow complete recoil of the chest after each compression.


    • Emphasis on minimizing any pauses in compressions
    • Avoid excessive ventilation
    Steill, Brown, Nichol et al (2014) Circulation.
    Idris, Guffey, Pepe et al (2015) Critical Care Medicine
    HIGH-QUALITY CPR
    • HQ-CPR (manual chest
    compressions with
    rescue breath)
    generates about 25% to
    33% of normal cardiac
    output and oxygen
    delivery
    Target

    40
    CoPP (mmHg)

    CoPP target
    20

    0
    1 5

    CPR Time (min)


    Capnography
    • Capnography is recommended for intubated patients.
    • This tool is used as an additional indicator of proper tube placement,
    monitoring CPR quality and detecting ROSC.
    Criteria for not starting CPR
    Situations where attempts to perform CPR would be
    place the rescuer at risk of serious injury or mortal
    peril (eg, exposure to infectious diseases)
    Obvious clinical signs of irreversible death (eg, rigor
    mortis, dependent lividity, decapitation, transection,
    decomposition)
    A valid advance directive/valid DNAR order
    Duration Of Resuscitation Attempt
    It is generally accepted that asystole for more than 20
    minutes in the absence of reversible cause and with
    ongoing ALS constitute a reasonable ground for
    stopping further resuscitation attempts
    Post-Cardiac Arrest Care
    • ALS does not end when a patient achieves ROSC
    THANK YOU

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