2010 AHA Guidelines

2015 AHA revised

A Change from A-B-C to C-A-B

Initial Assesment-ATLS
Rapid recognize
 Conscious or Unconscious ?
Unconscious
 Unresponsive
Not breathing or only gasping

 Shake shoulder & shout

 Activate emergency respons
Unresponsive
Not breathing or only gasping
 assume cardiac arrest
Simultaneous with:
 Pulse check
 < 10 seconds
Early CPR
 Push hard & fast; minimize interruption
 Complete recoil (avoid lean an chest
between compression)
 High quality (100-120x/m; depth 5-6cm)
Breathing
 Head tilt - chin lift
 Jaw thrust without
head extension

 Mouth to mouth
(regular breathing;
over 1 second)
 Avoid excessive ventilation;
chest rise)
≥ 2 rescuer

 Switch position every 2 minute

 Interuption < 10 second
Advance airway
 Intubation, stop compression- <10
second
 Breath 10x/min (every 6 second)
 Compression 100x/min
Indication of Intubation
 Inability to ventilate with bag mask:
ventilator, obstruction, anesthesia

 Absent of reflex protective airway:

Unconscious, aspiration, suction
Preparation
 Scope
 Tube
 Airway
 Tape
 Introducer
 Connector
 Suction
Pediatric & Infant
Infant :
Intermammari line
Two finger
Mouth to mouth & nose
Mouth to nose
Mouth to mouth

Child (>1 years) :

Lower half sternum
One or two hand

• 1 rescuer  30:2
• ≥ 2 rescuer  15:2
• Depth 1/3 AP ( child 5cm; infant 4cm)
 Pulse check : brachial artery in infant;
carotid or femoral in a child
 Palpaple pulse ≥60 with inadequate
breath  rescue breath 12-20x/min
(1breath every 3-5 second), reassess
the pulse every 2 minute
 Pulse<60 with pallor/cyanosischest
compression
2 rescuer
15:2

Excluding Newborn
Resuscitation
3:1
90 compression:30
breath/minute
Choking
 Back blow (infant)
 Cough
 Heimlich maneuver (child)
 Chest thrust
Recovery Position

 After return of spontaneus circulation

(ROSC)
 Unresponsive, normal breathing,
effective circullation
 Airway, prevent obstruction
 Without spine, hip, or pelvis injury
When to stop CPR?
 ROSC
 Sign of irreversibel death ( rigormortis,
decapitation, dependent lividity)
 Available scientific study show that: No ROSC at
anytime during 30 minutes (15 minute for
newborn)
 Do Not Attemp Resuscitation (DNAR)- valid order
from physician & family
 When the responsible clinician determines with a
high degree of certainly that the arrest victim will
not respond to further ACLS effort

 Ethical issue…?
When to witholding CPR?
Out of hospital:

 Patients lies dead (sign irreversible dead)

 When an expert healthcare provider is going to
take over
 Rescuer become exhaust and cannot continue
 Would place rescuer at risk of injury/environmental
hazard
 Valid DNAR order to the rescuer
ANY QUESTION

?
AHA 2015 :
 Naloxone (unresponsive; no normal
breathing; with a pulse)
 Witnessed (airport, casino, sport
facilities)-Public Access Defibrilation,
AED
 Bystander not trained hand only CPR,
untill rescuer / AED
 Simultaneously (checking pulse &
breath at the some time)
 CPR for all cardiac arrest ( a cardiac &
 Witnessed CA with AED available :
defibrilator as soon as possible
 Pregnancy : manual left uterine
displacement during CPR (aorto caval
compression), consider Sectio Cesarea
4 minute after cardiac arrest in patient
with poor prognostic
33

 Ventricular Tachycardia (no pulse)

 Ventricular Fibrilation (no pulse)

 Shockable Rhytm
 Resume CPR immediately after shock
 Consider antiarrhytmic (after 3x5 cycle
CPR)
 Asystole

 PEA (pulseless Electrical Activity)

 Any electrical activity without pulse
 Example: Sinus Rhytm ECG, but no
pulse
 Thank You
 References:

2010; American Heart Association Guidelines for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care

http://circ.ahajournals.org/content/122/1
8_suppl_3/S685.full

https://circ.ahajournals.org/content/122/
18_suppl_3/S729.full
Revised 2015
https://circ.ahajournals.org/content/132/
18_suppl_2.toc