Cardio-Pulmonary Resuscitation in the world of modern protocols of the

European resuscitation associationSpeaker: Head of department of emergency medicine,

TSMU І.Horbachevsky Ljakhovych R.М.

Resuscitation should be viewed as a protest against ungrounded death. A belief in true sense of human longevity and the importance to maintain human life.

Scientist V.А. Nehovsky

One of the most important tasks of becoming a physician is to acquire the skill of cardio-pulmonary-cerebral resuscitation, which allows to renew vital functions of life.

Intensive therapy– a complex of temporary methods of artificial maintenance of vital life functions in decompensated stages, which is directed to provision of life support.

Resuscitology – study about revival of the organism; prophylaxis and treatment of terminal stages. ( according to V.А. Nehovsky).

During lengthy process of dying the following stages are observed. Pre-agony. Physiological mechanism of the organism is in a state of deep exhaustion: central nervous system is decompensated; possible coma; cardiac function is weakened, thready pulse, systolic arterial pressure below critical point (70mm.Hg); weak , ineffective respirations, respiratory volume and rate is inadequate; disruption in the function of paranchymous organs. Pre-agony may last few minutes, hours, or even days. During this time the state of the patient deteriorates and ends in terminal pause. The patient loses consciousness, arterial pressure and pulse are indeterminable; respiration stops, reflexes are absent. Terminal pause lasts up to a minute. Next stage of dying is agony(fight). As a result of exhaustion the centers of vital functions -bulbar centers and reticular formation get out of control (activates). Muscle tone and reflexes are renewed in patient, respiration appears(disorderly, with help of accessory muscles). Above the magistral arteries a pulse can be felt, vessel tone can be renewed – systolic arterial pressure increases to 50-70 mmHg. The metabolic disruption in the cells of the organism becomes irreversible. The energy reserve burns out quickly and in 20-30 seconds clinical death occurs.

Main signs of clinical death:Absence of pulsation on magistral arteries (carotid and femoral),Pupils are fixed and dilated, non-reactive to light,Absence of independent breathing.

Additional signs :Change in skin colour (grey or cyanotic),Absence of consciousness,Absence of reflexes and loss of muscle tone

Important factor which influences on the effective resuscitation of clinical death is the surrounding temperature and duration of dying. During a sudden cardiac arrest clinical death lasts up to 5 minutes, during negative temperatures, up to 10 or more minutes. Lengthy period of dying worsen the effectiveness of resuscitation, and shortens period of clinical death. Biological death occurs as a consequence of irreversible changes in organism and most importantly the central nervous system, it is impossible for the organism to be brought back to life.

Complex of urgent methods that are performed to patient in the state of clinical death , which are directed to renewal of vital functions of the organism and precaution to irreversible changes of organs and systems is called resuscitation. The person that performs revival is called a resuscitator.

First stage of resuscitation- provision of first aid( basic life support).

First step – maintenance of airway patency. Resuscitator performs 3 elements (according to P. Safaro):

а) Pull the head back, by putting something behind the neck for example your own forearm. Most of the upper airways are cleared from the root of the tongue and the tongue in this position and are patent.

b) Open the patient’s mouth and with finger check for foreign bodies in the mouth as well as various liquids such as emesis, sputum, blood clots, etc.;

CPR 30:2Until defibrillator/monitor is hooked up

Evaluation of rhythm

To defibrillation(VF/VT without pulse)

No defibrillation (PEA/ asystole)

1 Defibrillation150-360 J Biphasic

or 360 J Monophasic

Provision of airway patency Determination of signs of life

Immediately start CPR 30:2

2 min.

Call resuscitation team

During CPR:•Rule out problems that can be corrected •Check placement and function of electrodes •Check: IV availability airway patency and oxygen •After airway support conduct chest compressions continuously•Inject adrenalin every 3-5 mins.•Choose: amiodarone, atropine, magnesium

Immediately startCPR 30:2

2 min.

… to confirm stopping of circulation кровообігу• Patient’s reaction

• Provide airway patency

• Evaluate respirations and pulse (not more then 10 seconds)

Provide airway patency Check for sign of life

Maintain airway patencyEvaluate sings of circulation

Call resuscitation

team

Confirmed ceasing of blood circulation

CPR 30:2Up to the point of

hooking up a defibrillator/monitor

Precardiac stroke

• Immediate treatment of observed and monitored circulatory arrest in VF/VT

• Perform, if defibrillator is unavailable

Chest compressions• 30:2 • depth 4-5 см• 100 min-1

• “center of chest”

• Avoid

• Exhaustion

• Breaks

“Quick Evaluation”Conduct ECG , classic electrodes, self adhesive electrodes.

Rhythms prior to defibrillation

(VF/VT)

First defibrillation• 150 - 200 J biphasic• 360 J monophasic

Evaluate rhythm

Prior to defibrillation (VF/VT without

pulse)

1 Defibrillation150-360 J biphasic

or 360 J monophasic

Immediate CPR 30:2

2 min

After performing defibrillation

•Continue CPR for the next 2 mins

•Stop CPR only when patient has signs of circulation

•Defibrillation – priority

•Adrenalin 1 mg (before 3)

•Аmiodarone 300 mg (before 4)

Rhythm not before defibrillation Asystole/PEA

AsystolePulseless electrical activity(PEA)

Evaluate Rhythm

Rhythm not before defibrillation(PEA/Asystole)

Immediate

CPR 30:2 2 min

Asystole/РЕА

During CPR:• Check for electrode connection• Adrenalin 1 mg i. v. every 3-5 min.• Atropine 3 mg i. v.

• Rule out/ treatable condition

Potentially treatable conditions:•Hypoxia•Hypovolemia•Hypo/hyperkalemia and metabolic disruptions •Hypothermia•Pneumothorax •Pericardial Тamponade•Тoxins•Тhromboembolism (coronary or pulmoary)

During CPR:• Rule out potentially treatable

conditions• Check placement of electrodes• Check: IV availability Airway patency and oxygen • After maintenance of airway patency

conduct continuous chest compressions• Inject adrenalin every 3-5 mins.• Choose : Amiodarone, atropine,

magnesium

Algorithm action during performance of CPR

Allows:• To begin necessary treatment without lengthy

discussions• To predicts next step of treatment• To prepare for it • To work with best knowledge• To be professional (colleagues, family)• Legal responsibility

Summary

• Algorithm ALS standardizes a way of treatment of circulatory arrest in adults

• Allows

Increase effectiveness of treatment.