2015 AHA Guidelines Highlights Vietnamese

NHNG IM NI BT
trong Hng dn cp nht ca American Heart Association
cho Hi sinh tim phi (CPR) v

Cp cu Tim mch (ECC) nm 2015
Ni dung
Gii thiu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Nhng vn o c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Cc h thng chm sc v Ci thin cht lng lin tc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Duy tr s sng c bn ngi ln v cht lng
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi):
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) khng chuyn . . . . . . . . 5
Duy tr s sng c bn ngi ln v Cht lng
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi):
BLS (Basic Life Support; Hi sinh tim phi c bn) cho Nhn vin y t . . . . . . . . . . . . 8
K thut thay th v Thit b ph cho CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Duy tr s sng tim mch nng cao ngi ln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Chm sc sau ngng tim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Hi chng mch vnh cp tnh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Cc Trng hp hi sinh c bit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Duy tr s sng c bn khoa nhi v Cht lng
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Duy tr s sng nng cao tr em. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Hi sc tr s sinh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Gio dc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Cp cu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Ti liu tham kho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Li cm n
American Heart Association cm n nhng ngi sau v nhng ng gp ca h cho s pht trin ca n bn ny: Mary
Fran Hazinski, RN, MSN; Michael Shuster, MD; Michael W. Donnino, MD; Andrew H. Travers, MD, MSc; Ricardo A. Samson,
MD; Steven M. Schexnayder, MD; Elizabeth H. Sinz, MD; Jeff A. Woodin, NREMT-P; Dianne L. Atkins, MD; Farhan Bhanji, MD;
Steven C. Brooks, MHSc, MD; Clifton W. Callaway, MD, PhD; Allan R. de Caen, MD; Monica E. Kleinman, MD; Steven L. Kronick,
MD, MS; Eric J. Lavonas, MD; Mark S. Link, MD; Mary E. Mancini, RN, PhD; Laurie J. Morrison, MD, MSc; Robert W. Neumar,
MD, PhD; Robert E. OConnor, MD, MPH; Eunice M. Singletary, MD; Myra H. Wyckoff, MD; v Nhm d n Nhng im ni
bt trong Hng dn ca AHA.
2015 American Heart Association
Gii thiu
n bn Nhng im ni bt trong hng dn ny tng
hp nhng vn v thay i ch yu trong Hng dn
cp nht ca American Heart Association (AHA) cho Hi sinh
tim phi (CPR) v Chm sc tim mch khn cp (ECC) nm
2015. n bn ny hng n mc ch gip nhng ngi
lm cng tc hi sinh v hun luyn vin ca AHA tp trung
vo cc khuyn ngh lin quan n khoa hc hi sinh v cc
nguyn tc ch dn quan trng nht hoc gy tranh ci nht,
hoc nhng khuyn ngh c kh nng mang li thay i
trong thc hnh hi sinh hoc o to hi sinh. Ngoi ra, n
bn cn cung cp c s l lun cho nhng khuyn ngh ny.
Do n bn ny c thit k thnh mt bn tm tt, n
khng cp n nhng nghin cu h tr c xut
bn v khng lit k cc Lp khuyn ngh hay Mc chng
c. bit thm thng tin v ti liu tham kho chi tit, c
gi nn c Hng dn cp nht ca AHA cho Hi sinh tim
phi (CPR) v Chm sc tim mch khn cp (ECC) nm 2015,

trong c Tm tt tng quan,1 c xut bn trong tp ch
Circulation (Tun hon mu) vo thng 10 nm 2015, v tham
kho phn tm tt chi tit v khoa hc hi sinh trong 2015
International Consensus on CPR and ECC Science With Treatment
Recommendations (ng thun Quc t nm 2015 v Khoa hc
Hi sinh tim phi (CPR) v Chm sc tim mch khn cp (ECC)
vi Cc iu tr Khuyn ngh), c xut bn ng thi trn tp
ch Circulation2 (Tun hon mu) v Resuscitation3 (Hi sc).
Hng dn cp nht ca AHA cho Hi sinh tim phi (CPR) v
Chm sc tim mch khn cp (ECC) nm 2015 da trn quy
trnh nh gi chng c quc t gm 250 ngi nh gi
chng c t 39 quc gia. Quy trnh nh gi c h thng
nm 2015 ca y ban lin lc quc t v hi sc (ILCOR) c
nhiu khc bit khi so snh vi quy trnh c s dng
nm 2010. i vi quy trnh nh gi c h thng nm 2015,
nhm cng tc ca ILCOR u tin cc ch cn nh gi,
la chn nhng ch c tnh khoa hc hoc gy tranh
ci thc y vic nh gi c h thng. Kt qu ca vic
Hnh 1
H thng phn loi mi ca AHA cho cc lp khuyn ngh v Mc chng c*

LP KHUYN NGH (CHC CHN)
MC (CHT LNG) CHNG C
LP I (MNH)
MC A
Li ch >>> Ri ro
Cc cm t gi vit khuyn ngh:

c khuyn ngh
Hm /hu dng/hiu qu/c li
Cn c thc hin/qun l/khc
Cc cm t so snh hiu qu:
Cch iu tr/chin lc A c khuyn ngh/hm u
tin hn cch iu tr B
Nn chn cch iu tr A thay v cch iu tr B
LP IIa (TRUNG BNH)
Li ch >> Ri ro

L hp l
C th hm /hu dng/hiu qu/c li
Cc cm t so snh hiu qu :
Cch iu tr/chin lc A c th c khuyn ngh/
hm u tin hn cch iu tr B
S hp l khi chn cch iu tr A thay v cch iu tr B
LP IIb (YU)
Li ch Ri ro

C th hp l
C th cn nhc
Cng dng/hiu qu cha bit/cha r rng/cha chc chn
hoc cha vng vng
LP III: Khng c li ch (TRUNG BNH) Li ch = Ri ro

(Ni chung, ch s dng LOE (Level of Evidence; Mc chng c) A hoc B)
Khng c khuyn ngh
Khng hm /hu dng/hiu qu/c li
Khng nn c thc hin/qun l/khc
LP III: Tc hi (MNH)
Chng c cht lng cao t hn 1 th nghim i chng

ngu nhin
Phn tch gp cc th nghim i chng ngu nhin cht lng cao
Mt hoc nhiu th nghim i chng ngu nhin c cng
c bi cc nghin cu lu tr cht lng cao
MC B-R
(Ngu nhin)
Chng c cht lng trung bnh t 1 hoc nhiu th nghim

i chng ngu nhin
Phn tch gp cc th nghim i chng ngu nhin cht
lng trung bnh
MC B-NR
(Phi ngu nhin)
Chng c cht lng trung bnh t 1 hoc nhiu nghin cu

phi ngu nhin, nghin cu quan st hay nghin cu lu tr
c thit k v thc hin k cng
Phn tch gp nhng nghin cu ny
MC C-LD
(D liu hn ch)
Cc nghin cu quan st hoc lu tr ngu nhin hoc phi

ngu nhin vi hn ch trong thit k hoc thc hin
Phn tch gp nhng nghin cu ny
Cc nghin cu sinh l hoc c hc i tng con ngi
MC C-EO
( kin chuyn gia)
S ng thun trong kin chuyn gia da trn tri nghim lm sng

Lp khuyn ngh (COR) v LOE (Level of Evidence; Mc chng c) c xc nh
c lp (Lp khuyn ngh (COR) bt k c th kt hp vi LOE (Level of Evidence;
Mc chng c) bt k).
Ri ro > Li ch

Tim n tc hi
Gy tc hi
Gn lin vi t sut bnh/t l t vong qu mc
Khng nn c thc hin/qun l/khc
Mt khuyn ngh c LOE (Level of Evidence; Mc chng c) C khng m ch rng

khuyn ngh yu. Nhiu vn lm sng quan trng c cp trong hng
dn khng thch hp vi th nghim lm sng. Mc d khng sn c th nghim i
chng ngu nhin (RCT), c th c s ng thun lm sng rt r rng rng mt th
nghim hay liu php c th l hu ch hoc hiu qu.
* Tc ng hoc kt qu ca can thip cn phi c th (tc ng lm sng c ci
thin hoc chnh xc chn on tng ln hoc thng tin tin lng tng ln).
i vi cc khuyn ngh so snh hiu qu (ch c Lp khuyn ngh (COR) I v IIa;
LOE (Level of Evidence; Mc chng c) A v B), cc nghin cu ng h s
dng cc ng t so snh cn bao gm cc so snh trc tip gia cc cch iu tr
hay chin lc ang c nh gi.
Phng php nh gi cht lng ang thay i, bao gm c vic p dng cc
cng c xp hng chng c c xc minh u tin, chun ha v s dng rng ri
v tch hp c mt y ban nh gi chng c nh gi c h thng.
COR cho bit Lp khuyn ngh; EO, kin chuyn gia; LD, d liu hn ch; LOE,
Mc chng c; NR, phi ngu nhin; R, ngu nhin v RCT, th nghim i chng
ngu nhin.
Nhng im ni bt trong Hng dn cp nht nm 2015
u tin ny l nm 2015, chng ti hon thnh t nh gi

hn (166) so vi nm 2010 (274).
Khi la chn c ch , c 2 b sung quan trng
cho quy trnh nh gi nm 2015.Th nht l nhng
ngi nh gi s dng Grading of Recommendations
Assessment, Development, and Evaluation (GRADE;
www.gradeworkinggroup.org), mt h thng nh gi
chng c c kt cu v kh nng ti to cao, nhm ci thin
tnh nht qun v cht lng ca cc nh gi c h thng
trong nm 2015. Th hai, nhng ngi nh gi trn khp
th gii c th lm vic vi nhau trn mng hon thnh
cc nh gi h thng thng qua vic s dng nn tng
chuyn dng ca AHA da trn web, c tn l Systematic
Evidence Evaluation and Review System (SEERS), c thit
k h tr nhiu bc trong quy trnh nh gi. Trang
web SEERS ny c s dng cng b cc d tho
2015 International Consensus on CPR and ECC Science With
Treatment Recommendations ca ILCOR v tip nhn kin
ca cng chng. tm hiu thm v SEERS v xem danh
sch y tt c cc nh gi c h thng do ILCOR tin
hnh, truy cp www.ilcor.org/seers.
Hng dn cp nht ca AHA cho Hi sinh tim phi (CPR)
v Cp cu Tim mch (ECC) nm 2015 rt khc bit so vi
nhng n bn Hng dn ca AHA cho Hi sinh tim phi
(CPR) v Chm sc tim mch khn cp (ECC) trc y.
y ban ECC xc nh rng n bn nm 2015 s l bn cp
nht, ch nhc n nhng vn c cp theo nh gi
chng c nm 2015 ca ILCOR hoc nhng vn m mng
li o to yu cu. Quyt nh ny bo m l chng ta
ch c mt tiu chun nh gi chng c v l quy
trnh do ILCOR thit lp. Do , Hng dn cp nht ca
AHA cho Hi sinh tim phi (CPR) v Chm sc tim mch khn
cp (ECC) nm 2015 khng phi l bn sa i ton din ca
Hng dn AHA cho Hi sinh tim phi (CPR) v Chm sc tim
mch khn cp (ECC) nm 2010. Phin bn tch hp ny c
sn trc tuyn ti ECCguidelines. heart. org.
Vic xut bn 2015 International Consensus on CPR and ECC
Science With Treatment Recommendations s khi ng mt
quy trnh nh gi lin tc i vi khoa hc hi sinh. Nhng
ch c nh gi nm 2015 s c cp nht nu cn
v s c nhng ch mi c thm vo. c gi cng
nn theo di trang web SEERS cp nht kin thc mi
v khoa hc hi sinh v nh gi ca ILCOR v khoa hc
. Khi c chng c cho thy cn thay i Hng dn
AHA cho Hi sinh tim phi (CPR) v Chm sc tim mch
khn cp (ECC), nhng thay i s c thc hin v
thng bo cho cc bc s lm sng v mng li o to.
Hng dn cp nht nm 2015 s dng phin bn nh
ngha mi nht ca AHA i vi Lp khuyn ngh v Mc
chng c (Hnh 1). c gi s thy rng phin bn ny
iu chnh khuyn ngh Lp III, Lp III: Khng c li ch,
khng c s dng thng xuyn khi bng chng cho
thy mt nghin cu c cht lng cao hoc trung bnh
(Mc chng c [LOE] A hoc B tng ng) chng minh
rng chin lc khng tt hn chin lc i chng. Mc
chng c cng c iu chnh. LOE (Level of Evidence;
Mc chng c) B nay c chia thnh LOE (Level of
Evidence; Mc chng c) B-R (nghin cu ngu nhin)
v LOE B-NR (nghin cu phi ngu nhin). LOE (Level of
Evidence; Mc chng c) C gi c chia thnh LOE
(Level of Evidence; Mc chng c) C-LD (d liu hn ch)
v C-EO ( kin chuyn gia).

American Heart Association
Hnh 2
Phn phi cc lp khuyn ngh v

Mc chng c di dng phn trm
trong tng s 315 Khuyn ngh trong
bn cp nht hng dn 2015 ca AHA
Cc lp khuyn ngh 2015

Lp III: C hi
5%
Lp III: Khng c li ch
2%
Lp
25%
Lp IIb
45%
Lp IIa
23%
Mc chng c
LOE A
1%
LOE C-EO
23%
LOE B-R
15%
LOE B-NR
15%
LOE C-LD
46%
Phn trm trong s 315 khuyn ngh.
Nh ra trong bo co mi xut bn gn y ca
Institute of Medicine4 v phn ng ng thun ca AHA
ECC i vi bo co ny,5 cn lm nhiu vic hn na
thc y khoa hc v thc tin v hi sinh. S cn c n
lc kt hp ti tr cho nghin cu hi sinh ngng tim
tng t nh ti tr cho nghin cu ung th v t qu
trong 2thp k qua. C th thy r nhng khong trng
trong khoa hc hi sinh khi xem xt k lng cc khuyn
ngh c trong Cp nht hng dn nm 2015 (Hnh 2). Nhn
chung, cc Mc chng c v Lp khuyn ngh trong hi
sinh l thp, ch 1% trong tng s khuyn ngh nm 2015
(3/315) da trn Mc chng c cao nht (LOE A) v ch
25% trong tng s khuyn ngh (78/315) c xp vo Lp
I (khuyn ngh mnh). Hu ht (69%) cc khuyn ngh trong
Cp nht hng dn 2015 c Mc chng c thp nht
(LOE C-LD hoc C-EO), v gn mt na (144/315; 45%) c
phn loi thnh Lp IIb (khuyn ngh yu).
Xuyn sut quy trnh nh gi chng c ca ILCOR v xy
dng Hng dn cp nht nm 2015, nhng ngi tham gia
tun th cht ch cc yu cu ca AHA v cng khai mu
thun quyn li. i ng nhn vin AHA x l hn 1000
k khai mu thun v quyn li, v tt c cc trng nhm
vit Hng dn v ti thiu 50% cc thnh vin nhm vit
Hng dn c yu cu khng c mu thun v quyn li
c lin quan.
Nhng vn o c
S pht trin ca thc hnh hi sinh ko theo s tin
trin ca cc cn nhc v o c. Vic qun l nhiu
quyt nh lin quan n hi sinh mang tnh thch
thc t nhiu gc , c bit l khi cc nhn vin y t
(HCP) ang i mt vi cc vn o c xoay quanh
quyt nh c can thip cp cu tim mch hay khng.
Nhng vn o c xoay quanh vic c nn bt u
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
hay khng v khi no th chm dt CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) c tnh phc tp v c th
khc nhau ty vo bi cnh (trong hay ngoi bnh vin),
ngi thc hin (cn bn hay chuyn su) v bnh nhn
(s sinh, tr em, ngi ln). Mc d cc nguyn tc o
c khng thay i t khi xut bn Hng dn nm 2010,
nhng d liu cung cp thng tin cho nhiu tho lun v
o c c cp nht thng qua qu trnh nh gi
chng c. Quy trnh nh gi chng c ca ILCOR nm 2015
v Hng dn cp nht tng hp ca AHA bao gm mt s
cp nht v khoa hc c th c tc ng n vic ra quyt
nh v o c i vi cc bnh nhn trc ngng tim,
ngng tim v sau ngng tim.
Nhng Khuyn ngh mi v cp nht quan trng c

th cung cp thng tin cho Quyt nh v o c
S dng Hi sc Tim phi ngoi c th (ECPR) cho ngng tim
Cc nhn t tin lng trong ngng tim
nh gi chng c v cc im tin lng i vi tr sinh non
Tin lng i vi tr em v ngi ln sau khi ngng tim
Chc nng ca cc c quan cy ghp hi phc sau khi ngng tim
sau ngng tim b hn m. D liu mi nht v cng dng

ca nhng th nghim v nghin cu c th c th cung cp
thng tin cho nhng quyt nh v mc tiu chm sc v hn
ch can thip.
Cc bc s ngy cng nhn thc c rng mc d tr em v
thiu nin khng th a ra nhng quyt nh c tnh rng
buc v mt php l, nhng vn nn chia s thng tin vi h
trong phm vi c th, bng cch s dng ngn ng v thng
tin ph hp i vi mc pht trin ca mi bnh nhn.
Ngoi ra, cm t cc hn ch v chm sc c i thnh
cc hn ch v can thip. Mu Ch th ca bc s iu tr duy tr
mng sng (POLST) cng tr nn thng dng hn, y l mt
phng php mi nhm xc nh mt cch hp php nhng
ngi c mt s hn ch i vi can thip lc cui i, c
ni tr v ngoi tr. K c vi thng tin mi rng thnh cng
trong cy ghp thn v gan t ngi hin tng trng thnh
l khng lin quan n vic ngi hin tng c tng tip nhn
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) hay
khng, vic hin ni tng sau khi hi sc vn cn gy tranh ci.
Nhng quan im v mt vi mi lo ngi h trng v o c,
vn l nhng ch vn ang c tranh ci quanh vic hin
tng trong bi cnh cp cu, c tng hp trong Phn 3:
Nhng vn o c trong Hng dn cp nht nm 2015.
Cc h thng chm sc v
Ci thin cht lng lin tc
Hng dn cp nht nm 2015 cung cp cho nhng ngi c
lin quan mt gc nhn mi v cc h thng chm sc, phn
bit gia ngng tim trong bnh vin (IHCA) vi ngng tim
ngoi bnh vin (OHCA). Nhng im ni bt chnh bao gm
Phn loi chung cc h thng chm sc
Tch Dy chuyn x tr cp cu cho ngi ln theo AHA thnh 2 dy chuyn:

Nhng chin lc hi sc mi nh ECPR (extracorporeal CPR;
mt dy chuyn dnh cho h thng chm sc trong bnh vin v mt dy
Hi sc Tim phi ngoi c th) quyt nh ngng cc bin
chuyn cho h thng chm sc ngoi bnh vin
php hi sc phc tp hn (xem mc Duy tr s sng tim mch
nh gi chng c tt nht v cch nh gi cc h thng chm sc
nng cao ngi ln trong n bn ny). Hiu c cch s
ngng tim ny, tp trung vo ngng tim, nhi mu c tim ST chnh
dng ph hp, cc h qu v li ch c th c lin quan n
(STEMI) v t qu
nhng cch iu tr mi
nh vy s c tc ng
n vic a ra quyt
Hnh 3
nh. C thng tin mi
v tin lng i vi
Phn loi h thng chm sc sc khe: SPSO
tr s sinh, tr em v
ngi ln b ngng
Kt cu Quy trnh H thng Kt qu
tim v sau khi ngng
tim (xem Hi sinh
tr s sinh (Neonatal
Mc hi lng
Con ngi
Giao thc
Chng trnh
Resuscitation), Duy
Gio dc
Chnh sch
T chc
tr s sng nng cao
Thit b
Th tc
Vn ha
khoa nhi (Pediatric
Advanced Life Support)
Kt qu
v Chm sc sau ngng
Kt cu
Quy trnh
H thng
Bnh nhn
tim (PostCardiac Arrest
Care)). Vic s dng
kim sot nhit c
Cht lng
an ton
ch ch (TTM) ngy
cng tng dn n
nhng thch thc mi
i vi vic d on
Ci thin cht lng lin tc
cc bin chng thn
Tch hp, Cng tc, nh gi, nh chun, Phn hi
kinh cc bnh nhn
Cc hp phn ca mt H thng chm sc

2015 (Mi): Cc yu t chung ca mt h thng chm sc
c xc nh nhm cung cp cho nhng ngi c lin
quan mt khun kh chung tp hp mt h thng hi
sinh tch hp (Hnh 3).
L do: Vic cung cp dch v chm sc sc khe yu cu cu
trc (v d: con ngi, thit b, gio dc) v quy trnh (v d:
chnh sch, nghi thc, th tc) m khi tch hp to thnh
mt h thng (v d: cc chng trnh, t chc, vn ha) dn
n kt qu ti u (v d: bnh nhn sng v an ton, cht
lng, hi lng). Mt h thng chm sc hiu qu cha tt
c nhng yu t nycu trc, quy trnh, h thng v kt
qu ca bnh nhntrong mt khun kh ci thin cht
lng lin tc.
Dy chuyn x tr cp cu
2015 (Mi): Dy chuyn x tr cp cu tch bit (Hnh 4)
c khuyn ngh xc nh nhng qu trnh chm sc
khc bit i vi bnh nhn tng b ngng tim trong
bnh vin so vi bi cnh ngoi bnh vin.
L do: Bt k vic ngng tim din ra u, tt c cc bnh
nhn sau ngng tim u c chm sc trong bnh vin,
thng thng l trong mt n v chm sc sc khe
chuyn su c cung cp dch v chm sc sau ngng
tim. Cc yu t cu trc v quy trnh cn thit trc khi
vo vin rt khc nhau trong 2 bi cnh. Bnh nhn b
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi

bnh vin) ph thuc vo s h tr ca cng ng ca
bnh nhn . Nhng ngi khng chuyn phi nhn
bit tnh trng ngng tim, ku gi tr gip v bt u CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) v kh
rung tim (kh rung tip cn i chng [PAD]) cho n khi
mt nhm nhng ngi thc hin EMS (emergency medical
service, dch v cp cu y t) c o to chuyn nghip
chu trch nhim v sau vn chuyn bnh nhn n
phng cp cu v/hoc phng thng tim can thip. Cui
cng bnh nhn c chuyn n n v chm sc tch cc
c tip tc chm sc. Ngc li, bnh nhn b IHCA
(in-hospital cardiac arrests; ngng tim trong bnh vin) ph
thuc vo h thng gim st ph hp (v d: h thng phn
ng nhanh hoc cnh bo sm) phng trnh ngng tim.
Nu xy ra ngng tim, bnh nhn ph thuc vo tng tc
sun s gia cc phng ban v dch v khc nhau ca vin
v mt nhm lin ngnh nhng ngi thc hin chuyn
nghp, bao gm bc s, y t, nh tr liu h hp v nhng
ngi khc.
S dng Phng tin truyn thng x hi triu tp

Ngi cu h
2015 (Mi): C th hp l khi cng ng kt hp cng ngh
truyn thng x hi triu tp nhng ngi cu h
gn nn nhn nghi ng b OHCA (out-of-hospital cardiac
arrests, ngng tim ngoi bnh vin), nhng ngi cu h
Hnh 4
Dy chuyn x tr cp cu ca IHCA v OHCA
IHCA
Gim st v phng trnh
Nhn bit v kch

hot h thng phn
ng khn cp
Ngay lp tc CPR
trnh cao
Cc nh cung cp chnh
Kh rung tim nhanh
Nhm m
Duy tr s sng v
chm sc hu ngng
tim nng cao
Phng thng
tim can thip
ICU
OHCA
Nhn bit v kch

hot h thng phn
ng khn cp
Ngay lp tc CPR
trnh cao
Khng chuyn mn
Kh rung tim nhanh
Cc dch v cp cu
c bn v nng cao
EMS
ED
Duy tr s sng v
chm sc hu ngng
tim nng cao
Phng thng
tim can thip
ICU
ny sn lng v c th tin hnh CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi).
L do: C t bng chng cho thy ngi iu phi s dng
phng tin truyn thng x hi thng bo cho ngi
cu h tim nng v trng hp c kh nng b ngng tim
gn v vic s dng truyn thng x hi cha cho thy
vic ci thin kh nng sng st sau khi b OHCA (out-ofhospital cardiac arrests, ngng tim ngoi bnh vin). Tuy
nhin, trong mt nghin cu gn y Thy in, c s gia
tng ng k trong t l hi sinh tim phi do ngi xung
quanh khi u khi s dng h thng phn phi bng in
thoi di ng.6 Vi tc hi thp v li ch tim nng cng
nh s hin din ph bin ca cc thit b k thut s, cc
thnh ph c th cn nhc tch hp nhng cng ngh ny
trong h thng chm sc OHCA (out-of-hospital cardiac
arrests, ngng tim ngoi bnh vin).
Hi sinh theo nhm: H thng du hiu cnh

bo sm, Nhm phn ng nhanh v H thng
nhm cp cu y t
2015 ( cp nht): i vi bnh nhn ngi ln, cc i phn
ng nhanh (RRT) hoc i cp cu ni khoa (MET) c th c
hiu qu trong vic gim t l xy ra ngng tim, c bit l
trong khu chm sc tng hp. Cc h thng MET/RRT nhi
khoa c th c cn nhc nhng c s c tr em mc
bnh nguy c cao c chm sc cc n v ni tr tng
hp. C th cn nhc s dng cc h thng du hiu cnh
bo sm cho c ngi ln v tr em.
2010 (C): Mc d c chng c mu thun, nhng cc
chuyn gia ng thun khuyn ngh vic xc nh mt
cch h thng cc bnh nhn c nguy c ngng tim, phn
ng hu hiu vi bnh nhn v nh gi kt qu nhm
thc y ci thin cht lng lin tc.
L do: Cc RRT (rapid response team; i phn ng nhanh)
hoc MET (medical emergency team; i cp cu ni khoa)
c thnh lp a ra can thip sm cho bnh nhn b
suy bin lm sng vi mc ch phng trnh IHCA
(in-hospital cardiac arrests; ngng tim trong bnh vin). Cc
i c th bao gm cc nhm bc s, y t v nh tr liu h
hp. Nhng i ny thng c triu tp n ging bnh
nhn khi nhn vin bnh vin xc nh c hin tng suy
bin cp tnh. Nhm thng mang thit b theo di khn
cp, thit b hi sinh v thuc. Mc d chng c vn ang
thay i, vn c s ng thun trn danh ngha v khi
nim o to cho cc nhm v k thut hi sinh phc tp.
Ci thin cht lng lin tc cho cc

Chng trnh hi sinh
2015 (Xc nhn li ca nm 2010): Cc h thng hi sinh cn thit
lp nh gi v ci thin lin tc h thng chm sc.
L do: C chng c v s khc nhau ng k gia cc vng
trong t l xy ra v kt qu ngng tim c ghi nhn ti
Hoa K. S khc bit ny nhn mnh nhu cu cn cc cng
ng v h thng nhn bit chnh xc mi ln xy ra ngng
tim c iu tr v ghi li kt qu. C kh nng s c c hi
ci thin t l sng st trong nhiu cng ng.
Cc chng trnh hi sc ti cng ng v bnh vin nn
theo di c h thng cc ca ngng tim, mc chm sc
hi sinh v kt qu. Ci thin cht lng lin tc bao gm

nh gi v phn hi, nh gi hay ly im chun v phn
tch c h thng. Cn n lc khng ngng ti u ha
vic chm sc hi sinh nhm thu hp khong cch gia hiu
qu hi sinh l tng v thc t.
Phn vng chm sc

2015 (Xc nhn li ca nm 2010): C th cn nhc cch tip cn
phn vng i vi hi sinh OHCA (out-of-hospital cardiac
arrests, ngng tim ngoi bnh vin) bao gm vic s dng
cc trung tm hi sinh tim.
L do: Trung tm hi sinh tim l mt bnh vin cung cp
dch v chm sc hi sinh theo chng c v chm sc sau
ngng tim, bao gm kh nng can thip mch vnh qua da
(PCI), TTM (targeted temperature management; kim sot
nhit mc tiu) 24gi/7 ngy c s ca hng nm v
cam kt khng ngng ci thin hiu qu bao gm nh
gi, ly im chun v c phn hi v thay i quy trnh. Hy
vng l cc h thng chm sc hi sinh s ci thin c t
l sng st sau khi thit lp cc h thng chm sc khc, v
d nh chn thng.
Duy tr s sng c bn ngi

ln v cht lng CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi):
CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) khng chuyn
Tm tt v cc vn chnh v thay i ln
Khuyn co trong Hng dn cp nht nm 2015 cho ngi
cu h khng chuyn thc hin CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) ngi ln bao gm
nhng vn chnh v thay i ln sau:
N
hng lin kt quan trng trong Dy chuyn x tr cp
cu ngoi bnh vin cho ngi ln vn gi nguyn t
nm 2010 v tip tc ch trng vo B quy tc Hi sinh
tim phi c bn (BLS) cho ngi ln.
B
quy tc BLS cho ngi ln c iu chnh
phn nh thc t rng ngi cu h c th kch hot
ng cu khn cp (thng qua s dng in thoi di
ng) m khng cn ri nn nhn.
N
hng cng ng c ngi c nguy c ngng tim
nn thc hin cc chng trnh PAD (public-access
defibrillation; kh rung tip cn i chng)
N
hng khuyn ngh c tng cng nhm khuyn
khch vic nhn bit ngay tnh trng khng phn ng,
kch hot h thng ng cu khn cp v bt u CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) nu
ngi cu h khng chuyn thy nn nhn khng phn
ng, khng th hay khng th bnh thng (v d th
hn hn).
C
s ch trng ngy cng tng vo vic ngi iu
phi nhn bit nhanh chng kh nng ngng tim v
ngay lp tc a ra hng dn CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) cho ngi gi (CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) theo
hng dn ca ngi iu phi).
T rnh t c khuyn ngh cho mt ngi cu h duy

nht c xc nh: ngi cu h duy nht s bt u
nhn ngc trc khi h hp nhn to (C-A-B ch khng
phi l A-B-C) gim tr ca ln nhn u tin. Ngi
cu h duy nht nn bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) sau khi nhn ngc 30 ln
km 2 ln th.
khu vc v bo m ngi xung quanh bit v tr ca

cc AED v thng c mt nhn vin y t gim st; (2)
o to ngi cu h d kin v CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) v s dng AED; (3) mt
lin kt tch hp vi h thng EMS (emergency medical
service, dch v cp cu y t) ca a phng v (4) mt
chng trnh ci thin cht lng lin tc.
V
n tip tc c s ch trng vo cc c im ca CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) cht
lng cao: nhn ngc vi tc v bin va cho
php ngc ny ln hon ton sau mi ln nhn, gim thiu
gin on trong khi nhn v trnh thng kh qu mc.
Cch tip cn h thng chm sc cho OHCA (out-of-hospital

cardiac arrests, ngng tim ngoi bnh vin) c th bao gm
chnh sch cng khuyn khch bo co v tr ca cc AED
(automated external defibrillator; my kh rung bn ngoi
t ng) cho cc im tip cn dch v cng cng (PSAP,
thut ng im tip cn dch v cng cng thay th trung
tm iu phi EMS (emergency medical service, dch v cp
cu y t) km chnh xc hn). Chnh sch nh vy s cho
php cc im tip cn dch v cng cng ch dn ngi
xung quanh tm c AED (automated external defibrillator;
my kh rung bn ngoi t ng) v h tr h s dng khi
xy ra OHCA (out-of-hospital cardiac arrests, ngng tim
ngoi bnh vin). Nhiu thnh ph cng nh chnh ph lin
bang Hoa K ban hnh lut t AED (automated external
defibrillator; my kh rung bn ngoi t ng) trong cc ta
nh th, cc a im cng cng rng ln, sn bay, sng
bi v trng hc. i vi 20% cc ca OHCA (out-of-hospital
cardiac arrests, ngng tim ngoi bnh vin) xy ra ti nhng
khu vc cng cng, cc chng trnh cng ng ny l mt
lin kt quan trng trong Dy chuyn x tr cp cu gia
vic nhn bit v kch hot cc im tip cn dch v cng
cng. Thng tin ny c trnh by r hn trong Phn 4:
H thng chm sc v Ci thin cht lng lin tc trong
Hng dn cp nht nm 2015.
T c nhn ngc c khuyn ngh l 100 n

120 ln/pht (cp nht t t nht 100 ln/pht).
K
huyn ngh c lm r i vi bin nhn ngc
ngi ln l t nht 2 inches (5 cm) nhng khng qu
2,4 inches (6 cm).
C
th cn nhc vic ngi xung quanh gip dng
naloxone cho cc trng hp khn cp nghi ng e da
mng sng lin quan n opioid.
Nhng thay i ny c thit k n gin ha vic o
to ngi cu h khng chuyn v ch trng nhu cu nhn
ngc sm cho nn nhn b ngng tim t ngt. Di y l
thng tin thm v nhng thay i ny.
Trong nhng ch tip theo, nhng thay i hay im
ch trng tng t nhau gia ngi cu h khng chuyn
v nhn vin y t c nh du bng du hoa th (*).
Chng trnh AED (automated external defibrillator;

my kh rung bn ngoi t ng) cho Ngi cu h
khng chuyn trong cng ng
2015 ( cp nht): Khuyn ngh thc hin cc chng trnh
PAD (public-access defibrillation; kh rung tip cn i chng)
cho bnh nhn b OHCA (out-of-hospital cardiac arrests,
ngng tim ngoi bnh vin) ti nhng a im cng cng
ni c kh nng tng i cao l s c ngi chng kin ca
ngng tim (v d: sn bay, sng bi, c s th thao).
2010 (C): Khuyn ngh vic ngi s cu ca c quan an ton
cng cng s dng CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) v my kh rung bn ngoi t ng (AED)
tng t l sng st i vi ca ngng tim t ngt ngoi bnh
vin. Hng dn nm 2010 khuyn ngh thit lp cc chng
trnh AED (automated external defibrillator; my kh rung
bn ngoi t ng) ti nhng a im cng cng ni c kh
nng tng i cao l s c ngi chng kin ca ngng tim
(v d: sn bay, sng bi, c s th thao).
L do: C chng c r rng v nht qun v vic t l sng
st sau ngng tim c ci thin khi ngi xung quanh
thc hin CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) v nhanh chng s dng mt AED (automated
external defibrillator; my kh rung bn ngoi t ng).
Do , c th ngay lp tc tip cn c mt my kh
rung l mt hp phn c bn ca h thng chm sc.
Vic thc hin mt chng trnh PAD (public-access
defibrillation; kh rung tip cn i chng) yu cu 4 hp
phn c bn: (1) phn ng c k hoch v thnh tho, l
tng l bao gm nhn bit v tr v khu dn c ni c
nguy c ngng tim cao, t cc AED (automated external
defibrillator; my kh rung bn ngoi t ng) ti nhng
Cha c chng c khuyn ngh nn hay khng nn

s dng AED (automated external defibrillator; my kh
rung bn ngoi t ng) ti nh. Cc nn nhn b OHCA
(out-of-hospital cardiac arrests, ngng tim ngoi bnh
vin) xy ra ti nh ring c t c hi c nhn ngc hn
rt nhiu so vi nhng bnh nhn b ngng tim ti ni
cng cng. Hng dn theo thi gian thc ca ngi iu
phi khn cp c th gip nhng ngi cu h tim nng
ti nh bt u hnh ng. Cc chng trnh o to CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) thit
thc cho cng ng v ngng tim cng vi cc giao thc
iu phi hiu qu v n u c th ci thin kt qu.
Ngi iu phi nhn bit Th ngp

Cc nn nhn ngng tim i khi c biu hin ging nh co
git hoc Th ngp, c th khin ngi cu h tim nng
bi ri. Ngi iu phi cn c o to c th nhn
bit nhng biu hin ngng tim ny c th nhn bit kp
thi v thc hin CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) theo hng dn ca ngi iu phi ngay
lp tc.
2015 ( cp nht): gip ngi xung quanh nhn bit
ngng tim, ngi iu phi cn hi xem nn nhn mt
phn ng hay cha v th c tt khng (bnh thng so
vi khng bnh thng). Nu nn nhn khng phn ng
km theo khng th hoc th khng bnh thng, ngi
cu h v ngi iu phi nn gi nh rng nn nhn
ang b ngng tim. Ngi iu phi cn c o to
nhn bit tnh trng khng phn ng km theo th khng
bnh thng v th ngp qua mt lot cc biu hin v m
t lm sng.
2010 (C): gip ngi xung quanh nhn bit ngng tim,
ngi iu phi cn hi v phn ng ca nn nhn l ngi
ln, nn nhn c ang th hay khng v c th bnh thng
hay khng c gng phn bit nn nhn Th ngp (c
ngha l ngi cn CPR) vi nn nhn ang th bnh thng
v khng cn CPR.
L do: Thay i ny so vi Hng dn nm 2010 nhn mnh
vai tr ca ngi iu phi khn cp trong vic gip ngi
cu h khng chuyn nhn bit tnh trng khng th hoc th
khng bnh thng.
Ngi iu phi cn c o to chuyn bit gip
ngi xung quanh nhn bit rng Th ngp l mt du hiu
ca ngng tim. Ngi iu phi cng cn bit rng co git
ton thn nhanh c th l biu hin u tin ca ngng
tim. Tm li, ngoi vic kch hot ngi s cp cu chuyn
nghip, ngi iu phi cn t ra nhng cu hi thng
thn v vic bnh nhn mt phn ng hay cha v th bnh
thng hay khng bnh thng nhn bit bnh nhn c
kh nng b ngng tim v cho php CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) theo hng dn ca ngi
iu phi.
Ch trng vo Nhn ngc*

2015 ( cp nht): Nhng ngi cu h khng chuyn
cha qua o to nn thc hin CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng cch nhn ngc
n thun (Hands-Only) cho nn nhn ngng tim l ngi
ln, cho d c hay khng c hng dn ca ngi iu
phi. Ngi cu h nn tip tc CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) nhn ngc n thun cho
n khi c mt AED (automated external defibrillator; my
kh rung bn ngoi t ng) hoc ngi cu h c o
to thm. Tt c nhng ngi cu h khng chuyn ti
thiu cn thc hin nhn ngc cho nn nhn b ngng tim.
Ngoi ra, nu ngi cu h c o to c th thc hin
Hp 1
S ln nhn ngc cung cp

B nh hng bi tc nhn ngc
v bi s ln gin on
Tng s ln nhn ngc cung cp trong qu trnh hi sinh tim l mt yu t quyt nh
quan trng s sng cn khi ngng tim.
S ln nhn ngc cung cp b nh hng bi tc nhn ngc (tn sut nhn ngc mi
pht) v bi t l nhn ngc (mt phn trong tng s thi gian CPR thc hin nhn
ngc). Tng tc nhn ngc v t l nhn ngc s lm tng tng s ln nhn ngc
cung cp. T l nhn ngc c ci thin bng cch gim s ln v khong thi gian
gin on khi nhn ngc.
Bn c th thy ging nh chuyn ng ca t. Khi di chuyn bng t, s dm i
c trong ngy b nh hng khng ch bi tc (tc di chuyn) m cn bi s ln
v khong thi gian dng li (gin on khi di chuyn). Di chuyn vi tc 60 dm/
pht m khng b gin on s chuyn thnh qung ng di chuyn thc l 60 dm
trong mt gi. Di chuyn vi tc 60 dm/pht tr dng li 10 pht s chuyn thnh
qung ng di chuyn thc l 50 dm trong mt gi. S ln dng li cng thng
xuyn hn v cng ko di hn th s dm thc t i c cng t hn.
Trong CPR, ngi cu h phi thc hin s ln nhn ngc hiu qu vi tc (100 ti
120 ln/pht) v bin thch hp trong khi gim thiu s ln v khong thi gian gin
on khi nhn ngc. S thnh phn b sung ca CPR cht lng cao cho php ngc ny
ln hon ton sau mi ln nhn v trnh thng kh qu mc.
h hp nhn to th ngi nn h hp nhn to thm vi

t l 30 ln nhn cho mi 2 ln th. Ngi cu h cn tip
tc CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
cho n khi c mt AED (automated external defibrillator;
my kh rung bn ngoi t ng) v sn sng s dng,
ngi thc hin EMS (emergency medical service, dch v
cp cu y t) tip nhn nn nhn hoc nn nhn bt u c
ng.
2010 (C): Nu ngi xung quanh cha c o to CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi), ngi
nn CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) bng cch nhn ngc n thun cho nn nhn l ngi
ln b ng qu t ngt, trong ch trng nhn mnh v
nhanh trn vng gia ngc hoc lm theo ch dn ca ngi
iu phi EMS (emergency medical service, dch v cp
cu y t). Ngi cu h cn tip tc CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng cch nhn ngc
n thun cho n khi c mt AED (automated external
defibrillator; my kh rung bn ngoi t ng) v sn sng
s dng hoc ngi thc hin EMS (emergency medical
service, dch v cp cu y t) tip nhn nn nhn. Tt c
nhng ngi cu h khng chuyn c o to ti thiu
cn thc hin nhn ngc cho nn nhn b ngng tim. Ngoi
ra, nu ngi cu h khng chuyn c o to c th thc
hin h hp nhn to th cn thc hin nhn ngc v h hp
nhn to vi t l 30 ln nhn cho mi 2 ln th. Ngi cu
h cn tip tc CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) cho n khi c mt AED (automated external
defibrillator; my kh rung bn ngoi t ng) v sn sng
s dng hoc ngi thc hin EMS (emergency medical
service, dch v cp cu y t) tip nhn nn nhn.
L do: Mt ngi cu h cha c o to c th thc
hin CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) bng cch nhn ngc n thun mt cch d dng v
c th hiu qu hn khi c ngi iu phi hng dn
qua in thoi. Hn na, t l sng st sau khi b ngng tim
ngi ln c cn nguyn v tim l nh nhau cho d CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) bng
cch nhn ngc n thun hoc CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng c nhn ngc v
h hp nhn to khi c thc hin trc khi c EMS
(emergency medical service, dch v cp cu y t). Tuy
nhin, i vi ngi cu h khng chuyn c o to
c kh nng th vn khuyn ngh ngi cu h thc hin c
nhn ngc v th.
Tc nhn ngc*
2015 ( cp nht): nn nhn ngng tim l ngi ln, s hp
l nu ngi cu h thc hin nhn ngc tc 100 n
120 ln/pht.
2010 (C): S hp l khi ngi cu h khng chuyn v nhn
vin y t thc hin nhn ngc tc t nht l 100 ln/pht.
L do: S ln nhn ngc c thc hin mi pht trong CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) l mt
yu t quyt nh quan trng i vi vic ti lp tun hon t
nhin (ROSC) v sng st vi chc nng thn kinh tt.
S ln nhn ngc thc t hiu qu c thc hin mi pht
c xc nh bi tc nhn ngc v s ln v khong thi
gian gin on khi nhn ngc (v d: m ng th, thc
hin h hp nhn to, cho php phn tch AED (automated
external defibrillator; my kh rung bn ngoi t ng)).
Trong hu ht cc nghin cu, s ln nhn ngc cng nhiu
th t l sng st cng cao v s ln nhn ngc t hn th t

l sng st thp hn. Vic thc hin nhn ngc y yu
cu ch trng khng ch vo tc nhn y m cn
phi gim thiu gin on i vi hp phn quan trng ny
ca CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi).
Tc nhn khng hoc gin on thng xuyn (hoc
c hai) s lm gim tng s ln nhn ngc c thc hin
mi pht. im mi trong Hng dn cp nht nm 2015 l
ngng trn ca tc nhn v bin nhn c khuyn
ngh da trn d liu s b cho thy rng tc v bin
nhn qu mc c nh hng xu n kt qu. Vic thm
vo ngng trn ca tc nhn c da trn 1 phn tch
nghin cu lu tr ln c lin quan n tc nhn qu
nhanh (ln hn 140 ln/pht) vi bin nhn khng .
1 s dng s tng t ca chuyn ng ca t gii thch
tc ng ca tc nhn v gin on n tng s ln nhn
ngc c thc hin mi pht trong khi hi sinh.
Bin nhn ngc*

2015 ( cp nht): Trong khi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng tay, ngi cu h cn
thc hin nhn ngc vi bin t nht l 2 inches (5 cm)
cho ngi ln trung bnh trong khi trnh bin nhn ngc
qu ln (ln hn 2,4 inches [6 cm]).
2010 (C): Xng c ca ngi ln cn c n xung t nht
l 2inches (5 cm).
L do: Nhn ngc to ra lu lng mu ch yu bng cch
tng p sut trong ngc v trc tip nhn ln tim, t
dn n cung cp lu lng mu v oxy thit yu cho tim
v no. Ngi cu h thng khng nhn ngc su bt
k khuyn ngh nhn mnh. Mc d khuyn ngh bin
nhn t nht l 2 inches (5 cm), Hng dn cp nht
nm 2015 tch hp chng c mi v kh nng c ngng
trn ca bin nhn (ln hn 2,4 inches [6 cm]) m qu
ngng c th xy ra bin chng. C th kh xc nh
bin nhn nu khng s dng cc thit b phn hi
v vic nhn bit ngng trn ca bin nhn c th
rt th thch. iu quan trng l ngi cu h phi bit
rng khuyn ngh v ngng trn ca bin nhn c
da trn 1 nghin cu rt nh ghi nhn mi lin kt gia
bin nhn qu mc v tn thng khng e da mng
sng. Hu ht vic theo di qua thit b phn hi CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) cho
thy rng nhn ngc thng c thc hin qu nng hn
l qu su.
Bng 1
2015 (Mi): i vi bnh nhn bit hoc nghi ng nghin

opioid khng c phn ng, th khng bnh thng nhng
c mch, s hp l khi ngi cu h khng chuyn v
ngi thc hin BLS (Basic Life Support; Hi sinh tim phi
c bn) c o to ph hp dng naloxone theo IM
(intramuscular; tim bp) hoc IN (intranasal; ng mi)
ngoi vic thc hin chm sc BLS (Basic Life Support; Hi
sinh tim phi c bn) tiu chun. C th cn nhc o to
ng cu qu liu opioid c hoc khng phn phi naloxone
cho nhng ngi c nguy c qu liu opioid trong bt k
trng hp no. Ch ny cng c cp trong mc
Cc trng hp hi sc c bit.
L do: C d liu dch t hc ng k cho thy gnh nng
bnh tt do qu liu opioid gy cht ngi cng nh mt
vi thnh cng c ghi li trong cc chin lc mc tiu
quc gia i vi vic ngi xung quanh gip dng naloxone
cho ngi c nguy c. Nm 2014, xy lanh t tim naloxone
c C quan qun l thc phm v dc phm Hoa K
(US Food and Drug Administration) ph duyt cho ngi
cu h khng chuyn v nhn vin y t s dng.7 Mng o
to hi sinh yu cu thng tin v cch tt nht tch
hp thit b trong hng dn v o to BLS cho ngi
ln. Khuyn ngh ny tch hp iu tr mi c ph duyt.
Duy tr s sng c bn ngi ln v

Cht lng CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi):
BLS (Basic Life Support; Hi sinh tim
phi c bn) cho Nhn vin y t
Khuyn co trong Hng dn cp nht nm 2015 cho nhn
vin y t bao gm nhng vn chnh v thay i ln sau:
N hng khuyn ngh ny cho php vic kch hot mt cch linh ng h thng
ng cu khn cp ph hp hn vi mi trng lm sng ca nhn vin y t.
Nhng vic nn lm v khng nn lm trong hi sinh tim phi c bn ca

Hi sinh tim phi cht lng cao ngi ln
Ngi cu h nn
Ngi xung quanh gip dng naloxone trong

Trng hp khn cp e da mng sng lin
quan n opioid.*
Ngi cu h khng nn
Thc hin nhn ngc tc 100-120 ln/pht
Nhn ngc tc chm hn 100 ln/pht hoc nhanh hn 120 ln/pht
Nhn ngc ti bin t nht l 2 inch (5 cm)
Nhn ngc ti bin cha n 2 inch (5 cm)

hoc ln hn 2,4 inch (6 cm)
ngc ny ln hon ton sau mi ln nhn ngc
T ln ngc gia cc ln nhn ngc
Gim thiu khong dng gia cc ln nhn ngc
p gin on hn 10 giy
Thng kh y (2 ln th sau 30 ln nhn ngc, mi ln th qu 1 giy, mi ln

th lm ngc phng ln)
thng kh qu nhiu
(tc l qu nhiu ln th hoc th qu mnh)
N gi cu h qua o to c khuyn khch thc hin ng thi mt s

bc (kim tra hi th v mch ng thi) n lc gim thi gian n ln
nhn ngc u tin.
i ng tch hp gm nhng ngi cu h c o to chuyn su c th s
dng cch tip cn bi bn, gip ng thi hon thnh nhiu bc v nh gi
hn so vi cch thc theo trnh t m tng ngi cu h s dng (v d mt
ngi cu h kch hot h thng ng cu khn cp trong khi ngi khc bt
u nhn ngc, ngi th ba thc hin thng kh hoc tm c bng bp cp
cu h hp nhn to v ngi th t tm v thit lp my kh rung).
C PR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) cht lng cao ngy
cng c ch trng, bng cch s dng cc mc tiu hiu sut (nhn ngc vi
tc v bin va cho php ngc ny ln hon ton gia cc ln nhn,
gim thiu gin on trong khi nhn v trnh thng kh qu mc). Xem Bng 1.
Tc nhn ngc c iu chnh n khong 100 n 120 ln/pht.
B
in nhn ngc cho ngi ln c iu chnh thnh t nht l 2 inches
(5 cm) nhng khng nn qu 2,4 inches (6 cm).
thnh ngc ny ln hon ton sau mi ln nhn ngc, ngi cu h phi
trnh ln ngc gia cc ln nhn.
C c tiu ch cho gim thiu gin on c lm r vi mc tiu t l
nhn ngc cao nht c th vi mc tiu t nht l 60%.
K hi h thng EMS (emergency medical service, dch v cp cu y t) p
dng cc gi chm sc c lin quan n nhn ngc lin tc th c th cn nhc
s dng k thut thng kh th ng nh mt phn ca gi cho nn nhn
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi bnh vin).
i vi bnh nhn ang c CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) v t ng th h tr, khuyn ngh t l thng kh n gin ha l
6 giy th 1 ln (10 ln th/pht).
Nhng thay i ny c thit k n gin ha vic o
to nhn vin y t v tip tc ch trng nhu cu thc hin
nhn ngc CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) sm v trnh cao cho nn nhn b ngng tim.
Di y l thng tin thm v nhng thay i ny.
Trong nhng ch tip theo cho nhn vin y t, du
hoa th (*) nh du nhng im tng t nh i vi
ngi cu h khng chuyn.
Nhn bit v kch hot ngay H thng

ng cu khn cp
2015 ( cp nht): Nhn vin y t phi ku gi s gip gn
khi thy nn nhn khng phn ng nhng thit thc l
nhn vin y t tip tc nh gi hi th v mch ng thi
trc khi kch hot hon ton h thng ng cu khn cp
(hoc ku gi h tr).
2010 (C): Nhn vin y t cn kim tra phn ng trong khi
quan st bnh nhn xc nh c th hay khng v th c
bnh thng hay khng.
L do: Mc ch thay i khuyn ngh l nhm gim thiu
tr v khuyn khch vic ng thi nh gi v phn
ng nhanh chng, hiu qu thay v cch tip cn tng bc
chm chp c h thng.
Ch trng vo Nhn ngc*

2015 ( cp nht): S hp l khi nhn vin y t thc hin
nhn ngc v thng kh cho tt c bnh nhn ngi ln khi
ngng tim cho d nguyn nhn l do tim hay khng phi
do tim. Ngoi ra, s thit thc nu nhn vin y t iu chnh
trnh t ca hnh ng cu h cho ph hp vi nguyn
nhn c kh nng gy ngng tim cao nht.
2010 (C): S thit thc khi c EMS (emergency medical

service, dch v cp cu y t) v ngi cu h chuyn
nghip trong bnh vin thc hin nhn ngc v h hp
nhn to cho bnh nhn b ngng tim.
L do: Mt ngi cu h cha qua o to c khuyn
ngh thc hin CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) bng cch nhn ngc n thun v vic
ny tng i d ngi iu phi hng dn qua
in thoi. D kin l nhn vin y t c o to v CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) v c
th thc hin hiu qu c nhn ngc v thng kh. Tuy
nhin, u tin cho nhn vin y t vn l kch hot h thng
ng cu khn cp v thc hin nhn ngc, c bit l nu
thc hin mt mnh. C th c nhng trng hp cho php
thay i trnh t, v d nh c sn mt AED (automated
external defibrillator; my kh rung bn ngoi t ng) m
nhn vin y t c th nhanh chng tm c v s dng.
Sc trc so vi CPR trc (Cardiopulmonary

Resuscitation; Hi sinh Tim phi)
2015 ( cp nht): i vi trng hp ngng tim ngi ln
c ngi chng kin khi c sn ngay mt AED (automated
external defibrillator; my kh rung bn ngoi t ng),
s hp l khi s dng my kh rung cng sm cng tt.
i vi ngi ln b ngng tim khng c gim st hoc
khng c sn ngay AED (automated external defibrillator;
my kh rung bn ngoi t ng), s hp l khi bt u CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) trong khi
tm v s dng thit b kh rung v s kh rung c tin
hnh ngay khi thit b sn sng s dng, nu c ch nh.
2010 (C): Khi bt k ngi cu h no chng kin mt v
ngng tim ngoi bnh vin v c sn ngay AED (automated
external defibrillator; my kh rung bn ngoi t ng) ti
ch th ngi cu h cn bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng cch nhn ngc v
s dng AED (automated external defibrillator; my kh
rung bn ngoi t ng) cng sm cng tt. Nhn vin y
t iu tr ngng tim trong bnh vin v cc c s khc c
AED (automated external defibrillator; my kh rung bn
ngoi t ng) hoc my kh rung ti ch cn thc hin
ngay v nn s dng AED (automated external defibrillator;
my kh rung bn ngoi t ng)/my kh rung cng
sm cng tt. Nhng khuyn ngh ny c thit k
h tr CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) sm v kh rung sm, c bit l khi c sn AED
t ng) hoc my kh rung c sn ngay khi xy ra ngng
tim t ngt. Khi xy ra OHCA (out-of-hospital cardiac
arrests, ngng tim ngoi bnh vin) khng c nhn s EMS
(emergency medical service, dch v cp cu y t) chng
kin, th EMS (emergency medical service, dch v cp cu
y t) c th bt u CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) trong khi kim tra nhp tim bng AED
t ng) hoc trn in tm (ECG; electrocardiogram)
v chun b kh rung. Trong nhng trng hp , c th
cn nhc CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) 1 pht ri n 3 pht trc khi n lc kh rung.
Bt k khi no c 2 ngi cu h tr ln, nn thc hin CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) trong
khi tm my kh rung.
Bng 2
Tm tt cc phn CPR cht lng cao dnh cho nh cung cp BLS
Thnh phn
Ngi ln v
Thiu nin
an ton ti hin
trng
Tr em
Tr s sinh
(T 1 tui ti tui dy th)
(Di 1 tui, Tr tr mi sinh)
m bo mi trng an ton cho ngi cu h v nn nhn
Nhn bit hin

tng ngng tim
Kim tra phn ng

Khng th hoc ch th hn hn (tc l khng th bnh thng)
Khng c mch r rng trong vng 10 giy
(C th thc hin kim tra th v mch ng thi trong thi gian cha y 10 giy)
Kch hot h thng

ng cu khn cp
T l nhn ngcthng kh m
khng cn ng
th h tr
Nu bn ch c mt mnh v khng c in
thoi di ng, hy ri khi nn nhn
kch hot h thng ng cu khn cp v
ly AED trc khi bt u CPR
Ng qu c ngi chng kin

Lm theo cc bc dnh cho ngi ln v thiu nin bn tri
Nu khng, hy nh ai v
bt u CPR ngay lp tc;
s dng AED cng sm cng tt
Ri khi nn nhn kch hot h thng ng cu khn cp v ly AED
1 hoc 2 ngi cu h
30: 2
1 ngi cu h
30: 2
Ng qu khng c ngi chng kin

Dnh 2 pht cho CPR
Quay li a tr hoc tr s sinh v tip tc CPR;
s dng AED ngay sau khi c sn
2 ngi cu h tr ln
15: 2
T l nhn ngcthng kh c ng
th h tr
Nhn ngc lin tc tc 100-120 ln/pht

6 giy th 1 ln (10 ln th/pht)
Tc nhn
Bin nhn
V tr t tay
100-120 ln/pht
t nht l 2 inch (5 cm)*
2 tay t trn na di ca xng c
t nht mt phn ba ng knh AP

ca ngc
t nht mt phn ba ng knh AP

ca ngc
Khong 2 inch (5 cm)
Khong 1 inch (4 cm)
2 tay hoc 1 tay (ty chn i vi tr rt

nh) t trn na di ca xng c
1 ngi cu h
2 ngn tay t gia ngc, ngay bn di
ng nm v
2 ngi cu h tr ln
2 ngn tay ci bao quanh phn gia ngc,
ngay di ng nm v
Ny ngc
Gim thiu s ln
gin on
ngc ny ln hon ton sau mi ln nhn ngc; khng t tay ln ngc sau mi ln nhn ngc
Gii hn s ln gin on khi nhn ngc di 10 giy
*Bin nhn ngc khng c ln hn 2,4 inch (6 cm).

Vit tt: AED, my kh rung bn ngoi t ng; AP, ng knh trc sau; CPR, hi sinh tim phi.
10
Vi ca ngng tim t ngt trong bnh vin, cha c

chng c ng h hoc bc b CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) trc khi kh rung. Tuy
nhin, nhng bnh nhn c theo di, thi gian t khi
rung tht (VF) n khi thc hin sc nn di 3 pht, v cn
thc hin CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) trong khi chun b my kh rung.
L do: Mc d v s nghin cu cp n vn liu
thc hin nhn ngc trong mt khong thi gian c th
(thng l t 1pht ri n 3 pht) trc khi thc hin
sc c ch li g khng so vi thc hin sc ngay khi AED
(automated external defibrillator; my kh rung bn ngoi t
ng) c th sn sng nhng cha thy kt qu c s khc
bit. Nn thc hin CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) trong khi s dng ming dn AED v cho n
khi AED (automated external defibrillator; my kh rung bn
ngoi t ng) sn sng phn tch nhp tim.
Tc nhn ngc: 100 n 120 ln/pht*

2015 ( cp nht): nn nhn ngng tim l ngi ln, s hp
l nu ngi cu h thc hin nhn ngc tc 100 n
120 ln/pht.
2010 (C): S hp l khi ngi cu h khng chuyn v
nhn vin y t thc hin nhn ngc tc t nht l
100 ln/pht.
L do: Tc nhn ngc c khuyn ngh ti thiu nn
duy tr mc 100 ln/pht. Tc ngng trn 120 ln/
pht c b sung v 1 chui nghin cu lu tr ln cho
rng khi tc nhn tng ln hn 120 ln/pht th bin
nhn gim xung t l tng ng. V d, t l nhn ngc c
bin khng l khong 35% vi tc nhn l 100 n
119 ln/pht nhng t l bin khng tng ln 50% s
ln nhn ngc khi tc nhn l 120 n 139 ln/pht v t
l bin khng tng ln 70% s ln nhn ngc khi tc
nhn ln hn 140 ln/pht.
Bin nhn ngc*

2015 ( cp nht): Trong khi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) bng tay, ngi cu h cn
thc hin nhn ngc vi bin t nht l 2 inches (5 cm)
cho ngi ln trung bnh trong khi trnh bin nhn ngc
qu ln (ln hn 2,4 inches [6 cm]).
2010 (C): Xng c ca ngi ln cn c n xung t
nht l 2 inches (5 cm).
L do: Bin nhn khong 5 cm gn lin vi kh nng c
kt qu tt cao hn so vi nhn ngc nng hn. Mc d hu
nh khng c chng c v vic liu c mt ngng trn m
vt qua th nhn ngc c th qu su hay khng, mt
nghin cu rt nh gn y cho rng c kh nng xy ra tn
thng (khng e da mng sng) do bin nhn ngc
qu mc (ln hn 2,4 inches [6 cm]). C th kh xc nh bin
nhn nu khng s dng cc thit b phn hi v vic
nhn bit ngng trn ca bin nhn c th rt th thch.
iu quan trng l ngi cu h phi bit rng bin nhn
ngc thng qu nng hn l qu su.
2010 (C): Ngi cu h cn ngc ny ln hon ton sau

mi ln nhn tim np y trc ln nhn tip theo.
L do: Thnh ngc ny ln hon ton xy ra khi xng c
quay tr li v tr t nhin hay trung ha trong sut pha
gim p ca CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi). Thnh ngc ny ln to mt p sut trong ngc
m tng i thc y hi lu tnh mch v lu lng mu
tim phi. ln thnh ngc gia cc ln nhn ngn thnh
ngc ny ln hon ton. Ny khng hon ton lm tng p
sut trong ngc v gim hi lu tnh mch, p lc truyn
dch mch vnh v lu lng mu c tim v c th nh
hng n kt qu hi sinh.
Gim thiu Gin on khi Nhn ngc*

2015 (Xc nhn li ca nm 2010): Ngi cu h cn n lc gim
thiu tn sut v khong thi gian gin on khi nhn ngc
ti a ha s ln nhn c thc hin mi pht.
2015 (Mi): i vi ngi ln b ngng tim c tip nhn
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) m
khng c ng th h tr th c th hp l khi thc hin
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) vi
mc tiu t l nhn ngc cao nht c th, vi mc tiu t
nht l 60%.
L do: Gin on khi nhn ngc c th l do ch theo
quy trnh chm sc cn thit (chng hn, phn tch nhp
tim v thng kh) hoc do v tnh (chng hn, ngi cu
h b phn tm). T l nhn ngc l mt s o t l thc
hin nhn ngc trong tng thi gian hi sinh. C th tng
t l nhn ngc bng cch gim thiu thi gian ngng khi
nhn ngc. Mc tiu ti u cho t l nhn ngc cha c
xc nh. Vic thm t l nhn ngc mc tiu l nhm hn
ch gin on khi nhn ngc v ti a ha truyn dch
mch vnh v lu lng mu trong CPR (Cardiopulmonary
So snh cc Yu t chnh ca BLS cho Ngi ln,

Tr em v Tr s sinh
Bng 2 lit k cc yu t chnh nm 2015 ca BLS (Basic
Life Support; Hi sinh tim phi c bn) cho ngi ln, tr
em v tr s sinh (khng bao gm CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) cho tr va sinh).
Phn hi khi nhn ngc

2015 ( cp nht): C th hp l khi s dng cc thit b phn
hi nghe nhn trong CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) ti u ha hiu sut ca CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) theo
thi gian thc.
Ny ngc*
2010 (C): Cc thit b thc y v phn hi CPR

(Cardiopulmonary Resuscitation; Hi sinh Tim phi) mi c
th hu dng trong o to ngi cu h v nh mt phn
trong chin lc tng th nhm ci thin cht lng ca CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) trong hi
sinh thc t. Vic o to kt hp phc tp cc k nng cn
thit thc hin nhn ngc y cn tp trung vo vic
minh ha mt cch thnh tho.
2015 ( cp nht): S hp l khi ngi cu h trnh ln

ngc gia cc ln nhn thnh ngc ny ln hon ton
ngi ln b ngng tim.
L do: Cng ngh cho php theo di, ghi nhn v phn hi
theo thi gian thc v cht lng CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi), bao gm c cc thng s
11
Hnh 5
B quy tc ngng tim ngi ln ca nh cung cp dch v chm sc sc khe BLSBn cp nht 2015
B quy tc ngng tim ngi ln ca
nh cung cp dch v chm sc sc khe BLSBn cp nht 2015
Xc minh an ton ti hin trng.
Nn nhn khng phn ng.

Ku ln ku gi tr gip gn .
Kch hot h thng ng cu khn cp qua thit b di
ng (nu ph hp).
Ly AED (automated external defibrillator; my kh rung
bn ngoi t ng) v thit b cp cu (hoc c ngi
lm vic ).
Theo di cho n
khi ngi tr li
khn cp n.
Th bnh
thng, c
mch
Th khng
Kim tra xem khng th
bnh thng,
hay ch th hn hn v
c mch
kim tra mch (ng thi).
C cm nhn c mch dt
khot trong vng 10 giy
hay khng?
Khng th hoc
ch th hn hn,
khng c mch

Hi sinh Tim phi)
Bt u cc chu k 30 ln nhn v 2 ln th.
S dng AED (automated external defibrillator; my
kh rung bn ngoi t ng) ngay khi sn sng.
Thc hin h hp nhn to:

5-6 giy th 1 ln hay khong
10-12 ln th/pht.
Kch hot h thng ng cu
khn cp (nu cha lm)
sau 2 pht.
Tip tc h hp nhn
to, kim tra mch
khong 2 pht/ln. Nu
khng c mch, bt u
CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim
phi) (n CPR).
Nu c th l qu liu
opioid, cho dng naloxone
nu sn c theo giao thc.
Ti thi im ny trong tt c cc
kch bn, h thng ng cu khn cp
hoc h tr c kch hot v AED
(automated external defibrillator; my
kh rung bn ngoi t ng) v thit
b cp cu c tm thy hoc ai
ang tm chng.
C AED (automated external defibrillator;

my kh rung bn ngoi t ng).
C,
sc c
Kim tra nhp tim.

Nhp c sc c khng?
Sc 1 ln. Ngay lp tc tip tc

(Cardiopulmonary Resuscitation; Hi
sinh Tim phi) trong khong 2 pht (cho
n khi c AED (automated external
defibrillator; my kh rung bn ngoi t
ng) cho php kim tra nhp tim).
Tip tc cho n khi nhn vin ALS tip
nhn hoc nn nhn bt u c ng.
12
Khng,
khng sc c
Ngay lp tc tip tc
sinh Tim phi) trong khong 2 pht
(cho n khi c AED (automated
external defibrillator; my kh rung
bn ngoi t ng) cho php kim tra
nhp tim). Tip tc cho n khi nhn
vin ALS tip nhn hoc nn nhn
bt u c ng.
sinh l ca bnh nhn v s liu v hiu sut ca ngi cu

h. C th s dng nhng d liu quan trng ny theo thi
gian thc trong khi hi sinh, cho bo co sau khi hi sinh v
cho cc chng trnh ci thin cht lng ton h thng.
Trong khi CPR, duy tr tp trung vo cc c im ca tc
v bin nhn v ny ngc trong khi gim thiu gin
on l mt th thch phc tp k c cho cc chuyn gia
c o to chuyn su. C mt s chng c v vic s
dng phn hi CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) c th hiu qu trong iu chnh tc nhn
ngc qu nhanh v c chng c ring v vic phn hi CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) lm
gim lc trong khi nhn ngc. Tuy nhin, cc nghin cu
cho n nay cha cho thy c ci thin ng k trong bin
chng thn kinh hoc sng st thun li sau khi xut vin
khi s dng cc thit b phn hi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) trong cc tnh hung
ngng tim thc t.
Tr hon thng kh
2015 (Mi): i vi OHCA (out-of-hospital cardiac arrests,
ngng tim ngoi bnh vin) c ngi chng kin vi
nhp tim c th sc c, c th hp l khi h thng EMS
(emergency medical service, dch v cp cu y t) c ng
cu nhiu lp da trn u tin s tr hon thng kh p lc
dng (PPV) bng cch s dng chin lc ln n 3 chu k
gm 200 ln nhn lin tip km bm oxy th ng v h tr
ng th.
L do: Mt vi h thng EMS (emergency medical service,
dch v cp cu y t) th nghim chin lc thc hin
nhn ngc lin tc ban u vi PPV (positive-pressure
ventilation; Thng kh p lc dng) tr hon cho nn nhn
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi
bnh vin) l ngi ln. Trong tt c cc h thng EMS
(emergency medical service, dch v cp cu y t) ny,
ngi thc hin c o to thm, ch trng vo vic
thc hin nhn ngc cht lng cao. Ba nghin cu trong
cc h thng s dng ng cu nhiu lp da trn u tin
c cng ng th v nng thn v thc hin gi chm
sc bao gm ln n 3 chu k bm oxy th ng, chn
h tr ng th v 200 ln nhn ngc lin tip vi sc
can thip cho thy ci thin kh nng sng st vi tnh
trng thn kinh thun li cho nn nhn ngng tim c ngi
chng kin hoc c nhp tim c th sc c.
Thng kh trong CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi) c ng th h tr
2015 ( cp nht): C th hp l khi ngi thc hin thc hin
6 giy th 1 ln (10 ln th/pht) trong khi ang thc
hin nhn ngc lin tip (trong CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) c ng th h tr).
2010 (C): Khi t ng th h tr (ng ni kh qun,
Combitube (ng i), hoc mt n thanh qun) khi c 2 ngi
thc hin CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi), th c 6 n 8giy cho th 1 ln m khng cn n lc
ng b hi th gia cc ln nhn (vic ny s dn n thc
hin 8 n 10 ln th mi pht).
Hi sinh theo nhm: Cc Nguyn tc c bn

2015 (Mi): i vi nhn vin y t, Hng dn cp nht nm
2015 cho php kch hot mt cch linh hot h thng ng
cu khn cp v qun l sau ph hp hn vi mi
trng lm sng ca ngi thc hin (Hnh 5).
L do: Cc bc trong b quy tc BLS, theo truyn thng, c
trnh by theo trnh t gip ngi cu h duy nht u tin
ha cc hnh ng. Tuy nhin, c mt vi nhn t m trong
bt k tnh hung hi sinh no (v d loi ngng tim, a im,
ngi thc hin c o to c gn khng, ngi cu h
c phi ri nn nhn kch hot h thng ng cu khn
cp khng) c th yu cu iu chnh trnh t BLS (Basic Life
Support; Hi sinh tim phi c bn). B quy tc BLS cp nht
dnh cho nhn vin y t nhm truyn t c th linh hot khi
no v phn no trong trnh t.
K thut thay th v Thit b ph cho CPR

(Cardiopulmonary Resuscitation;
Hi sinh Tim phi)
truyn thng bao gm nhn ngc bng tay i khi km h
hp nhn to vn khng hiu qu trong vic to kt qu
ng k cho tim. Mt lot cc phng n v h tr cho CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) truyn
thng c pht trin nhm ci thin kt qu cho tim
trong hi sinh do ngng tim. K t khi xut bn Hng dn
nm 2010, mt s th nghim lm sng a ra d liu
mi v hiu qu ca nhng phng n ny.
So vi CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) truyn thng, nhiu k thut v thit b trong s ny
yu cu phi c thit b v o to chuyn dng. Khi ngi
cu h hay h thng chm sc sc khe ang cn nhc vic
thc hin th phi lu rng mt vi k thut v thit b ch
c th nghim cc nhm nh cc bnh nhn ngng
tim c la chn gt gao.
K
hng khuyn ngh s dng u n my ngng
tr khng (ITD) h tr CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) truyn thng.
M
t th nghim i chng ngu nhin gn y cho thy
rng vic s dng ITD (impedance threshold device,
my ngng tr khng) cng vi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) nhn-th ch ng gn
lin vi kh nng sng st vi thn kinh nguyn vn c
ci thin cho bnh nhn OHCA (out-of-hospital cardiac
arrests, ngng tim ngoi bnh vin).
K
hng khuyn ngh s dng u n thit b nhn ngc
c hc nhng c xc nh nhng trng hp c bit
trong k thut ny c th hu dng.
C
th cn nhc s dng ECPR (extracorporeal CPR; Hi sc
Tim phi ngoi c th) cho cc bnh nhn c la chn
trong nhng trng hp nghi ng nguyn nhn ngng tim
c th o ngc.
L do: T l duy nht n gin ny p dng cho ngi ln,

tr em v tr s sinh s d hc, d nh v d thc hin hn
l mt lot cc ln th mi pht.
13
My ngng tr khng
2015 ( cp nht): Khng khuyn ngh s dng u n ITD
(impedance threshold device, my ngng tr khng) h
tr trong CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) truyn thng. Vic kt hp ITD (impedance threshold
device, my ngng tr khng) vi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) nhn-th c th l phng n
hp l thay cho CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) truyn thng trong cc trng hp sn c thit b v
nhn s c o to ph hp.
2010 (C): C th cn nhc nhn s c o to s dng
ITD (impedance threshold device, my ngng tr khng)
h tr CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) trong ca ngng tim ngi ln.
L do: Hai th nghim i chng ngu nhin ln
a ra thng tin mi v vic s dng ITD (impedance
threshold device, my ngng tr khng) trong OHCA
(out-of-hospital cardiac arrests, ngng tim ngoi bnh
vin). Mt th nghim lm sng ngu nhin a trng
tm ln khng cho thy bt k ci thin no gn lin
vi vic s dng ITD (impedance threshold device, my
ngng tr khng) (so vi gi thit b) h tr cho CPR
thng. Mt th nghim lm sng khc cho thy li ch khi
s dng CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) nhn-th ch ng cng vi ITD (impedance
threshold device, my ngng tr khng) khi so snh vi
truyn thng v khng c ITD (impedance threshold
device, my ngng tr khng). Tuy nhin, khong tin
cy quanh c lng im kt qu c bn rt rng v
c nguy c b lch cao trn c s ng can thip (nhm
tip nhn CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) nhn-th ch ng cng vi ITD (impedance
threshold device, my ngng tr khng) cng c thc
hin CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) bng cch s dng thit b phn hi cht lng CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi), trong
khi nhm i chng khng c s dng thit b phn hi
nh vy).
Thit b nhn ngc c hc

2015 ( cp nht): Chng c khng cho thy c li ch khi
s dng thit b pt-tng c hc nhn ngc so vi nhn
ngc bng tay bnh nhn ngng tim. Nhn ngc bng tay
vn l tiu chun chm sc iu tr ngng tim. Tuy nhin,
thit b c th l mt phng n hp l thay th cho CPR
thng trong nhng trng hp c bit trong vic thc
hin nhn ngc bng tay cht lng cao c th kh khn
hoc nguy him i vi ngi thc hin (v d ngi cu h
sn c hn ch, CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) ko di, CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) trong khi ngng tim gim nhit, CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) trong xe
cp cu di chuyn, CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) trong phng chp, CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) trong khi chun b ECPR
(extracorporeal CPR; Hi sc Tim phi ngoi c th).
14
2010 (C): C th cn nhc cho nhn s c o to ph hp

s dng thit b pt-tng c hc trong nhng trng hp
c bit iu tr ngng tim ngi ln trong nhng tnh
hung (v d trong qu trnh chn on v can thip) kh hi
sinh bng tay. C th cn nhc nhn s c o to ph
hp s dng ai phn b ti trng trong nhng trng hp
c bit iu tr ngng tim.
L do: Ba th nghim i chng ngu nhin so snh thit
b nhn ngc c hc cha cho thy kt qu ci thin cho
bnh nhn OHCA (out-of-hospital cardiac arrests, ngng tim
ngoi bnh vin) khi so snh vi nhn ngc bng tay. V l
do ny, nhn ngc bng tay vn l tiu chun chm sc.
Cc K thut ngoi c th v Thit b ti mu xm ln

2015 ( cp nht): C th cn nhc ECPR (extracorporeal CPR;
Hi sc Tim phi ngoi c th) l mt phng n thay th
cho CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
truyn thng cho cc bnh nhn c la chn b ngng
tim v nghi ng cn nguyn ngng tim c kh nng c th
o ngc.
2010 (C): Cha c chng c khuyn ngh nn s dng
u n ECPR (extracorporeal CPR; Hi sc Tim phi ngoi
c th) cho bnh nhn ngng tim. Tuy nhin, trong nhng
trng hp sn c ECPR (extracorporeal CPR; Hi sc Tim
phi ngoi c th), c th cn nhc khi thi gian khng c
lu lng mu ngn v tnh trng dn n ngng tim c
th o ngc (v d gim nhit bt ng, nhim c thuc)
hoc do cy ghp tim (v d vim c tim) hoc ti to mch
(v d nhi mu c tim cp tnh).
L do: Thut ng hi sc tim phi ngoi c th (ECPR) c
s dng m t bt u tun hon v trao i oxy ngoi
c th trong khi hi sinh bnh nhn ngng tim. ECPR
(extracorporeal CPR; Hi sc Tim phi ngoi c th) bao
gm t catheter khn cp cho mt ven v ng mch ln
(v d mch i). Mc ch ca ECPR (extracorporeal CPR;
Hi sc Tim phi ngoi c th) l h tr cc bnh nhn
ngng tim trong khi ang iu tr tnh trng c kh nng c
th o ngc. ECPR (extracorporeal CPR; Hi sc Tim phi
ngoi c th) l mt quy trnh phc tp yu cu mt nhm
c o to chuyn su, thit b chuyn dng v h tr lin
ngnh trong h thng chm sc sc khe ca a phng.
Khng c th nghim lm sng no v ECPR (extracorporeal
CPR; Hi sc Tim phi ngoi c th) v cc chui xut bn
sn c s dng cc tiu chun chn v loi tr nghim
ngt la chn cc bnh nhn cho ECPR (extracorporeal
CPR; Hi sc Tim phi ngoi c th). Mc d nhng tiu ch
chn ny c tnh bin thin cao, hu ht u ch gm nhng
bnh nhn tui t 18 n 75 c nhng bnh i km hn ch
c cn nguyn ngng tim sau khi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) hn 10pht m khng ti
lp tun hon t nhin. Nhng tiu ch chn ny cn c
cn nhc khi ngi thc hin la chn cc ng vin tim
nng cho ECPR (extracorporeal CPR; Hi sc Tim phi ngoi
c th).
Duy tr s sng tim mch

nng cao ngi ln
Khuyn co trong Hng dn cp nht nm 2015 cho duy tr
s sng tim nng cao bao gm nhng vn chnh v thay i
ln sau:
V
ic s dng kt hp vasopressin v epinephrine khng
em li li th so vi s dng liu chun epinephrine trong
ngng tim. ng thi, vasopressin khng em li li th so
vi vic ch s dng epinephrine. Do , n gin ha
quy tc, vasopressin c loi b ra khi Cp nht B
quy tc ngng tim ngi lnnm 2015.
L ng CO2 cui k th ra (ETCO2) thp bnh nhn
c lun ng sau 20 pht CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) gn lin vi kh nng
hi sinh rt thp. Mc d khng nn ch dng thng s
ny a ra quyt nh, ngi thc hin c th cn nhc
ETCO2 (end-tidal carbon dioxide; lng CO2 cui k th ra)
thp sau 20 pht CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) kt hp vi cc nhn t khc gip
xc nh khi no th chm dt hi sinh.
S teroids c th em li li ch no khi kt hp
vi vasopressin v epinephrine trong iu tr IHCA
(in-hospital cardiac arrests; ngng tim trong bnh vin).
Mc d khng khuyn ngh s dng u n nhng
nghin cu theo di cn ang treo, s hp l khi ngi
thc hin theo di nhm cho IHCA (in-hospital cardiac
arrests; ngng tim trong bnh vin).
K
hi c thc hin nhanh chng, ECPR (extracorporeal
CPR; Hi sc Tim phi ngoi c th) c th ko di kh
nng sng st do c th cung cp thi gian iu tr cc
tnh trng c kh nng c th o ngc hoc thu xp
cy ghp tim cho bnh nhn khng c hi sinh bng
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi).

nhng bnh nhn ngng tim c nhp khng sc c
v nhng bnh nhn tip nhn epinephrine, ngh nn
sm cung cp epinephrine.
N
hng nghin cu v vic s dng lidocaine sau khi ti
lp tun hon t nhin vn mu thun v khng khuyn
ngh s dng u n lidocaine. Tuy nhin, c th cn
nhc bt u hoc tip tc s dng lidocaine ngay sau khi
ti lp tun hon t nhin t ngng tim do rung tht/tim
nhp nhanh v mch (pVT).
M
t nghin cu quan st cho thy rng vic s dng cht
chn- sau khi ngng tim c th gn lin vi kt qu tt
hn khi khng s dng cht chn-. Mc d nghin cu
quan st ny khng phi l chng c chc chn
khuyn ngh s dng u n nhng c th cn nhc bt
u hoc tip tc s dng cht chn- qua ng ming
hoc ng tnh mch sm sau khi nhp vin do ngng
tim v rung tht/tim nhp nhanh v mch.
Tng huyt p cho hi sinh: Vasopressin

2015 ( cp nht): Vasopressin kt hp vi epinephrine khng
em li li th thay th cho liu chun epinephrine trong
ngng tim.
2010 (C): Mt liu vasopressin 40 n v qua tnh mch/

trong xng c th thay th liu epinephrine th nht hoc
th hai trong iu tr ngng tim.
L do: Vic ung c epinephrine v vasopressin trong khi
ngng tim cho thy ci thin ti lp tun hon t nhin.
nh gi chng c sn c cho thy hiu qu ca 2 loi thuc l
nh nhau v khng c li ch c th chng minh t vic ung
c epinephrine v vasopressin khi so vi ch dng epinephrine.
n gin ha, vasopressin c loi b ra khi B quy
tc ngng tim ngi ln.
Tng huyt p cho hi sinh: Epinephrine

2015 (Mi): C th hp l khi ung epinephrine ngay khi c
th sau khi bt u ngng tim do nhp khng sc c ban
u.
L do: Mt nghin cu quan st rt ln v ngng tim vi
nhp khng sc c so snh epinephrine c cho dng
t 1 n 3pht vi epinephrine c cho dng 3 khong
thi gian sau (4 n 6, 7 n 9 v hn 9 pht). Nghin
cu thy rng c mi lin h gia vic ung epinephrine
sm v ti lp tun hon t nhin v kh nng sng st
tng ln sau khi xut vin v kh nng sng st vi thn
kinh nguyn vn.
ETCO2 (end-tidal carbon dioxide; lng CO2 cui k

th ra) cho D on hi sinh tht bi
2015 (Mi): nhng bnh nhn c lun ng, nu khng
t c ETCO2 (end-tidal carbon dioxide; lng CO2 cui
k th ra) ln hn 10 mm Hg bng thn dng sng sau
20 pht CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) c th c coi l mt hp phn trong cch tip cn
a phng thc nhm quyt nh khi no nn kt thc n
lc hi sinh nhng khng nn ch dng ch s ny.
L do: Nu khng t c ETCO2 (end-tidal carbon dioxide;
lng CO2 cui k th ra) 10 mm Hg bng thn dng
sng sau 20 pht hi sinh c gn lin vi c hi ti lp
tun hon t nhin v sng st rt thp. Tuy nhin, cc
nghin cu cho n nay ch hn ch trong c kh nng
trng hp v c s bnh nhn tng i nh v th khng
nn ch da vo ETCO2 (end-tidal carbon dioxide; lng CO2
cui k th ra) xc nh khi no th chm dt hi sinh.
Hi sc Tim phi ngoi c th (ECPR)

2015 (Mi): C th cn nhc ECPR (extracorporeal CPR; Hi
sc Tim phi ngoi c th) trong cc bnh nhn ngng tim
c la chn khng phn ng vi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) truyn thng ban u
trong nhng trng hp c th thc hin nhanh chng.
L do: Mc d cha c nghin cu cht lng cao no so
snh ECPR (extracorporeal CPR; Hi sc Tim phi ngoi
c th) vi CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) nhng mt s nghin cu cht lng thp hn
cho thy kh nng sng st c ci thin vi bin chng
thn kinh tt cho nhm bnh nhn c la chn. V ECPR
(extracorporeal CPR; Hi sc Tim phi ngoi c th) l mt
ti nguyn chuyn su v tn km nn ch cn nhc khi bnh
nhn c kh nng hng li cao hp ltrong nhng trng
hp bnh nhn c bnh c kh nng c th o ngc hoc
h tr bnh nhn trong khi ch cy ghp tim.
15
Liu php dng thuc sau ngng tim: Lidocaine

2015 (Mi): Cha c chng c khuyn ngh nn s
dng u n lidocane cho ngng tim. Tuy nhin, c th
cn nhc bt u hoc tip tc s dng lidocaine ngay sau
khi ti lp tun hon t nhin t ngng tim do rung tht/
tim nhp nhanh v mch.
L do: Mc d nhng nghin cu trc y cho thy c
mi lin h gia vic cho dng lidocaine sau khi nhi mu
c tim v t l t vong tng ln, mt nghin cu gn y v
lidocaine nhng ngi sng st sau khi ngng tim cho
thy t l rung tht/tim nhp nhanh v mch ti pht gim
xung nhng khng cho thy c li ch hay tc hi lu di.
Liu php dng thuc sau ngng tim: Cht chn-

2015 (Mi): Cha c chng c khuyn ngh nn s
dng u n cht chn- sau khi ngng tim. Tuy nhin,
c th cn nhc bt u hoc tip tc s dng cht chn-
qua ng ming hoc tnh mch sm sau khi nhp vin v
ngng tim do rung tht/tim nhp nhanh v mch.
L do: Trong mt nghin cu quan st gm cc bnh nhn
ti lp tun hon t nhin of sau khi ngng tim do rung tht/
tim nhp nhanh v mch, vic dng cht chn- gn lin vi
t l sng st cao hn. Tuy nhin pht hin ny ch l quan
h lin i v vic s dng u n cht chn- sau khi
ngng tim c th nguy him v cht chn- c th gy ra
hoc lm trm trng hn tnh trng khng n nh huyt
ng lc, lm suy tim trm trng hn v gy ra nhp tim
chm. Do , ngi thc hin cn nh gi tng bnh nhn
xem c ph hp vi cht chn- hay khng.
Hp 2
Pht hin lm sng hu ch

C lin quan n
Bin chng thn kinh km*
Khng phn x ng t vi nh sng trong 72 gi tr ln sau khi ngng tim
Xut hin tnh trng git c (khc vi rung git c cc b) trong 72 gi u sau
khi ngng tim
Khng c sng v no gi cm gic xc gic N20 trong khong 24 n 72 gi
sau khi ngng tim hoc sau khi lm m li
Xut hin s gim ng k t l xm-trng trn CT no nhn c trong 2 gi
sau khi ngng tim
Hn ch khuch tn m rng trn MRI no t 2 n 6 ngy sau khi ngng tim
Lin tc khng c phn ng EEG vi kch thch t bn ngoi trong 72 gi sau khi
ngng tim
Lin tc c ch bng pht hoc tnh trng ng kinh kh cha trn EEG sau khi
lm m li
Khng c chuyn ng m t, t th dui hoc rung git c khng c s dng mt
mnh d on kt qu.
*Sc, nhit , ri lon chuyn ha, cc loi thuc gim au hoc chn thn kinh c
trc v cc yu t y hc khc phi c xem xt k lng v chng c th nh hng
n kt qu hoc din gii ca mt s kim tra.
Vit tt: CT, chp ct lp vi tnh; EEG, in no ; MRI, chp cng hng t.
16
Chm sc sau ngng tim

Khuyn co trong Hng dn cp nht nm 2015 cho chm
sc sau ngng tim bao gm nhng vn chnh v thay i
ln sau:
C hp mch vnh cp cu c khuyn co i vi tt c cc bnh nhn b nng
cao on ST v i vi bnh nhn khng n nh v in hoc huyt ng lc
khng b nng cao on ST i vi nhng ngi b nghi ng c thng tn v
tim mch.
C c khuyn co TTM (targeted temperature management; kim sot nhit
mc tiu) c cp nht vi bng chng mi cho thy rng phm vi nhit
c th chp nhn nhm ti trong khong thi gian sau ngng tim.
S au khi kim sot nhit mc tiu hon tt, st c th din tin. Mc d c
nhng mu thun trong d liu quan st v tc hi ca st sau khi kim sot
nhit mc tiu, nhng vic ngn nga st c coi l lnh tnh v do vic
thc hin l hp l.
N hn bit v hiu chnh gim huyt p c khuyn co trong giai on ngay
sau khi ngng tim.
B o trc gi c khuyn co khng sm hn 72 gi sau khi hon thnh kim
sot nhit mc tiu; i vi nhng ngi khng thc hin kim sot nhit
mc tiu, bo trc khng c khuyn co sm hn 72 gi sau khi ti lp
tun hon t nhin.
T t c nhng bnh nhn ang tin trin n cht no hoc cht tun hon sau
khi ngng tim nguyn pht nn c xem l ngi hin tng tim nng.
Chp mch vnh

2015 ( cp nht): Chp mch vnh nn c thc hin khn
cp (thay v mun hn trong khi nm vin hoc khng h
thc hin) i vi bnh nhn ngng tim ngoi bnh vin
nghi ng b ngng tim bnh l v nng cao on ST trn
ECG (electrocardiogram; in tm ). Chp mch vnh cp
cu l hp l i vi mt s bnh nhn ngi ln c chn
lc (v d: khng n nh v in hoc huyt ng lc) b
hn m sau khi ngng tim ngoi bnh vin c cn nguyn
nghi ng l do tim nhng khng c nng cao on ST trn
in tm . Chp mch vnh l hp l cc bnh nhn
sau ngng tim c ch nh chp mch vnh, bt k bnh
nhn b hn m hay tnh.
2010 (C): PCI (percutaneous coronary intervention; Can
thip mch vnh qua da) tin pht (PPCI) sau ti lp tun
hon t nhin cc i tng b ngng tim bnh l c
cho l do thiu mu cc b c th hp l, ngay c trong
trng hp khng xc nh r rng c nhi mu c tim ST
chnh khng. iu tr ph hp cho cc hi chng mch
vnh cp (ACS) hoc nhi mu c tim ST chnh, bao gm
Can thip mch vnh qua da hoc fibrinolysis, nn c bt
u bt k c hn m hay khng.
L do: Nhiu nghin cu quan st pht hin s kt hp
tch cc gia ti ti mu mch vnh khn cp v c kt qu
sng st v chc nng thun li. Trong trng hp khng
b ngng tim, cc hng dn khuyn co iu tr cp
cu nhi mu c tim ST chnh v iu tr cp cu hi chng
mch vnh cp khng c nng cao on ST c s khng
n nh v in hoc huyt ng lc. Do kt qu ca tnh
trng hn m c th c ci thin bng cch iu chnh
s khng n nh ca tim v tin lng hn m khng th

c xc nh mt cch tin cy trong vi gi u tin sau
khi ngng tim, iu tr cp cu cho bnh nhn sau ngng
tim nn tun theo cc hng dn ging nhau.
Kim sot nhit mc tiu

2015 ( cp nht): Tt c bnh nhn ngi ln hn m (ngha
l: khng c phn ng c ngha theo khu lnh) b ti
lp tun hon t nhin sau ngng tim nn thc hin TTM
(targeted temperature management; kim sot nhit
mc tiu), vi nhit mc tiu trong khong 32C n
36C c chn v t n, sau duy tr khng i trong t
nht 24 gi.
2010 (C): Bnh nhn ngi ln b hn m (ngha l: khng
c phn ng c ngha theo khu lnh) c ti lp tun hon
t nhin sau khi ngng tim rung tht ngoi bnh vin nn
c gi lnh 32C n 34C trong 12 n 24 gi. H thn
nhit gy ra cng c th phi xem xt i vi bnh nhn
ngi ln b hn m c ti lp tun hon t nhin sau IHCA
(in-hospital cardiac arrests; ngng tim trong bnh vin) ca
nhp tim u tin bt k hoc sau OHCA (out-of-hospital
cardiac arrests, ngng tim ngoi bnh vin) c nhp tim u
tin ca hot ng in v mch hoc suy tim.
L do: Nhng nghin cu ban u v kim sot nhit
mc tiu nghin cu lm mt n nhit trong khong
32C n 34C so vi khng xc nh r kim sot nhit
mc tiu v pht hin ci thin v bin chng thn kinh i
vi nhng ngi c thc hin gim nhit. Mt nghin
cu cht lng cao gn y so snh vic kim sot nhit
36C v 33C v pht hin nhng kt qu tng t
cho c hai. c thc hin ng thi, nhng nghin cu
ban u ny cho thy rng kim sot nhit mc tiu l
c li, v vy khuyn co vn chn mt nhit mc tiu v
thc hin kim sot nhit mc tiu. Cn c vo vic 33C
khng tt hn 36C, cc bc s lm sng c th chn trong
mt phm vi nhit mc tiu rng hn. Nhit c
chn c th c xc nh theo u tin ca bc s lm sng
hoc cc yu t lm sng.
Tip tc kim sot nhit qu 24 gi

2015 (Mi): Tch cc ngn nga st bnh nhn hn m sau
kim sot nhit mc tiu l hp l.
L do: Trong mt s nghin cu quan st, st sau khi lm
m li t kim sot nhit mc tiu c lin quan n tn
thng thn kinh din tin xu i, mc d cc nghin cu
cn mu thun. Do vic ngn nga st sau kim sot nhit
mc tiu tng i lnh tnh v st c th i km vi tc
hi, nn vic ngn nga st c xut.
H st ngoi bnh vin

2015 (Mi): H st thng thng cho bnh nhn trc khi
n vin bng cch truyn dung dch h st IV sau khi ti
lp tun hon t nhin khng c khuyn co.
L do: Trc nm 2010, h st cho bnh nhn ti c s
chm sc cp cu trc khi n vin cha c nh
gi rng ri. Ngi ta cho rng bt u h st sm hn
c th mang li thm li ch v cng cho rng bt u
trc khi n vin c th to iu kin thun li v gip
cho vic h st tip tc ti bnh vin. Cc nghin
cu cht lng cao mi c cng b gn y chng
minh rng vic h st trc khi n vin khng c li

ch g v cng xc nh cc bin chng tim n khi s
dng dung dch h st IV h st trc khi n vin.
Cc mc tiu huyt ng hc sau khi hi sc

2015 (Mi): Trnh v ngay lp tc cha gim huyt p (huyt
p tm thu nh hn 90 mm Hg, huyt p ng mch trung
bnh nh hn 65 mm Hg) trong qu trnh chm sc sau
ngng tim.
L do: Cc nghin cu i vi bnh nhn sau ngng tim
pht hin rng huyt p tm thu nh hn 90 mm Hg hoc
huyt p ng mch trung bnh nh hn 65 mm Hg c lin
quan n t l t vong cao hn v kh nng phc hi chc
nng gim i, trong khi huyt p ng mch tm thu
ln hn 100 mm Hg c lin quan n kh nng phc hi tt
hn. Mc d huyt p cao hn c v tt hn, nhng cha
th xc nh cc mc tiu huyt p tm thu hoc huyt p
ng mch trung bnh c th, do cc th nghim thng
nghin cu mt nhm nhiu can thip, bao gm c kim
sot huyt ng lc. Ngoi ra, do huyt p c s khc nhau
gia cc bnh nhn, nn cc bnh nhn khc nhau c th
c cc yu cu khc nhau duy tr tnh trng ti mu cho
c quan ti u.
Bo trc sau khi ngng tim

2015 (Mi): Thi gian sm nht bo trc mt bin chng
thn kinh xu bng khm lm sng trn bnh nhn khng
c iu tr bng kim sot nhit mc tiu l 72 gi sau
ngng tim, nhng thi gian ny thm ch c th di hn sau
ngng tim nu nghi ng c tc dng d ca thuc gim
au hoc lit gy nhm ln khi khm lm sng.
2015 ( cp nht): i vi bnh nhn c iu tr vi kim
sot nhit mc tiu, trong thuc gim au hoc lit
c th gy nhm ln khi khm lm sng, th vic i cho n
72 gi sau khi tr v huyt p bnh trc trc khi d on
bin chng l hp l.
2010 (C): Mc d thi gian cho tnh hu ch ca cc xt
nghim c th c xc nh, nhng khng c khuyn
co chung c th no c a ra v thi gian bo trc.
L do: Cc pht hin lm sng, phng thc in sinh hc,
phng thc chp nh v du n mu u hu ch d
on bin chng thn kinh bnh nhn hn m, nhng
mi pht hin, xt nghim v du n b nh hng khc
nhau bi thuc gim au hoc tc nghn thn kinh c.
Ngoi ra, hn m no c th nhy cm hn vi cc loi
thuc v thuc c th mt nhiu thi gian chuyn ha hn
sau ngng tim.
Khng c xt nghim hay pht hin vt l n no c th
d on kh nng phc hi thn kinh sau ngng tim vi
chc chn 100%. Nhiu phng thc xt nghim v kim tra
c s dng ng thi d on bin chng sau nhng
tc dng ca h thn nhit v thuc c cho php
gii quyt, nhiu kh nng cung cp d on kt qu chnh
xc nht ( 2).
Hin tng
2015 ( cp nht): Tt c nhng bnh nhn tnh li sau ngng
tim nhng sau tin trin n t vong hoc cht no nn
c nh gi l ngi hin tng tim nng. Nhng bnh
nhn khng t c ti lp tun hon t nhin v nhng
17
ngi chm dt hi sc theo cch khc c th c coi l

ngi hin thn hoc gan tim nng ti cc c s c chng
trnh phc hi c quan nhanh.
2010 (C): Bnh nhn ngi ln ang tin trin n cht no
sau hi sc do ngng tim nn c xem l ngi hin tng.
L do: Khng c sai lch c bo co v chc nng tc th
hoc di hn ca cc c quan t ngi hin tng cht
no sau ngng tim khi so vi ngi hin tng cht no
do nguyn nhn khc. Ni tng c cy ghp t nhng
ngi hin tng ny c t l thnh cng c th so snh vi
ni tng c ly t nhng ngi hin tng tng t c
tnh trng khc.
Hi chng mch vnh cp tnh

Hng dn cp nht nm 2015 nh du s thay i v
phm vi ca Hng dn AHA cho nh gi v kim sot
ACS (acute coronary syndromes; hi chng mch vnh cp).
Bt u vi cp nht ny, nhng khuyn ngh s ch gii
hn trong cc bc chm sc trc khi n bnh vin v
phng cp cu. Chm sc trong bnh vin c cp
trong hng dn cho qun l nhi mu c tim do AHA v T
chc Trng Tim mch Hoa K ng xut bn.
Khuyn co trong Hng dn cp nht nm 2015 cho ACS
(acute coronary syndromes; hi chng mch vnh cp) bao
gm nhng vn chnh vi thay i ln sau:
Ly v din gii ECG (electrocardiogram; in tm ) trc khi n bnh vin
C hn mt chin lc ti ti mu khi sn c thuc tiu si huyt trc khi
chuyn ti bnh vin
C hn mt chin lc ti ti mu mt bnh vin khng c kh nng PCI
(percutaneous coronary intervention; Can thip mch vnh qua da)
Troponin xc nh nhng bnh nhn c th c ri phng cp cu an ton
N hng can thip c th c hoc c th khng em li li ch trc khi n
bnh vin
Ly v din gii ECG (electrocardiogram; in tm )

trc khi n bnh vin
2015 (Mi): Cn ly ECG (electrocardiogram; in tm )
12im sm cho bnh nhn c kh nng b ACS (acute
coronary syndromes; hi chng mch vnh cp) trc khi
n bnh vin.
2015 (Mi): Nhng ngi khng phi l bc s c o
to c th tin hnh din gii ECG (electrocardiogram; in
tm ) xc nh kt qu o c cho thy chng c nhi
mu c tim ST chnh hay khng.
2015 ( cp nht): C th s dng din gii in tm bng
my tnh cng vi din gii ca bc s hoc nh cung cp
c o to nhn bit nhi mu c tim ST chnh.
2015 ( cp nht): Cn tin hnh thng bo trc khi
n bnh vin v/hoc kch hot phng thng tim can
thip trc khi n bnh vin cho tt c cc bnh nhn
b nhi mu c tim ST chnh c xc nh trn ECG
(electrocardiogram; in tm ) trc khi n bnh vin.
2010 (C): Nu ngi thc hin khng c o to din
gii ECG (electrocardiogram; in tm ) 12 u, khuyn
18
ngh s dng chuyn ECG (electrocardiogram; in tm )

ti ch hoc bo co t my tnh n bnh vin tip nhn.
2010 (C): Cn a ra thng bo trc cho bnh vin tip
nhn i vi bnh nhn c xc nh l ang b nhi mu
c tim ST chnh.
L do: ECG (electrocardiogram; in tm ) 12 im khng
tn km, d thc hin v c th nhanh chng a ra chng
c nng on ST cp tnh. Mi lo ngi rng din gii ECG
(electrocardiogram; in tm ) ca ngi khng phi l
bc s c th dn n chn on qu mc vi kt qu l lm
dng ti nguyn hoc trng hp khc l chn on b st
c th dn n tr hon iu tr hn ch vic m rng cc
chng trnh ECG (electrocardiogram; in tm ) cho h
thng EMS (emergency medical service, dch v cp cu y
t). Cng tn ti nhng mi lo ngi tng t vi vic din
gii in tm bng my tnh. nh gi t liu cho thy khi
khng cho dng thuc tiu si huyt trc khi chuyn ti
bnh vin th vic thng bo sm cho bnh vin v vic sp
c bnh nhn vi nh gi ST hoc kch hot phng thng
tim can thip trc khi n bnh vin s lm gim thi gian
ti ti mu v gim t sut bnh v t l t vong. V c th
cn thi gian nh cung cp cha c kinh nghim pht
trin k nng din gii ECG (electrocardiogram; in tm )
12 im, c th k vng din gii bng my tnh s gia tng
chnh xc ca din gii khi c s dng cng vi din
gii ca ngi khng phi l bc s c o to.
Ti ti mu
2015 (Mi): Khi sn c thuc tiu si huyt trc khi chuyn
ti bnh vin nh mt phn trong h thng chm sc nhi
mu c tim ST chnh v c th vn chuyn trc tip n
mt trung tm PCI (percutaneous coronary intervention;
Can thip mch vnh qua da) th c th u tin phn loi
bnh theo mc nguy cp trc khi n bnh vin v
vn chuyn trc tip n mt trung tm PCI (percutaneous
coronary intervention; Can thip mch vnh qua da) v iu
ny s lm gim t l xut huyt ni s mc tng i
nh. Tuy nhin khng c chng c cho thy liu php no
c t l t vong thp hn so vi liu php cn li.
2015 (Mi): bnh nhn ngi ln c biu hin nhi mu
c tim ST chnh trong phng cp cu ca mt bnh
vin khng c kh nng PCI (percutaneous coronary
intervention; Can thip mch vnh qua da), chng ti
khuyn ngh ngay lp tc chuyn i m khng c thuc
tiu si huyt t c s ban u sang mt trung tm PCI
PCI (percutaneous coronary intervention; Can thip mch
vnh qua da) thay v cho dng thuc tiu si huyt ngay lp
tc bnh vin ban u vi vic chuyn vin ch cho PCI
(percutaneous coronary intervention; Can thip mch vnh
qua da) do thiu mu cc b.
2015 (Mi): Khi khng th chuyn cc bnh nhn nhi mu
c tim ST chnh sang mt bnh vin c kh nng PCI
qua da) kp thi th tr liu tiu huyt khi vi vic chuyn
u n chp (xem di y) c th l mt phng n
c th chp nhn c ngay lp tc chuyn sang PCI
qua da) tin pht.
2015 (Mi): Khi tr liu tiu huyt khi c dng cho bnh
nhn nhi mu c tim ST chnh mt bnh vin khng
c kh nng PCI (percutaneous coronary intervention; Can
Hnh 6
B quy tc (Ngi
ln)
trng hp
cp e hp
da mng
linda
quan n OpioidB mi 2015
B quy
tcv(Ngi
ln)khn
v trng
khnsng
cp e
mng sng lin quan n Opioid
nh gi v kch hot.
Kim tra xem khng c phn ng hay khng v ku gi tr

gip gn . C ngi gi 9-1-1 v ly AED (automated
external defibrillator; my kh rung bn ngoi t ng)
v naloxone.
Quan st xem th hoc khng th hay ch th hn hn.
Bt u CPR (Cardiopulmonary
Nu nn nhn khng c phn ng km theo khng th

hoc ch th hn hn, bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi).*
Nu ch c mt mnh, thc hin CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) trong khong 2 pht trc
khi ri i gi 9-1-1 v ly naloxone v AED (automated
external defibrillator; my kh rung bn ngoi t ng).
Cho dng naloxone.
Cho dng naloxone ngay khi sn c.

2 mg qua ng mi hoc 0,4 mg tim bp.
C th lp li sau 4 pht.
Ngi c phn
ng khng?
Ngi c c c ng,
th u, rn hay c phn ng
khc ti bt k thi im
no hay khng?
Kch thch v nh gi li.
Tip tc kim tra phn ng v hi

th cho n khi c s tr gip nng
cao. Nu ngi ngng phn ng
th bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) v
cho dng li naloxone.
Khng
Tip tc CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi) v s dng
AED (automated external defibrillator;
my kh rung bn ngoi t ng)
ngay khi sn sng.
Tip tc cho n khi ngi phn ng hoc c s tr gip

chuyn su.
*K thut CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) da trn
mc o to ca ngi cu h.
thip mch vnh qua da) th c th hp l khi vn chuyn

ton b bnh nhn dng thuc tiu si huyt chp
thng l sm trong 3 n 6 gi v ln n 24 gi u tin
thay v vn chuyn nhng bnh nhn dng thuc tiu
si huyt ch khi h yu cu chp theo tnh trng thiu mu
cc b.
2010 (C): Vic chuyn nhng bnh nhn nguy c cao
c ti ti mu tin pht vi tr liu tiu huyt khi l
hp l.
L do: Thuc tiu si huyt l tiu chun chm sc nhi
mu c tim ST chnh trong hn 30 nm. Trong 15 nm qua,
PPCI (Primary PCI; Can thip mch vnh qua da tin pht)
tr nn sn c hn hu ht cc ni ca Bc M v
cho thy ci thin kt qu mc va phi khi so snh vi
thuc tiu si huyt do PPCI (Primary PCI; Can thip mch
vnh qua da tin pht) c th c thc hin kp thi bi
nhng ngi hnh ngh c kinh nghim. Tuy nhin, khi tr
hon PPCI (Primary PCI; Can thip mch vnh qua da tin
pht) th ty vo thi gian tr hon, vic s dng thuc tiu
si huyt ngay lp tc c th tt hn bt k li ch no khc
ca PCI (percutaneous coronary intervention; Can thip
mch vnh qua da). Chuyn trc tip n mt bnh vin
c kh nng PCI (percutaneous coronary intervention; Can
19
thip mch vnh qua da) khng c bt k khc bit no

trong t l t vong so vi s dng thuc tiu si huyt trc
khi chuyn ti bnh vin nhng chuyn cho PPCI (Primary
PCI; Can thip mch vnh qua da tin pht) s lm gim t
l xut huyt ni s mc tng i nh. Xem xt li chng
c cho php phn tng cc khuyn ngh iu tr theo thi
gian t khi pht triu chng v tr hon PPCI (Primary PCI;
Can thip mch vnh qua da tin pht) d kin v cho php
a ra c khuyn ngh c bit cho cc bc s lm sng
nhng bnh vin khng c kh nng PCI (percutaneous
coronary intervention; Can thip mch vnh qua da). PCI
qua da) ngay lp tc sau khi iu tr bng thuc tiu si
huyt khng em li li ch thm no nhng chp u n
trong vng 24 gi u tin sau khi cho dng thuc tiu si
huyt lm gim t l ti nhi mu.
Troponin Xc nh nhng Bnh nhn c th c

ri Phng cp cu an ton
2015 (Mi): Khng nn ch dng ring troponin T v troponin
I c nhy cao c o 0 v 2 gi (khng thc hin
phn tng ri ro lm sng) loi tr chn on ACS (acute
coronary syndromes; hi chng mch vnh cp) nhng
c th s dng cc php o troponin I c nhy cao
di 99bch phn v c o 0 v 2 gi cng vi phn
tng nguy c thp (im Tan cc huyt trong nhi mu
c tim [TIMI] l 0 hoc 1 hoc nguy c thp theo quy tc
Vancouver) d on c hi di 1% s xy ra bin c
tim mch nng (MACE) trong 30 ngy. ng thi, c th s
dng cc php o troponin I hoc troponin T m 0 gi v
t 3 n 6 gi cng phn tng nguy c rt thp (im TIMI
bng 0, im nguy c thp theo quy tc Vancouver, im
au ngc Bc M bng 0 v tui di 50 hoc im HEART
nguy c thp) d on c hi di 1% s xy ra MACE
(major adverse cardiac event; bin c tim mch nng) trong
30 ngy.
2010 (C): Nu cc du n sinh hc ban u m tnh trong
vng 6 gi sau khi khi pht triu chng th khuyn ngh
nn o li cc du n sinh hc t 6 n 12 gi sau khi khi
pht triu chng.
L do: Da vo kt qu kim tra troponin m tnh cho d
n l hay kt hp vi nh gi nguy c khng kt cu u
dn n t l cao khng th chp nhn c s xy ra MACE
(major adverse cardiac event; bin c tim mch nng) sau
30 ngy. Tuy nhin cc d on da trn kt qu kim tra
troponin m tnh kt hp vi nh gi nguy c c kt cu
c nguy c di 1% s xy ra MACE (major adverse cardiac
event; bin c tim mch nng) sau 30 ngy.
Cc Can thip khc

Khi mt loi thuc lm gim t sut bnh hay t l t vong th
vic cho dng loi thuc trc khi chuyn n bnh vin
cho php thuc bt u cng dng sm hn v c th lm
gim thm t sut bnh hay t l t vong so vi cho dng
khi vin. Tuy nhin khi thi gian phn ng v vn chuyn
ca EMS (emergency medical service, dch v cp cu y t)
th ngn th c hi cho thuc pht huy tc dng c th
khng ln. Hn na thm thuc lm tng kh nng phc tp
ca vic chm sc trc khi chuyn n bnh vin, iu ny
ngc li c th to ra tc ng tiu cc.
20
S c ch adenosin diphosphat cho bnh nhn trong bnh vin nghi ng b

nhi mu c tim ST chnh c khuyn ngh trong nhiu nm. Vic cho
dng mt cht c ch adenosin diphosphat trc khi chuyn n bnh vin
khng c li ch khc cng khng gy tc hi so vi vic ch cho dng thuc
trong bnh vin.
H eparin cha phn on (UFH) c dng cho bnh nhn b nhi mu c tim
ST chnh trc khi chuyn n bnh vin cha cho thy em li li ch hn so
vi dng thuc trong bnh vin. Trong nhng h thng m cho dng
UFH (Unfractionated heparin; heparin cha phn on) trc khi chuyn n
bnh vin th s hp l khi tip tc s dng thuc . Khi cha s dng trc
khi chuyn n bnh vin th vic hp l l ch ch n khi n bnh vin mi
cho dng UFH (Unfractionated heparin; heparin cha phn on).
T rc khi c khuyn ngh nm 2010, oxy c cho dng u n cho tt c cc
bnh nhn nghi ng b ACS (acute coronary syndromes; hi chng mch vnh
cp) bt k bo ha oxy hay tnh trng h hp. Nm 2010, chng c yu
v vic khng c li ch v tc hi c th c thc y khuyn ngh rng vic
b sung oxy l khng cn thit i vi cc bnh nhn b ACS (acute coronary
syndromes; hi chng mch vnh cp) c bo ha oxy ca hemoglobin 94%
hoc hn (tc l khng b thiu oxy) v khng c chng c b suy h hp. Chng
c khc rng vic b sung oxy u n c th c hi vi s h tr ca mt th
nghim i chng ngu nhin a trng tm c xut bn sau khi nh gi c
h thng nm 20158 cng c khuyn ngh khng dng oxy cho bnh nhn c
kh nng b ACS (acute coronary syndromes; hi chng mch vnh cp) m c
bo ha oxy bnh thng (tc l ngi khng b thiu oxy).
i vi bnh nhn b nhi mu c tim ST chnh th hp l khi cho dng UFH
(Unfractionated heparin; heparin cha phn on) hoc bivalirudin.
i vi bnh nhn nghi ng b nhi mu c tim ST chnh ang c chuyn
PPCI (Primary PCI; Can thip mch vnh qua da tin pht) th enoxaparin l
mt phng n hp l thay th cho UFH (Unfractionated heparin; heparin cha
phn on).
Cc Trng hp hi sinh c bit

K inh nghim iu tr bnh nhn bit hoc nghi ng dng qu liu opioid
cho thy rng c th cho dng naloxone vi an ton v hiu qu r rng
trong trng hp s cu v BLS (Basic Life Support; Hi sinh tim phi c bn).
V l do ny, ngi cu h khng chuyn v nhn vin y t c khuyn ngh
dng naloxone v o to n gin ha ang c ngh. Ngoi ra cn c
mt b quy tc mi cho qun l cc bnh nhn khng phn ng b nghi ng
dng qu liu opioid.
C th cn nhc dng nh tng lipid truyn tnh mch (ILE) iu tr c
tnh c h thng gy t cc b. Ngoi ra cn c mt khuyn ngh mi cng c
vai tr tim nng cho ILE (Intravenous lipid emulsion; nh tng lipid truyn
tnh mch) bnh nhn ngng tim v khng t cc s o hi sinh do c tnh
ca thuc ch khng phi l v c tnh c h thng gy t cc b.
T m quan trng ca CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
cht lng cao trong khi ngng tim dn n vic nh gi li cc khuyn
ngh v vic gim p lc nt aortocaval trong khi ngng tim trong thai k. Vic
nh gi li ny a ra cc khuyn ngh c iu chnh v cc chin lc
cho chuyn dch t cung.
Gio dc v qu liu opioid v o to v phn pht

naloxone
2015 (Mi): S hp l khi cung cp o to v phn ng qu
liu opioid n l hoc kt hp vi phn phi v o to
noloxone cho nhng ngi c nguy c qu liu opioid (hoc
nhng ngi sng cng hoc thng xuyn tip xc vi
nhng ngi ). S hp l khi vic o to ny da vo cc
khuyn ngh cp cu v BLS (Basic Life Support; Hi sinh tim
Hnh 7
B quy tc ngng tim tr em ca nh cung cp dch v chm sc sc khe

BLS cho mt ngi cu hBn cp nht 2015
B quy tc ngng tim tr em ca

nh cung cp dch v chm sc sc khe BLS cho ngi cu h duy nhtBn cp nht 2015
Nn nhn khng phn ng.

Kch hot h thng ng cu khn
cp qua thit b di ng
(nu ph hp).
Kch hot h thng
ng cu khn cp
(nu cha lm).
Quay li vi nn
nhn v Theo di
cho n khi ngi
tr li khn cp n.
Th bnh
thng, c
mch
Th khng
Kim tra xem khng th
bnh thng,
hay ch th hn hn v
c mch
C cm nhn c mch dt
khot trong vng 10 giy
hay khng?
Khng th hoc
ch th hn hn,
khng c mch
Ng qu t ngt
c ngi chng kin?
Khng

12-20 ln th/pht.
Thm nhn ngc nu mch
duy tr 60 ln/pht km du
hiu truyn mu km.
khn cp (nu cha lm)
sau 2 pht.
Tip tc h hp nhn to,
kim tra mch khong 2 pht/
ln. Nu khng c mch, bt
u CPR (Cardiopulmonary
phi) (n CPR).

khn cp (nu cha lm) v
tm AED (automated external
defibrillator; my kh rung bn
ngoi t ng)/my kh rung.

1 ngi cu h: Bt u cc chu k 30 ln nhn v 2 ln th.
(S dng t l 15:2 nu ngi cu h th hai n.)
S dng AED (automated external defibrillator; my kh rung
bn ngoi t ng) ngay khi sn sng.
Sau khong 2 pht, nu vn ch c mt mnh th kch hot

h thng ng cu khn cp v tm AED (automated external
defibrillator; my kh rung bn ngoi t ng) (nu cha lm).
C,
sc c
AED (automated
external defibrillator;
my kh rung bn ngoi t
ng) phn tch nhp tim.
Nhp c sc c
khng?

sinh Tim phi) trong khong 2 pht (cho
n khi c AED (automated external
defibrillator; my kh rung bn ngoi t
ng) cho php kim tra nhp tim).
Tip tc cho n khi nhn vin ALS tip
nhn hoc nn nhn bt u c ng.
Khng,
khng sc c
Ngay lp tc tip tc
nhp tim). Tip tc cho n khi nhn
vin ALS tip nhn hoc nn nhn bt
u c ng.
21
phi c bn) cho ngi khng phi nhn vin y t thay v da

vo thc hnh nng cao hn dnh cho cc nhn vin y t.
iu tr qu liu opioid
2015 (Mi): C th hp l khi cho dng thc nghim
naloxone IM (intramuscular; tim bp) hoc IN (intranasal;
ng mi) cho tt c cc nn nhn khng phn ng cp
cu c kh nng e da mng sng c lin quan n opioid
b tr cho cc giao thc tiu chun cho s cu v BLS (Basic
Life Support; Hi sinh tim phi c bn) cho ngi khng

phi l nhn vin y t. i vi bnh nhn bit hoc nghi
ng dng qu liu opioid m c mch dt khot nhng th
khng bnh thng hoc ch th hn hn (tc l ngng h
hp) th ngoi vic thc hin chm sc tiu chun, s hp l
khi ngi cu h c o to ph hp dng naloxone IM
cho cc bnh nhn cp cu h hp c lin quan n opioid
(Hnh 6). Ngi ng cu khng nn tr hon tip cn dch v
Hnh 8
B quy tc ngng tim tr em ca nh cung cp dch v chm sc sc

khe BLS cho 2 ngi cu h tr lnBn cp nht 2015
B quy tc ngng tim tr em ca

nh cung cp dch v chm sc sc khe BLS cho 2 ngi cu h tr lnBn cp nht 2015
Nn nhn khng phn ng.

Ngi cu h th nht li vi nn nhn.
Ngi cu h th hai kch hot h thng ng cu khn
cp v tm AED (automated external defibrillator; my
kh rung bn ngoi t ng) v thit b cp cu.
Theo di cho n
khi ngi tr li
khn cp n.
Th bnh
thng, c
mch
Kim tra xem khng th

hay ch th hn hn v
C cm nhn c mch
dt khot trong vng 10
giy hay khng?
Th khng
bnh thng,
c mch
Khng th hoc
ch th hn hn,
khng c mch
Ngi cu h th nht bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) vi t l 30: 2 (nhn
ngc trn ln th).
Khi ngi cu h th hai quay li, s dng t
l 15: 2 (nhn ngc trn ln th).
S dng AED (automated external defibrillator; my kh
rung bn ngoi t ng) ngay khi sn sng.
C,
sc c
AED (automated
external defibrillator;
my kh rung bn ngoi t
ng) phn tch nhp tim.
Nhp c sc c
khng?

nhp tim).
Tip tc cho n khi nhn vin ALS
tip nhn hoc nn nhn bt u
c ng.
22

12-20 ln th/pht.
Thm nhn ngc nu mch
duy tr 60 ln/pht km du
hiu truyn mu km.
khn cp (nu cha lm)
sau 2 pht.
Tip tc h hp nhn to,
kim tra mch khong 2 pht/
ln. Nu khng c mch, bt
u CPR (Cardiopulmonary
phi) (n CPR).
Khng,
khng sc c
Ngay lp tc tip tc
Hi sinh Tim phi) trong khong
2 pht (cho n khi c AED
(automated external defibrillator;
my kh rung bn ngoi t ng)
cho php kim tra nhp tim). Tip
tc cho n khi nhn vin ALS tip
nhn hoc nn nhn bt u
c ng.
y t nng cao hn trong khi ch bnh nhn phn ng vi

naloxone hoc cc can thip khc.
C th hp l khi cho dng thc nghim naloxone IM
cho tt c cc bnh nhn cp cu hi sinh c lin quan
n opioid m khng phn ng b tr cho cc giao thc
tiu chun cho s cu v BLS (Basic Life Support; Hi sinh
tim phi c bn) cho ngi khng phi l nhn vin y t.
Quy trnh hi sinh tiu chun, bao gm c kch hot EMS
(emergency medical service, dch v cp cu y t) , khng
c chm tr cho dng naloxone.
Ngng tim Bnh nhn bit hoc nghi ng dng

opioid qu liu
2015 (Mi): Bnh nhn khng c mch dt khot c th b
ngng tim hoc c th c mch yu hoc chm khng pht
hin ra c. Nhng bnh nhn ny cn c qun l nh
bnh nhn ngng tim. Cc bin php hi sinh tiu chun
cn c u tin so vi cho dng naloxone, tp trung vo
cht lng cao (nhn ngc cng vi thng kh). C th hp
l khi cho dng naloxone IM (intramuscular; tim bp) hoc
IN (intranasal; ng mi) da trn kh nng bnh nhn b
ngng h hp ch khng phi l ngng tim. Ngi ng cu
khng nn tr hon tip cn dch v y t nng cao hn trong
khi ch bnh nhn phn ng vi naloxone hoc cc can
thip khc.
L do: Trc y khng khuyn ngh nh cung cp s cu,
ngi khng phi l nhn vin y t hoc nh cung cp BLS
(Basic Life Support; Hi sinh tim phi c bn) cho dng
naloxone. Tuy nhin, cc thit b cho dng naloxone dnh
cho ngi cu h khng chuyn s dng hin nay c
ph duyt v sn c s dng ti Hoa K v vic thc hin
thnh cng cc chng trnh naloxone dnh cho ngi cu
h khng chuyn c Centers for Disease Control nu
9
bt ln. Mc d naloxone khng c k vng s c li
trong ca ngng tim cho d nguyn nhn c phi l qu liu
opioid hay khng nhng ngi ta cng nhn l c th kh
phn bit ngng tim vi suy gim h hp nn nhn dng
qu liu opioid. Mc d khng c bng chng rng vic
cho dng naloxone s gip bnh nhn ngng tim nhng
vic cung cp naloxone c th gip bnh nhn khng phn
ng b suy gim h hp nghim trng ch c v ngoi nh
ngng tim (tc l kh xc nh c mch hay khng).
Nh tng lipid truyn tnh mch

2015 ( cp nht): C th hp l khi cho dng ILE (Intravenous
lipid emulsion; nh tng lipid truyn tnh mch) ng thi
vi chm sc hi sinh tiu chun cho bnh nhn c tnh c
hi thn kinh bo trc hay ngng tim do c tnh gy t
cc b. C th hp l khi cho bnh nhn c cc dng c
tnh ca thuc khc khng t cc s o hi sinh tiu chun
dng ILE (Intravenous lipid emulsion; nh tng lipid truyn
tnh mch).
2010 (C): C th hp l khi cn nhc ILE (Intravenous lipid
emulsion; nh tng lipid truyn tnh mch) cho c tnh
gy t cc b.
L do: K t nm 2010, cc nghin cu ng vt v bo
co v trng hp ngi c xut bn kim tra
vic s dng ILE (Intravenous lipid emulsion; nh tng

lipid truyn tnh mch) cho bnh nhn c c tnh ca
thuc m khng phi do tim gy m ni b. Mc d
kt qu ca nhng nghin cu v bo co ny khng
thng nht nhng c th c ci thin lm sng sau khi
cho dng ILE (Intravenous lipid emulsion; nh tng lipid
truyn tnh mch). Do vic tin lng bnh nhn khng
t cc s o hi sinh tiu chun l rt km nn vic
cho dng thc nghim ILE (Intravenous lipid emulsion;
nh tng lipid truyn tnh mch) trong tnh hung ny
c th hp l bt k chng c rt yu v mu thun.
Ngng tim trong thai k: Thc hin CPR

(Cardiopulmonary Resuscitation; Hi sinh Tim phi)
2015 ( cp nht): u tin i vi ph n c thai b ngng tim
l thc hin CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) cht lng cao v gim p lc nt aortocaval. Nu
chiu cao t y bng hoc khong mc im rn th vic
chuyn dch t cung bn tri bng tay c th c li trong
vic gim p lc nt aortocaval trong khi nhn ngc.
2010 (C): gim p lc nt aortocaval trong khi nhn
ngc v ti u ha cht lng CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi), s hp l khi thc hin
chuyn dch t cung bn tri bng tay v tr nm nga trc
tin. Nu k thut ny khng thnh cng v sn c mt ci
nm ph hp th nh cung cp c th cn nhc t bnh
nhn nm nghing sang bn tri mt gc 27 n 30 bng
mt ci nm chc chn khung xng chu v ngc.
L do: Vic ghi nhn tm quan trng thit yu ca CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) cht
lng cao v v tr nm nghing sang bn khng thch hp
vi CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
cht lng cao thc y loi b khuyn ngh s dng
v tr nm nghing sang bn v cng c khuyn ngh dch
chuyn t cung sang bn.
Ngng tim trong thai k: M ly thai khn cp

2015 ( cp nht): Trong nhng tnh hung v d nh chn
thng ngi m khng th cu sng c hay tnh trng
v mch ngi m ko di, trong n lc hi sinh ngi
m r rng l khng c hiu qu th khng c l do g tr
hon thc hin m ly thai trong khi m sp cht (PMCD).
Nn cn nhc PMCD (perimortem cesarean delivery; m
ly thai trong khi m sp cht) 4 pht sau khi khi pht
ngng tim ngi m hoc n lc hi sinh (i vi ngng
tim khng c ngi chng kin) nu ngi m khng ti
lp tun hon t nhin. Quyt nh lm sng thc hin
PMCD (perimortem cesarean delivery; m ly thai trong khi
m sp cht) v thi hn lin quan n ngng tim ngi
m l phc tp do tnh bin kh bin trong trnh o to
ca ngi hnh ngh v nhm, cc nhn t v bnh nhn
(v d cn nguyn ngng tim, tui thai trong thai k) v ti
nguyn ca h thng.
2010 (C): C th cn nhc m ly thai khn cp 4 pht sau
khi khi pht ngng tim ngi m nu khng ti lp tun
hon t nhin.
L do: PMCD (perimortem cesarean delivery; m ly thai
trong khi m sp cht) em li c hi hi sinh ring cho
thai c kh nng sng st v cui cng l gim p lc nt
23
aortocaval c th ci thin kt qu hi sinh ngi m. Kch

bn v tnh hung lm sng ca ngng tim cn cung cp
thng tin cho quyt nh cui cng quanh thi gian m ly
thai khn cp.
Duy tr s sng c bn khoa nhi

v Cht lng CPR
Hi sinh Tim phi)
Nhng thay i i vi BLS (Basic Life Support; Hi sinh tim
phi c bn) cho tr em song song vi nhng thay i trong
BLS (Basic Life Support; Hi sinh tim phi c bn) cho ngi
ln. Cc ch c nh gi li y bao gm:
X c nhn li trnh t C-A-B l trnh t u tin cho CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) tr em
C c b quy tc mi cho CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
cho nhn vin y t nhi khoa trong trng hp 1 ngi cu h v nhiu ngi
cu h trong thi i in thoi di ng
Thit lp ngng trn l 6 cm cho bin nhn ngc thanh thiu nin
P hn nh tc nhn ngc c khuyn co theo BLS cho ngi ln l
100 n 120 ln/pht
X c nhn li chc chn rng cn nhn ngc v thng kh BLS (Basic Life
Support; Hi sinh tim phi c bn) khoa nhi
Trnh t C-A-B
2015 ( cp nht): Mc d s lng v cht lng ca d
liu cng c l hn ch nhng c th hp l khi duy tr
trnh t t Hng dn nm 2010 bng cch bt u CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) vi
trnh t C-A-B thay v A-B-C. C k h trong kin thc v
cn nghin cu c th kim tra trnh t tt nht cho CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) tr em.
2010 (C): Bt u CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) cho tr s sinh v tr em bng cch
nhn ngc ch khng phi l h hp nhn to (C-A-B ch
khng phi l A-B-C). Nn bt u CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) vi 30 ln nhn (bi ngi
cu h duy nht) hoc 15 ln nhn (trong trng hp c
2 nhn vin y t hi sinh tr s sinh v tr em) ch khng
phi 2 ln thng kh.
L do: Khng c d liu mi nn trnh t nm 2010 khng
thay i. Tnh nht qun trong th t nhn ngc, ng th
v th cho CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) cc nn nhn thuc mi la tui c th l iu
d nh v thc hin nht cho nhng ngi cu h iu tr
mi ngi thuc mi la tui. Duy tr cng mt trnh t cho
ngi ln v tr em to ra s nht qun trong ging dy.
Cc B quy tc mi cho CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi) cho nhn vin y t
trong trng hp 1 ngi cu h v nhiu ngi cu h
Cc b quy tc mi cho CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) nhi khoa cho nhn vin y
24
t trong trng hp 1 ngi cu h v nhiu ngi cu h

c tch ring (Hnh 7 v 8) hng dn nhng ngi
cu h hiu qu hn thng qua cc giai on u ca hi
sinh trong thi i ph bin in thoi di ng cm tay c
loa. Nhng thit b ny c th cho php ngi cu h duy
nht kch hot ng cu khn cp trong khi bt u CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi); ngi
cu h c th tip tc ni chuyn vi ngi iu phi trong
khi thc hin CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi). Nhng b quy tc ny tip tc nhn mnh u
tin cao cho CPR (Cardiopulmonary Resuscitation; Hi sinh
Tim phi) cht lng cao v trong trng hp ng qu t
ngt v c ngi chng kin th cho vic nhanh chng ly
c AED (automated external defibrillator; my kh rung
bn ngoi t ng) v s vic nh vy c kh nng c cn
nguyn v tim.
Bin nhn ngc

2015 ( cp nht): S hp l khi ngi cu h thc hin nhn
ngc sao cho p ngc xung t nht mt phn ba ng
knh trc-sau ca bnh nhn khoa nhi (tr s sinh [di
1 tui]) cho n tr em bt u dy th). Mc ny bng
khong 1,5 inches (4 cm) tr s sinh n 2 inches (5 cm)
tr em. Khi tr em n giai on dy th (thanh thiu nin)
th s dng bin nhn ngc ngi ln c khuyn
ngh l t nht 2 inches (5 cm) nhng khng qu 2,4inches
(6 cm).
2010 (C): nhn ngc hiu qu, ngi cu h nn nhn t
nht mt phn ba ng knh trc-sau ca ngc. Mc ny
tng ng khong 1,5 inches (khong 4 cm) hu ht tr s
sinh v khong 2 inches (5 cm) hu ht tr em.
L do: Mt nghin cu ngi ln xut rng c hi
khi nhn ngc su hn 2,4 inches (6 cm). iu ny dn n
thay i trong khuyn co BLS cho ngi ln l bao gm
mt ngng trn cho bin nhn ngc; cc chuyn gia
nhi khoa chp nhn khuyn co ny cho thanh thiu
nin qua tui dy th. Mt nghin cu nhi khoa quan st
thy kh nng sng st sau 24 gi c ci thin khi bin
nhn ln hn 2 inches (51 mm). Kh xc nh bin nhn
ti cnh ging v c th hu ch khi s dng thit b phn
hi cung cp thng tin nu c.
Tc nhn ngc
2015 ( cp nht): ti a ha tnh n gin trong o to
khi khng c y chng c nhi khoa, s hp l khi s
dng tc nhn ngc cho ngi ln c khuyn ngh l
100n 120 ln/pht cho tr s sinh v tr em.
2010 (C): Nhn nhanh: Nhn tc t nht l 100 ln
nhn mi pht.
L do: Mt nghin cu lu tr v ngi ln cho thy
bin nhn ngc khng y vi tc nhn nhanh
qu mc. ti a ha tnh nht qun v duy tr gio dc
khi khng c d liu nhi khoa, cc chuyn gia nhi khoa
p dng cng mt khuyn co cho tc nhn c
a ra cho BLS (Basic Life Support; Hi sinh tim phi c
bn) cho ngi ln. Xem mc BLS (Basic Life Support; Hi
sinh tim phi c bn) cho ngi ln v Cht lng CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) ca n
bn ny bit thm chi tit.
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim

phi) nhn ngc n thun
A miodarone hoc lidocaine l mt cht chng lon nhp tim c chp nhn
cho chong khng do rung tht nhi khoa v tim nhp nhanh v mch
tr em.
2015 ( cp nht): Nn thc hin CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi) truyn thng (h hp
nhn to v nhn ngc) cho tr s sinh v tr nh b
ngng tim. Tnh cht ngt ca hu ht cc ca ngng tim
nhi khoa i hi phi thng kh nh mt phn ca CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) hiu
qu. Tuy nhin, do CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) nhn ngc n thun ch c th hiu
qu nhng bnh nhn ngng tim tin pht, nu ngi
cu h khng sn lng hoc khng th thc hin h hp
nhn to, chng ti khuyn co ngi cu h thc hin CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) nhn
ngc n thun cho tr s sinh v tr em b ngng tim.
E pinephrine vn c khuyn co dng lm cht tng huyt p tr em b

ngng tim.
2010 (C): CPR (Cardiopulmonary Resuscitation; Hi sinh Tim

phi) ti u tr s sinh v tr em bao gm c nhn ngc v
thng kh cn nhn ngc n thun khng c u tin cho
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi).
M
t vi bin s lm sng trong ngng tim v sau ngng tim c kim tra
ngha tin lng. Khng c bin s n l no c xc nh l tin cy d
on kt qu. Do ngi chm sc cn cn nhc nhiu nhn t khi c gng d
on kt qu trong khi ngng tim v hu ti lp tun hon t nhin.
L do: Cc nghin cu lu tr ln cho thy kt qu t hn

i vi cc ca ngng tim nhi khoa c cho l do ngt (bao
gm ch yu l cc ca ngng tim nhi khoa ngoi bnh vin)
c iu tr bng CPR (Cardiopulmonary Resuscitation;
Hi sinh Tim phi) nhn ngc n thun. Trong 2 nghin
cu, khi CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) truyn thng (nhn ngc cng vi th) khng c
thc hin trong ca ngng tim c cho l do ngt th kt
qu khng khc so vi khi nn nhn khng c tip nhn
bt k CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) no t ngi xung quanh. Khi c cn nguyn v tim
c c on th kt qu l tng t cho d thc hin CPR
thng hay nhn ngc n thun.
S au khi ti lp tun hon t nhin, vic truyn dch v truyn hot mch cn
c s dng duy tr huyt p tm trng trn 50 bch phn v cho tui .
Duy tr s sng nng cao tr em

Nhiu vn chnh trong khi nh gi t liu v duy tr s
sng nng cao tr em dn n vic iu chnh cc khuyn
co hin ti ch khng a ra nhng khuyn co mi.
Thng tin mi hoc cp nht c a ra v truyn dch
trong hi sc trong bnh gy st, vic s dng atropone
trc khi t ni kh qun, vic s dng amiodarone v
lidocaine trong chong khng do rung tht/tim nhp
nhanh v mch, TTM (targeted temperature management;
kim sot nhit mc tiu) sau khi hi sinh ngng tim
tr s sinh v tr em v kim sot huyt p sau ngng tim.
T rong nhng trng hp c th khi iu tr bnh nhn nhi khoa c bnh gy
st th vic s dng lng tinh ng trng hn ch dn n kh nng sng
st c ci thin. iu ny tri ngc vi suy ngh truyn thng rng hi sinh
theo lng nhiu u n l c li.
N gi ta vn ang tranh ci vic s dng u n atropine lm thuc tin m
cho t ni kh qun khn cp khng phi tr s sinh, c bit phng trnh
lon nhp tim. ng thi c d liu cho thy rng khng c liu ti thiu cn
thit i vi atropine cho ch dn ny.
N u sn c theo di huyt p ng mch xm ln th c th c s dng
iu chnh CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi) t c
mc tiu huyt p c th cho tr em b ngng tim.
i vi cc bnh nhn nhi khoa c chn on tim v IHCA (in-hospital cardiac

arrests; ngng tim trong bnh vin) trong nhng trng hp c giao thc trao
i oxy qua mng ngoi c th hin ti th c th cn nhc ECPR (extracorporeal
CPR; Hi sc Tim phi ngoi c th).
C n trnh st khi chm sc tr em hn m c ti lp tun hon t nhin sau khi
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi bnh vin). Mt th
nghim i chng ngu nhin ln v liu pht lm gim thn nhit cho tr em
b OHCA (out-of-hospital cardiac arrests, ngng tim ngoi bnh vin) cho thy
khng c khc bit trong kt qu cho d thc hin liu pht lm gim thn
nhit vi mc va phi (vi nhit c duy tr 32C n 34C) hay duy
tr cht ch nhit bnh thng (vi nhit c duy tr 36C n 37C).
S au khi ti lp tun hon t nhin cn t mc tiu n mc oxy bnh thng.

Khi sn c thit b cn thit th cn chm dt cho dng oxy t mc tiu mt
bo ha oxy ca hemoglobin l 94% n 99%. Cn cht ch trnh thiu oxy.
L tng l oxy cn c chun n mt gi tr ph hp vi tnh trng ca
bnh nhn c th. Tng t, sau khi ti lp tun hon t nhin cn t mc tiu
Paco2 ca tr mt mc ph hp vi tnh trng ca mi bnh nhn. Cn trnh
nguy c tng CO2 huyt hoc gim CO2 huyt nghim trng.
Khuyn co cho Truyn dch trong hi sc

2015 (Mi): Vic cho dng cc dung dch ng trng IV
sm v nhanh c chp nhn rng ri nh nn mng ca
liu php cho sc nhim trng. Gn y, mt th nghim
i chng ngu nhin ln v truyn dch trong hi sc c
tin hnh tr em c bnh gy st nghim trng trong
trng hp ti nguyn hn ch thy rng kt qu t hn
gn lin vi tim nhanh dung dch IV. i vi tr em b sc
th tim nhanh dung dch ln u mc 20 mL/kg l hp l.
Tuy nhin, i vi tr em c bnh gy st trong trng hp
tip cn hn ch vi ti nguyn chm sc thit yu (thng
kh c hc v h tr co tht tim) th vic cho dng cc dung
dch IV bng cch tim nhanh cn c tin hnh v cng
thn trng do c th c tc hi. iu tr c th ha v nh
gi li lm sng thng xuyn c ch trng.
L do: Khuyn co ny tip tc ch trng vic cho dng
dung dch IV tr em b sc nhim trng. Ngoi ra khuyn
co ch trng cc k hoch iu tr c th ha cho mi
bnh nhn da trn nh gi lm sng thng xuyn
trc, trong v sau khi tin hnh tr liu bng dung dch
v gi nh tnh sn c ca cc phng php tr liu chm
sc quan trng khc. Trong nhng trng hp hn ch ti
nguyn c th, vic tin hnh tim nhanh dung dch qu
mc cho tr em ang st c th dn n cc bin chng
nu khng c thit b v chuyn mn ph hp gii
quyt hiu qu cc mi tim.
Atropine cho t ni kh qun

2015 ( cp nht): Khng c chng c ng h vic routine s
dng u n atropine lm thuc tin m phng trnh
nhp tim chm trong t ng cp cu nhi khoa. C th cn
25
nhc trong nhng tnh hung gia tng nguy c nhp tim
gim. Khng c chng c ng h mt liu atropine ti thiu
khi c s dng lm cht tin m cho t ng cp cu.
2010 (C): Mt liu atropine ti thiu l 0,1 mg IV c
khuyn ngh t cc bo co v nhp tim chm nghch l xy ra
tr s sinh rt nh c tip nhn cc liu atropine thp.
L do: Chng c gn y mu thun v vic liu atropine
c phng trnh nhp tim chm v cc chng lon nhp tim
khc trong khi t ng cp cu tr em. Tuy nhin nhng
nghin cu gn y ny s dng cc liu atropine di
0,1 mg m khng tng kh nng b lon nhp tim.
Theo di huyt ng lc xm ln trong CPR

(Cardiopulmonary Resuscitation; Hi sinh Tim phi)
2015 ( cp nht): Nu vic theo di huyt ng lc xm lm
sn c ti thi im tr b ngng tim th c th hp l khi s
dng vic ny dn dt cht lng CPR (Cardiopulmonary
2010 (C): Nu bnh nhn c catheter ng mch trong th
c th s dng dng sng nh phn hi nh gi v tr
tay v bin nhn ngc. Nhn n mt mc tiu huyt p
tm trng c th cha c nghin cu ngi nhng c
th ci thin kt qu ng vt.
L do: Hai th nghim i chng ngu nhin ng vt
thy rng c ci thin trong ti lp tun hon t nhin v
kh nng sng st sau khi hon thnh th nghim khi k
thut CPR c iu chnh da trn c s theo di huyt
ng lc xm ln. iu ny cha c nghin cu ngi.
Cc thuc chng lon nhp cho Chong khng do

rung tht hoc Nhp nhanh tht v mch
2015 ( cp nht): Amiodarone hoc lidocaine c chp
nhn nh nhau cho iu tr chong khng do rung tht
hoc nhp nhanh tht v mch tr em.
2010 (C): Amiodarone c khuyn co cho chong
khng do rung tht hoc nhp nhanh tht v mch. C th
cho dng lidocaine nu khng sn c amiodarone.
L do: Lu tr theo di t trc gn y ca nhiu vin v
tr nhp vin b ngng tim cho thy rng so vi amiodarone
th lidocaine gn lin vi t l ti lp tun hon t nhin v
kh nng sng st sau 24 gi cao hn. Tuy nhin vic cho
dng c lidocaine v amiodarone u khng gn lin vi
kh nng sng st c ci thin sau khi xut vin.
Tng huyt p cho hi sinh

2015 ( cp nht): S hp l khi cho dng epinephrine trong
ca ngng tim.
2010 (C): Cn cho dng epinephrine cho ca ngng tim v
mch.
L do: Khuyn co v vic cho dng epinephrine trong ca
ngng tim b coi nh trong Lp khuyn ngh. Khng c
nghin cu nhi khoa cht lng cao no cho thy hiu qu
ca bt k cht lm tng huyt p no trong ngng tim. Hai
nghin cu quan st nhi khoa khng c tnh thuyt phc v
1 nghin cu ngu nhin ngi ln ngoi bnh vin thy
rng epinephrine gn lin vi ti lp tun hon t nhin
26
v kh nng sng st c ci thin sau khi nhp vin ch

khng phi l sau khi xut vin.
ECPR (extracorporeal CPR; Hi sc Tim phi ngoi c

th) so vi Hi sinh tiu chun
2015 ( cp nht): C th cn nhc ECPR (extracorporeal CPR;
Hi sc Tim phi ngoi c th) cho tr em vi tnh trng tim
c s b IHCA (in-hospital cardiac arrests; ngng tim trong
bnh vin) vi giao thc, chuyn mn v thit b ph hp
sn c.
2010 (C): Cn nhc kch hot sm h tr sng ngoi c th
cho ngng tim xy ra trong mi trng c gim st cht
ch, v d nh n v chm sc chuyn su, vi giao thc
lm sng sn c v chuyn mn v thit b sn c bt
u nhanh chng. Ch nn cn nhc h tr sng ngoi c
th cho tr em b ngng tim khng cc n lc hi sinh
tiu chun vi nguyn nhn ngng tim c kh nng c th
o ngc.
L do: OHCA (out-of-hospital cardiac arrests, ngng tim
ngoi bnh vin) tr em khng c cn nhc. i
vi IHCA (in-hospital cardiac arrests; ngng tim trong bnh
vin) khoa nhi, khng c s khc bit trong kh nng
sng st tng th khi so snh ECPR (extracorporeal CPR;
Hi sc Tim phi ngoi c th) vi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) m khng c trao i oxy
qua mng ngoi c th. nh gi lu tr theo di t trc
cho thy kt qu tt hn vi ECPR (extracorporeal CPR; Hi
sc Tim phi ngoi c th) cho bnh nhn c bnh tim so
vi nhng ngi b bnh phi l bnh tim.
Kim sot nhit mc tiu

2015 ( cp nht): i vi tr em hn m trong mt vy ngy
u tin sau khi ngng tim (trong bnh vin hoc ngoi
bnh vin), cn theo di nhit lin tc v tch cc iu tr
cn st.
i vi tr hn m c hi sinh t OHCA (out-of-hospital
cardiac arrests, ngng tim ngoi bnh vin), s hp l khi
ngi chm sc duy tr 5 ngy nhit bnh thng (36C
n 37,5C) hoc 2 ngy gim thn nhit lin tc ban u
(32C n 34C) sau l 3 ngy nhit bnh thng.
i vi tr duy tr hn m sau khi IHCA (in-hospital cardiac
arrests; ngng tim trong bnh vin) cha c d liu
khuyn co gim thn nhit so vi nhit bnh thng.
2010 (C): C th cn nhc liu php lm gim thn nhit
(32C n 34C) cho tr duy tr hn m sau khi hi sinh t
ngng tim. S hp l khi thanh thiu nin c hi sinh
t ngng tim do rung tht ngoi bnh vin c ngi
chng kin.
L do: Mt nghin cu trin vng a trng tm v cc nn
nhn OHCA (out-of-hospital cardiac arrests, ngng tim
ngoi bnh vin) khoa nhi ngu nhin c tip nhn
liu php lm gim thn nhit (32C n 34C) hoc nhit
bnh thng (36C n 37,5C) cho thy khng c khc
bit trong kt qu chc nng sau 1 nm gia 2 nhm.
Nghin cu ny v nhng nghin cu khc cho thy khng
c bin chng khc trong nhm c iu tr bng liu
php lm gim thn nhit. Cc kt qu hin cn ang treo
t th nghim ln i chng ngu nhin a trng tm v
liu php lm gim thn nhit cho bnh nhn hn m sau
khi ti lp tun hon t nhin sau IHCA (in-hospital cardiac

arrests; ngng tim trong bnh vin) khoa nhi (xem trang
web Liu php lm gim thn nhit sau ngng tim nhi khoa:
www.THAPCA.org).
Cc Nhn t tin lng trong v sau ngng tim

2015 ( cp nht): Cn cn nhc nhiu nhn t khi c gng
d on kt qu trong khi ngng tim. Nhiu nhn t c
vai tr trong quyt nh tip tc hay chm dt cc n lc
hi sinh trong ngng tim v d tnh kh nng hi phc sau
ngng tim.
2010 (C): Nhng ngi hnh ngh cn cn nhc nhiu bin
s tin lng kt qu v s dng nhn nh chun
cc n lc cho ph hp.
L do: Khng c bin s trong v sau ngng tim no c
thy l d on kt qu tt hoc xu mt cch ng tin cy.
Cc Dung dch v thuc lm tng co c cho sau

ngng tim
2015 (Mi): Sau khi ti lp tun hon t nhin, vic truyn
dch v truyn thuc lm tng co c/hot mch cn c
s dng duy tr huyt p tm trng trn 50 bch phn
v cho tui . Cn s dng theo di huyt p trong ng
mch theo di lin tc huyt p v nhn bit v iu tr
gim huyt p.
L do: Khng c nghin cu no c xc nh l nh
gi cc cht hot mch c th cc bnh nhn nhi khoa hu
ti lp tun hon t nhin. Cc nghin cu quan st gn y
thy rng tr tng b gim huyt p hu ti lp tun hon
t nhin c kh nng sng st sau khi xut vin thp hn v
bin chng thn kinh t hn.
Pao2 v Paco2 sau ngng tim

2015 ( cp nht): Sau khi ti lp tun hon t nhin tr
em, c th hp l khi ngi cu h chun vic cho dng
oxy t c nhit bnh thng ( bo ha oxy ca
hemoglobin l 94% hoc hn). Khi sn c thit b cn thit
th cn chm dt cho dng oxy t mc tiu mt bo
ha oxy ca hemoglobin trong khong t 94% n 99%.
Mc tiu l cn cht ch trnh thiu oxy trong khi duy tr
mc oxy bnh thng. Tng t, cc chin lc thng kh
hu ti lp tun hon t nhin tr cn t mc tiu PaCO2
sao cho ph hp cho mi bnh nhn trong khi trnh tng
CO2 huyt hoc gim CO2 huyt qu mc.
2010 (C): Khi tun hon c khi phc, nu sn c thit b
ph hp th c th hp l khi chm dt t l ca oxy ht vo
duy tr bo ha oxy ca hemoglobin l 94% hoc ln
hn. Khng c khuyn co c a ra v PaCO2.
L do: Mt nghin cu quan st ln khoa nhi v IHCA
(in-hospital cardiac arrests; ngng tim trong bnh vin) v
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi bnh
vin) thy rng mc oxy bnh thng (c nh ngha l
PaO2 t 60 n 300 mm Hg) gn lin vi kh nng sng st
c ci thin sau khi c ra khi n v chm sc chuyn
su nhi khoa khi so vi tha oxy (PaO2 ln hn 300 mm Hg).
Cc nghin cu ngi ln v ng vt cho thy t l t
vong tng ln gn lin vi tha oxy. Tng t, cc nghin cu
ngi ln sau khi ti lp tun hon t nhin cho thy kt
qu t hn bnh nhn gn lin vi tng CO2 huyt.
Hi sc tr s sinh
Ngng tim tr s sinh phn ln l do ngt v th vic bt
u thng kh duy tr trng im hi sinh ban u. Di y
l cc ch chnh v tr s sinh trong nm 2015:
T h t ca 3 vn nh gi thay i thnh (1) Thai k c khng?
(2) Tnh trng c tt khng? v (3) Th hay khc?
D u hiu Pht vng (60 giy) hon thnh cc bc ban u l nh gi li
v bt u thng kh (nu cn) c gi li nhn mnh tm quan trng ca
vic trnh tr hon khng cn thit trong vic bt u thng kh, bc quan
trng nht cho hi sinh thnh cng tr va sinh khng phn ng vi nhng
bc ban u.
C khuyn co mi rng kp dy nhau tr hon hn 30 giy l hp l cho tr s
sinh ngy v tr sinh non khng cn hi sinh khi sinh nhng khng c
chng c khuyn co cch tip cn kp dy nhau cho tr s sinh cn hi sinh
khi sinh v ngh chng li vic s dng u n vic vt dy rn (bn ngoi
trng hp nghin cu) cho tr sinh di 29 tun ca thai k cho n khi bit
nhiu hn v cc li ch v bin chng.
Cn ghi li nhit l ch s d bo kt qu v l ch s cht lng.
N hit ca tr s sinh khng b ngt khi mi sinh cn c duy tr t 36,5C
n 37,5C sau khi sinh thng qua nhn v n nh ha.
M
t lot cc chin lc (lng p ta nhit, bc plastic c m, chiu nhit, kh
m nng v nhit phng tng ln cng vi m cng vi chiu nhit) c th
hp l phng trnh gim thn nhit tr sinh non. Cn trnh thn nhit
cao (nhit ln hn 38C) v hin tng ny em li nhiu nguy c gn lin
c th xy ra.
T rong cc trng hp hn ch ti nguyn, cc bin php n gin phng
trnh gim thn nhit trong nhng gi u tin trong i (s dng bc plastic,
da tip xc da v thm ch t tr s sinh sau khi lm kh trong ti plastic ng
thc phm sch trm n c) c th lm gim t l t vong.
N u tr sinh qua nc i nhum phn su v c biu hin c yu v hi th
khng , cn t tr s sinh di lng p ta nhit v cn bt u PPV
(positive-pressure ventilation; Thng kh p lc dng) nu cn. Khng nn
p dng quy trnh lun ng ht ni kh qun na bi v khng c bng
chng tip tc khuyn co ny. S can thip ph hp h tr thng kh v
trao i oxy nn bt u nh c ch dn cho mi mt tr s sinh c lp. iu
ny c th bao gm c qu trnh t v ht nu ng th b tc.
nh gi nhp tim vn quan trng trong pht hi sinh u tin v vic s
dng ECG (electrocardiogram; in tm ) 3 im c th hp l v nh cung
cp khng th tip cn nhp tim chnh xc bng thnh chn hay bt mch
v my o oxy da vo mch p c th m thiu nhp tim. S dng ECG
(electrocardiogram; in tm ) khng thay th nhu cu cn my o oxy da
vo mch p nh gi trao i oxy ca tr s sinh.
C n bt u hi sinh tr sinh non di 35 tun ca thai k vi oxy thp (21%
n 30%) v oxy c chun t c bo ha oxy trc ng mch
ng bng khong t c tr s sinh ngy khe mnh.
K hng c d liu v an ton v phng php p dng bm duy tr trong
thi gian hn 5 giy cho tr va sinh mi chuyn.
C th cn nhc mt n thanh qun l mt phng n thay th cho t ni
kh qun nu mt n thng kh khng thnh cng v mt n thanh qun c
khuyn co trong khi hi sinh tr va sinh 34 tun thai k hoc hn khi t
ni kh qun khng thnh cng hoc khng kh thi.
T r sinh non th ng thi vi suy h hp c th c h tr bng p lc ng
th dng lin tc thay v t ng u n cho dng PPV (positive-pressure
ventilation; Thng kh p lc dng).
27
Bng 3
Khi nim o to chnh v AHA ECC
n gin ha
Ni dung kha hc phi c n gin ha theo c phn trnh by ni dung v rng ca ni dung nhm to iu kin t c cc mc
tiu ca kha hc.10,11
Tnh nht qun
Ni dung kha hc v trnh din k nng phi c trnh by theo cch thc nht qun. Hng dn qua video, va xem va thc hnh l
phng php u tin cho o to k nng tm vn ng c bn v phng php ny gim tnh bin ng ca ngi hng dn, c th i
trch khi lch trnh d kin ca kha hc.11-14
Ng cnh
Nguyn tc hc tp cho ngi ln15 phi c p dng cho tt c cc kha hc ECC, tp trung vo vic to cc tnh hung o to c lin
quan c th c p dng trn thc t theo bi cnh th gii thc ca ngi hc chng hn nh cho ngi hc bnh vin thc hnh CPR
trn ging thay v trn sn.
Thc hnh thc t
Cn c thc hnh thc t mt cch ng k t c mc tiu hiu qu ca k nng lnh o/phi k thut v tm vn ng.11,12,16-18
Thc hnh n mc
tinh thng
Ngi hc phi c c hi thc hin nhiu ln cc k nng chnh cng vi nh gi kht khe v phn hi giu thng tin trong mt mi trng
c kim sot.19-22 Chng trnh thc hnh thn trng ny phi da vo mc tiu xc nh r rng23-25 v khng mt nhiu thi gian, nhm
gip hc vin tr thnh bc thy. 26-30
Phng vn
Vic cung cp phn hi v/hoc thm tra l mt thnh phn quan trng ca hc tp thc nghim.31 Phn hi v thm tra sau khi thc hnh
v m phng k nng cho php ngi hc (v nhm ngi hc) c c hi suy ngm v hiu qu hc tp v nhn c phn hi c cu trc v
cch ci thin kt qu hc tp ca h trong tng lai.32
nh gi
nh gi hc tp trong kha hc hi sc nhm mc ch m bo t c nng lc ng thi a ra cc tiu chun m sinh vin s phn
u. nh gi cng cung cp c s cho phn hi ca sinh vin (nh cho cho hot ng hc tp). Chin lc nh gi phi nh gi nng lc
v khuyn khch hc tp. Mc tiu hc tp33 phi r rng v c th o lng c ng thi ng vai tr l c s cho nh gi.
nh gi kha hc/
chng trnh
y l mt hp phn c bn ca chng trnh o to v hi sc, c nh gi v kha hc hi sc bao gm ngi hc, ngi hng dn,
kha hc v hiu qu ca chng trnh.34 T chc o to phi s dng thng tin ny thc y quy trnh ci tin cht lng lin tc.
Vit tt: AHA, American Heart Association; CPR, hi sinh tim phi; ECC, cp cu tim mch.
C c khuyn co v k thut nhn ngc (dng 2 ngn ci v bn ngn cn li

bao quanh) v t l nhn ngc-thng kh (3: 1 vi 90 ln nhn v 30 ln th mi
pht) duy tr khng thay i. Nh trong cc khuyn co nm 2010, ngi cu
h c th cn nhc s dng cc t l cao hn (v d 15: 2) nu ngng tim c
cho l c cn nguyn v tim.
M
c d khng c nghin cu lm sng v vic s dng oxy trong CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) nhng Nhm vit
hng dn cho tr s sinh vn tip tc ng s dng 100% oxy bt k khi
no thc hin nhn ngc. S hp l khi chm dt tp trung oxy ngay khi
nhp tim hi phc.
C c khuyn co v vic s dng epinephrine trong CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) v cho dng theo liu lng khng c nh
gi trong nm 2015 v vy cc khuyn co nm 2010 vn cn hiu lc.
L iu php lm gim thn nhit do cm ng nhng khu vc di do ti
nguyn cho tr sinh tun 36 thai k hoc hn c hin tng no thiu oxythiu mu cc b t trung bnh n nghim trng khng c nh gi trong
nm 2015 v vy cc khuyn co nm 2010 vn cn hiu lc.
C th cn nhc s dng liu php lm gim thn nhit trong cc trng hp
hn ch ti nguyn theo giao thc quy nh r rng tng t nh nhng giao
thc dng trong th nghim lm sng v ti cc c s c kh nng chm sc a
ngnh v theo di.
N hn chung, khng c d liu mi c xut bn xc minh thay i trong cc
khuyn co nm 2010 v vic khng hoc hy b hi sinh. Ch s Apgar bng
0ti thi im 10 pht l mt ch s d bo chc chn v t l t vong v t
sut bnh tr sinh non v tr ngy b mt nhng nhng quyt nh tip
tc hay ngng cc n lc hi sinh phi c c th ha.
V ic o to nhim v hi sinh tr s sinh c ngh din ra thng xuyn
hn khong cch 2 nm hin nay.
28
Kim sot dy rn: Kp dy nhau tr hon

2015 ( cp nht): Kp dy nhau tr hon sau 30 giy c
ngh cho c tr sinh ngy v tr sinh non khng cn hi
sinh khi sinh. Khng c chng c khuyn co cch
tip cn kp dy nhau cho tr s sinh cn hi sinh khi sinh.
2010 (C): Ngy cng c nhiu chng c v li ch ca vic
tr hon kp dy nhau trong t nht 1 pht c tr sinh
ngy v tr sinh non khng cn hi sinh. Khng c
chng c ng h hoc bc b khuyn co tr hon kp
dy nhau tr s sinh cn hi sinh.
L do: tr s sinh khng cn hi sinh th kp dy nhau tr
hon gn lin vi xut huyt no tht, huyt p cao v th
tch mu cao hn, nhu cu truyn sau sinh thp hn v t b
vim rut hoi t hn. Hu qu xu duy nht thy c l
mc bilirubin tng nh, gn lin vi nhu cu cn quang tr
liu nhiu hn.
Ht tr s sinh khng khe mnh qua

nc i nhum phn su
2015 ( cp nht): Nu tr sinh qua nc i nhum phn su c
biu hin c yu v hi th khng , cc bc hi sc ban
u nn c hon thnh vi bc x m hn. PPV (positivepressure ventilation; Thng kh p lc dng) nn c bt
u nu tr s sinh khng th hoc nhp tim nh hn 100/
pht sau khi hon thnh cc bc ban u. Khng nn p
dng quy trnh lun ng ht ni kh qun phn ny, bi
v khng c bng chng tip tc phn thc hnh .
Tuy nhin, vn nn c ngi c kinh nghim trong vic lun

ng th cho tr s sinh trong nhm phng giao nhn.
2010 (C): Khng c bng chng gi s thay i v
quy trnh thc hin ht ni kh qun hin ti cho tr khng
khe mnh qua nc i nhum phn su.
L do: Xem xt bng chng gi rng quy trnh hi sc nn
theo cc tiu ch chung cho tr sinh qua nc i nhum phn
su vi nhng tr sinh qua nc i sch; iu c ngha l,
nu c biu hin c khng khe v th khng th cc
bc bt u hi sc (lm m v duy tr nhit , gi v tr
ca tr, lm sch ng th ca c quan bi tit nu cn, lm
kh, v kch thch tr s sinh) nn c hon thnh trn c
s m hn. PPV (positive-pressure ventilation; Thng kh p
lc dng) nn c bt u nu tr s sinh khng th hoc
nhp tim nh hn 100/pht sau khi hon thnh cc bc ban
u. Cc chuyn gia t gi tr ca vic trnh tc hi (v d, tr
hon a ti-mt n thng kh, nhn t c hi tim n trong
quy trnh) ln trn li ch cha c bit n khi can thip
bng quy trnh t v ht ni kh qun. S can thip ph hp
h tr thng kh v trao i oxy nn bt u nh c
ch dn cho mi mt tr s sinh c lp. iu ny c th bao
gm c qu trnh t v ht nu ng th b tc.
nh gi Nhp Tim: S dng ECG

(electrocardiogram; in tm ) 3-ch
2015 ( cp nht): Trong qu trnh hi sc ca tr
sinh thng v tr sinh thiu thng, s dng ECG
(electrocardiogram; in tm ) 3-ch o nhp tim cho
tr s sinh c nhanh chng v chnh xc c th s hu
ch. S dng ECG (electrocardiogram; in tm ) khng
thay th nhu cu cn my o oxy da vo mch p
nh gi trao i oxy ca tr s sinh.
2010 (C): Mc d s dng ECG (electrocardiogram; in
tm ) khng c cp vo nm 2010, nhng vn
lm th no nh gi nhp tim vn c cp ti: nh
gi nhp tim nn c thc hin bng cch chn bnh
khng lin tc mch p trc tim. Khi mt mch p c
pht hin, vic xem mch xung rn cng c th cung cp
c tnh nhanh chng ca mch v chnh xc hn l xem
mch ti cc im khc. My o oxy da vo mch p c
th cung cp nh gi mch lin tc m khng gin on
cc bin php hi sc khc, nhng thit b ny mt 1-2 pht
dng c v c th khng hot ng trong tnh trng
u ra ca tim yu hoc khi truyn dch.
L do: nh gi lm sng nhp tim ti phng giao nhn cho
thy l khng ng tin cy v khng chnh xc. S nh gi
thp nhp tim c th dn n vic hi sc khng cn thit.
ECG (electrocardiogram; in tm ) c cho l hin th
nhp tim chnh xc nhanh hn so vi my o oxy da vo
mch p. My o oxy da vo mch p thng xuyn
hin th mt t l thp trong 2 pht u tin ca s sng,
thng cc cp cho thy s cn thit phi can thip.
Qun l Oxy cho Tr s sinh thiu thng

2015 ( cp nht): Hi sc cho tr sinh non cha 35 tun
ca thai k nn c bt u vi lng oxy thp (21% n
30%), v nng oxy nn c chun t c mt
bo ha oxy trc ng ng mch xp x di t phn
c o tr s sinh khe mnh thng sau khi sinh ng
m o mc nc bin. Khng nn bt u hi sc cho tr
s sinh thiu thng vi lng oxy cao (65% hoc hn).

ngh ny phn nh u tin cho vic khng mo him tr s
sinh thiu thng vi lng oxy b sung m khng c d liu
chng minh li ch c cng nhn cho nhng kt qu
quan trng.
2010 (C): Bt u hi sc vi mc kh (21% oxy mc nc
bin) l hp l. Oxy b sung c th c qun l v chun
t c mt bo ha xy trc ng ng mch
xp x di t phn c o tr s sinh khe mnh
thng sau khi sinh ng m o mc nc bin. Hu ht d
liu l cho tr sinh thng khng trong qu trnh hi sc,
v mt nghin cu n l vi tr sinh non trong qu trnh
hi sc.
L do: D liu hin ti c sn t phn tch tng hp ca
7 nghin cu ngu nhin chng minh khng c li ch trong
s sng cn n vic bi chc bnh vin, cng tc phng
chng lon sn ph qun, xut huyt no tht hoc bnh
vng mc do sinh non khi tr sinh thiu thng (t hn
35 tun ca thai k) c hi sc vi nng oxy cao (65%
hoc hn) so vi nng oxy thp (21% n 30%).
Liu php lm gim thn nhit Sau hi sc:

bi cnh ti nguyn gii hn
2015 ( cp nht): Ngi ta khuyn ngh rng vic s dng
liu php lm gim thn nhit trong bi cnh ti nguyn
gii hn (v d thiu i ng nhn vin c trnh , khng
y thit b v. v. ) c th c xem xt v c cung cp
theo giao thc quy nh r rng tng t nh nhng giao
thc dng trong th nghim lm sng c cng b v ti
cc c s c kh nng chm sc a ngnh v theo di theo
chiu dc.
2010 (C): Tr sinh t 36 tun ca thai k tr ln c hin
tng no thiu oxy-thiu mu cc b t trung bnh n
nng c khuyn co nn p dng liu php lm gim
thn nhit. Liu php lm gim thn nhit nn c qun
l theo giao thc quy nh r rng tng t nh nhng giao
thc dng trong th nghim lm sng c cng b v ti
cc c s c kh nng chm sc a ngnh v theo di theo
chiu dc.
L do: Trong khi khuyn co s dng liu php lm gim thn
nhit trong iu tr hin tng no thiu oxy-thiu mu cc
b t trung bnh n nng trong bi cnh ti nguyn phong
ph vn khng c g thay i, th mt khuyn co c b
sung hng dn vic s dng cc phng thc ny trong
bi cnh ni ngun ti nguyn c th hn ch cc la chn
cho mt s phng php iu tr.

Gio dc
Mc d c nhng tin b khoa hc ng k trong vic chm

sc ca nn nhn ngng tim, vn c bin ng ng k
trong t l sng st m khng th quy cho c tnh bnh
nhn mt mnh. ti u ha kh nng rng nn nhn
ngng tim nhn c chm sc da trn bng chng cht
lng cao nht, gio dc hi sc phi s dng nguyn tc
gio dc m thanh c h tr bng nghin cu gio dc thc
nghim bin kin thc khoa hc vo thc tin. Trong
khi hng dn gio dc AHA 2010 bao gm thc hin v
cc i trong khuyn ngh ca n, cc nguyn tc gio dc
AHA vo nm 2015 hin nay tp trung cht ch v gio dc,
29
vi vic thc hin v cc i c bao gm trong cc phn

khc ca bn Hng dn Cp Nht nm 2015.
Khuyn ngh quan trng v cc im nhn mnh bao gm:
K huyn ngh s dng mt thit b thng tin phn hi CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) h tr trong vic hc cc k nng tm l
ca CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi). Thit b cung cp
ng thng tin phn hi v hiu sut c a thch hn thit b cung cp ch
bo (v d nh my nhp).
V ic s dng cc ma-n-canh trung thc cao c khuyn khch cho cc
chng trnh c c s h tng, nhn vin c o to, v cc ngun lc duy
tr chng trnh. ma-n-canh tiu chun tip tc l mt s la chn thch hp
cho cc t chc cha c kh nng ny.
K nng BLS (Basic Life Support; Hi sinh tim phi c bn) dng nh cng
d hc thng qua t hng dn (da trn video hoc my tnh) vi thc hnh
thc t ging nh hc thng qua cc kha hc truyn thng c ging vin
hng dn.
M
c d o to trc v CPR (Cardiopulmonary Resuscitation; Hi sinh Tim
phi) khng phi l thit yu i vi ngi cu h tim nng bt u
CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi), nhng o to ny
s gip mi ngi hiu cc k nng v pht trin s t tin cung cp CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) khi gp mt nn nhn
ngng tim.
gim thiu thi gian kh rung tim cho nn nhn ngng tim, vic trin khai
mt AED (automated external defibrillator; my kh rung bn ngoi t ng)
khng nn gii hn cho cc c nhn c o to (mc d o to vn cn c
khuyn ngh).
S kt hp gia t hng dn v cc kha hc c ging vin hng dn vi o
to thc t c th c coi l mt thay th cho cc kha o to c ngi hng
dn truyn thng cho nh cung cp khng chuyn.
C hun b trc kha hc bao gm xem xt cc thng tin ni dung ph hp,
kim tra trc tuyn/trc kha hc, v/hoc thc hnh cc k nng k thut
cn thit c th ti u ha vic hc t cc kha hc h tr cuc sng nng cao
dnh cho ngi ln v tr em.
V i tm quan trng ca ng lc nhm trong hi sc, o to vi s tp trung
vo nguyn tc lnh o v lm vic nhm nn c tch hp vo cc kha hc
h tr nng cao cuc sng.
C c cng ng c th xem xt o to ngi xung quanh cho vic CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) ch nhn i vi ngi ln
OHCA (out-of-hospital cardiac arrests, ngng tim ngoi bnh vin) nh l mt
thay th cho o to CPR (Cardiopulmonary Resuscitation; Hi sinh Tim phi)
thng thng.
C hu k o to li hai nm khng phi l ti u. o to thng xuyn hn
na v cc k nng h tr s sng t c bn ti nng cao c th hu ch cho nh
cung cp c kh nng gp phi mt ngi ngng tim.
Nhm vn bn hng dn gio dc AHA ECC nm 2015 nht
tr v mt s khi nim ct li hng dn pht trin cc
kha hc v ti liu hc (Bng 3).
Thit b Phn hi CPR (Cardiopulmonary

Resuscitation; Hi sinh Tim phi)
2015 ( cp nht): S dng thit b phn hi c th hiu qu
trong vic ci thin hiu sut ca CPR trong o to.
2015 (Mi): Nu khng c cc thit b phn hi, hng dn
thnh gic (v d: my nhp, m nhc) c xem xt ci
thin vic tun th cc khuyn ngh cho t l nhn ngc.
2010 (C): S dng thit b phn hi CPR c th hiu qu
trong o to.
30
L do: Bng chng mi phn bit li ch ca cc loi phn

hi khc nhau cho o to, vi mt cht li th nht nh
phn hi ton din hn.
S dng cc ma-n-canh trung thc cao

2015 ( cp nht): Vic s dng ma-n-canh trung thc cao
trong o to nng cao h tr cuc sng c th mang li li ch
cho vic ci thin hiu sut cc k nng khi kt thc kha hc.
2010 (C): ma-n-canh thc t c th hu ch cho vic tch
hp kin thc, k nng, v cc hnh vi trong o to nng
cao h tr cuc sng.
L do: Trong bn nghin cu bng chng nm 2010, khng
c bng chng khuyn ngh s dng quy trnh man-canh thc t hn ci thin hiu sut k nng trong
hi sc thc t, c bit l khi cn nhc cc chi ph b sung
v cc ngun lc cn thit. Xem xt c li ch tim nng ca
vic dng ma-n-canh thc t hn cng nh vic tng chi
ph v ngun lc tham gia, nghin cu mi c xut bn
h tr vic s dng cc ma-n-canh trung thc cao, c
bit l trong cc chng trnh m ti nguyn (v d nh, con
ngi v ngun lc ti chnh) c sn.
Hnh thc Hc Tng hp

2015 ( cp nht): T hng dn CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) thng qua cc video
v/hoc m-un da trn my tnh vi thc hnh thc t
c th l mt la chn hp l cho cc kha hc c ngi
hng dn.
2015 (Mi): S dng phng thc ging dy thay th cho
vic ging dy h tr cuc sng t c bn n nng cao c
th l hp l trong mi trng c ngun lc hn ch.
2010 (C): Hng dn ngn qua video kt hp vi thc hnh
thc t ng b l mt la chn hiu qu cho cc kha hc
BLS c ngi hng dn.
L do: Kt qu ca ngi hc quan trng hn hnh thc ca
kha hc. Vic thu thp v lu gi kin thc v k nng v,
cui cng, hiu qu lm sng v kt qu ca bnh nhn
phi nh hng gio dc hi sc. C bng chng mi ch
ra rng cc nh dng c th, v d nh t hng dn CPR
(Cardiopulmonary Resuscitation; Hi sinh Tim phi) bng
cc video v/hoc m-un da trn my tnh, c th cung
cp kt qu tng t cho cc kha hc c ngi hng dn.
Kh nng s dng hiu qu cc hnh thc kha hc thay th
c bit quan trng trong mi trng ngun lc hn ch
ni m cc kha hc c ngi hng dn c th khng c
chi ph. Cc kha hc t hng dn to c hi o to
nhiu c nhn hn cung cp CPR trong khi gim chi ph
v ngun lc cn thit cho cc yu t o to quan trng
khi xem xt s lng ln cc nhn vin cu h tim nng
ang cn c o to.
o to c ch ch
2015 (Mi): o to nhng ngi chm sc chnh v/hoc
thnh vin gia nh ca bnh nhn c nguy c cao c th l
hp l.
L do: Cc nghin cu u cho thy CPR do cc thnh vin
gia nh c o to v/hoc nhng ngi chm sc bnh
nhn tim mch c nguy c cao thc hin c hiu qu cao so
vi nhng ngi khng c o to.
o to M rng cho AED
i vi cc c nhn c kh nng gp phi ngi ngng tim.
2015 ( cp nht): S kt hp gia t hng dn v o to

c ngi hng dn vi o to thc t c th c coi l
mt thay th cho cc kha o to c ngi hng dn
truyn thng cho nh cung cp khng chuyn. Nu khng
c kha o to c ngi hng dn, th o to t nh
hng c th c xem xt cho cc nh cung cp khng
chuyn hc tp k nng AED.
2015 (Mi): Vi nhng li ch gio dc tim nng ca cc

bui bi dng ngn, thng xuyn kt hp vi kh nng
tit kim chi ph t vic gim thi gian o to v a cc
nhn vin ra khi mi trng lm sng o to bi
dng, s l hp l khi cc c nhn c kh nng gp phi
mt nn nhn ngng tim thc hin o to li da trn
ma-n-canh mt cch thng xuyn hn. Cha c
chng c khuyn ngh khong thi gian ti u.
2015 (Mi): Phng php o to t nh hng c th

c xem xt cho cc chuyn gia chm sc sc khe hc
tp k nng AED.
2010 (C): Bi v ngay c o to ti thiu trong s dng
AED c chng minh l ci thin hiu sut trong ngng
tim m phng, c hi o to cn c sn v khuyn khch
ngi cu h khng chuyn.
L do: AED c th hot ng ng m khng cn bt k o
to trc no: Yu cu o to phi ch trng vic s dng
AED ca cng chng l khng cn thit. Tuy nhin, ngay c
o to ti thiu cng nng cao hiu sut, tnh kp thi v
hiu qu. o to t nh hng m ra cc c hi o to
cho c cc nh cung cp khng chuyn v cc chuyn gia
chm sc sc khe.
Lm vic nhm v Lnh o

2015 ( cp nht): Khi cn nhc nhng nguy c rt nh v tn
hi v li ch tim nng ca o to nhm v lnh o, vic
kt hp o to nhm v lnh o nh l mt phn ca o
to h tr cuc sng nng cao l hp l.
2010 (C): o to k nng lm vic nhm v lnh o nn
c kt hp trong kha hc h tr cuc sng nng cao.
L do: Hi sc l mt qu trnh phc tp m thng lin
quan n s hp tc ca nhiu c nhn. Lm vic nhm v
kh nng lnh o l yu t quan trng ca hi sc hiu
qu. Mc d cc yu t ny rt quan trng, nhng c t bng
chng cho thy o to v lm vic nhm v lnh o nh
hng ti kt qu ca bnh nhn.

Hi sinh Tim phi) nhn ngc n thun
2015 (Mi): Cng ng c th xem xt o to ngi xung
quanh cho vic CPR (Cardiopulmonary Resuscitation; Hi
sinh Tim phi) ch nhn i vi ngi ln OHCA (outof-hospital cardiac arrests, ngng tim ngoi bnh vin)
nh l mt thay th cho o to CPR (Cardiopulmonary
Resuscitation; Hi sinh Tim phi) thng thng.
L do: CPR ch nhn i vi cc nh cung cp khng chuyn
l n gin hn CPR truyn thng (p vi hi th) v thm
ch c th c hun luyn bi mt ngi iu phi trong
lc khn cp. Cc nghin cu thc hin sau mt chin dch
o to CPR ch nhn cho ngi xung quanh trn ton bang
cho thy s ph bin ca c CPR tng th v CPR ch nhn
do ngi xung quanh thc hin u tng ln.
Khong thi gian o to li BLS

2015 ( cp nht): Khi cn nhc vic k nng BLS b gim
nhanh chng sau khi o to, song song vi s ci thin k
nng v s t tin quan st c trong s nhng sinh vin
o to thng xuyn hn, o to li BLS c th l hp l
2010 (C): Hiu sut ca k nng nn c nh gi trong

chng nhn 2 nm v cng c thm khi cn thit.
L do: Trong khi cc bng chng tip tc cho thy rng ti
chng nhn v h tr cuc sng t c bn ti nng cao
mi 2 nm l khng cho hu ht mi ngi, thi im
ti u o to li vn cha c xc nh. Cc yu t
nh hng n khong thi gian o to li ti u bao
gm cht lng o to ban u, thc t cho thy mt s
k nng dng nh d b mt i hn so vi nhng k nng
khc, v tn sut m k nng c s dng trong thc hnh
lm sng. Mc d d liu cn gii hn, nhng vn thy
c s ci thin v k nng v s t tin ca sinh vin c
o to thng xuyn hn. Ngoi ra, cc kha bi dng
thng xuyn vi m phng thu nh c th gip tit kim
chi ph bng cch s dng t hn tng thi gian o to li
so vi khong thi gian o to li tiu chun.
Cp cu
Hng dn cp nht v S cp cu ca AHA v Hi ch thp
Hoa K nm 2015 ti khng nh mc tiu ca cp cu:
gim t l mc v t vong bng cch gim au, ngn nga
hn na bnh tt hoc chn thng, v thc y s phc
hi. Phm vi ca cp cu c m rng. Cp cu c th
c bt u bi bt k ai, trong bt k tnh hung no, v
bao gm c vic t chm sc bn thn.
S dng h thng nh gi t qu c th h tr nh cung cp cp cu bng
cch xc nh biu hin v triu chng ca t qu.
V in nn glucose c a dng cho bnh nhn b h ng huyt nh nhng
chng c th khng c sn. Trong trng hp ny, cc dng ng c tm
thy trong cc sn phm n king thng thng c th c dng thay th
vin nn glucose cho bnh nhn b tiu ng h ng huyt c triu chng
lm sng nh, nhng ngi vn cn nhn thc c v c th nut v lm theo
mnh lnh.
C ho php nh cung cp cp cu c th vt thng ngc h v khng cn che
li. Nu vic bng vt thng v p lc trc tip l cn thit cm mu, cn
ch m bo vt bng khng v tnh b chuyn thnh vt bng bt li.
K hng c h thng nh gi chn ng mt cp h tr nh cung cp cp
cu trong vic nhn din cc chn ng.
K hi vic cy li mt chic rng chn thng b tr hon th vic bo qun tm
thi chic rng trong dung dch ph hp s gip ko di kh nng sng
ca rng.
G io dc v cp cu c truyn t qua cc chin dch bo v sc khe cng
cng, cc ch tp trung v cc kha hc cp chng ch c th tng t l sng
st, lm gim mc nghim trng ca chn thng v gim thi gian iu tr
trong bnh vin, v c th gii quyt cc triu chng ca nhng ngi b bnh
hoc b thng.
31
K hi chm sc cho ngi ht th bnh thng nhng khng c phn ng, v

khng c chn thng nng i vi ct sng hoc xng chu th vic t
ngi ny v tr nm nghing mt bn c th gip ci thin c ch hot
ng ca ng kh. V tr hi phc theo phng php HAINES (High Arm in
Endangered Spine, Tay cao trong trng hp ct sng gp nguy him) khng
cn c khuyn co.
V n tip tc khng c ch dn cho nh cung cp cp cu trong vic theo di
thng xuyn lng oxy b sung. i vi nhng nh cung cp cp cu c
o to c bit trong vic s dng oxy b sung, vic theo di mc oxy c th
c ch i vi nhng ngi b chn thng do gim p. Cc trng hp khc khi
cn nhc vic theo di bao gm nghi ng nhim c carbon monoxide v cc
bnh nhn ung th phi b kh th km theo thiu oxy.
C c khuyn ngh vn ch ra rng trong khi ch i EMS (emergency medical
service, dch v cp cu y t) n cp cu, nh cung cp cp cu c th khuyn
khch ngi b au ngc nhai aspirin nu cc du hiu v cc triu chng cho
thy ngi ny ang b ln cn au tim v h khng b d ng hoc chng ch
nh i vi aspirin, v d nh b chy mu gn y. Tuy nhin, bn cp nht
ca khuyn ngh ny lu rng nu mt ngi b au ngc nhng khng phi
do nguyn nhn au tim, hoc nu nh cung cp cp cu khng chc chn v
nguyn nhn gy au ngc hoc khng thoi mi khi theo di aspirin, th ngi
cp cu khng nn khuyn khch h dng aspirin.
K huyn co dng Epinephrine i vi tnh trng e da mng sng ca
sc phn v, v nhng ngi c nguy c ny nn thng xuyn mang theo
epinephrine xt t ng, thng l gi 2 liu. Khi triu chng ca sc phn v
khng c gii quyt vi liu u tin ca Epinephrine, v EMS (emergency
medical service, dch v cp cu y t) n chm 5-10 pht, nn xem xt dng
liu epinephrine th 2.
C c phng php chnh kim sot chy mu l dng p lc mnh, trc tip.
Khi p lc trc tip khng hiu qu i vi trng hp chy my nghim trng
hoc e da mng sng, nn kt hp s dng bng cm mu vi bng trc tip
nhng yu cu phi c o to dng ng ni, ng ch nh.
K huyn co nh cung cp cp cu khng nn s dng ai gi c. i vi nhng
ngi b thng c nguy c cao b chn thng ct sng, phng php l tng
cho mt nh cung cp cp cu gip ngn chn s chuyn ng ca ct sng
i hi phi nghin cu thm nhng c th bao gm nhc nh bng li hoc
n nh bng tay trong khi ch i nhn vin chm sc cao cp n.
C h bao trm trong bn Cp nht Hng dn nm 2015 m khng c
khuyn co mi no t nm 2010 bao gm vic s dng cc thuc gin ph
qun vi bnh hen suyn, kh th, chn thng mt c hi, kim sot chy
mu, s dng ga r, iu tr nghi ng gy xng di, lm mt vt bng nhit,
bng vt bng, v hn ch vn ng ct sng.
Nhn din t qu
2015 (Mi): Khuyn co nh cung cp cp cu nn s dng
h thng nh gi t qu. So vi cc h thng nh gi
t qu m khng i hi o glucose, h thng nh gi
bao gm o glucose c nhy tng t nhng c
hiu nhn din t qu cao hn. H thng nh gi t
qu Face, Arm, Speech, Time; Mt, Tay, Li ni, Thi gian
(FAST) hoc Cincinnati Prehospital Stroke Scale (CPSS) l
cng c n gin nht nh cung cp cp cu s dng,
vi nhy cao khi xc nh t qu.
L do: Bng chng cho thy rng sm nhn din t qu v
s dng mt h thng nh gi t qu gip gim khong
thi gian gia thi im t qu khi pht v n bnh
vin v iu tr. Trong 1 nghin cu, hn 94% ngi khng
chuyn c o to trong mt h thng nh gi t qu
32
c th nhn din du hiu v triu chng t qu, v kh

35,36
nng ny tn ti khong 3 thng sau kha o to.
H ng huyt
2015 (Mi): i vi bnh nhn tiu ng vi h ng
huyt c triu chng lm sng nh c th lm theo mnh
lnh v nut c an ton, vic s dng glucose ung
dng vin nn glucose gip cu tr lm sng nhanh chng
hn so vi cc dng ng khc c tm thy trong
sn phm n ung thng thng. Nn s dng vin nn
glucose, nu c sn, x l h ng huyt cho nhng
ngi ny. Nu khng c sn vin nn glucose, cc dng
thc phm v ung cha ng c nh gi c bit
khc nh sucrose, fructose, v oligosaccharides c th c
la chn thay th hiu qu cho s o ngc ca h ng
huyt c triu chng lm sng nh.
L do: H ng huyt l mt trng hp m nh cung cp
cp cu thng gp. iu tr sm h ng huyt nh c
th ngn chn s tin trin thnh h ng huyt nng.
H ng huyt nng c th dn ti tnh trng mt nhn
thc hoc co git v v c bn cn s theo di ca EMS
(emergency medical service, dch v cp cu y t).
iu tr Vt thng Ngc H
2015 (Mi): Nh cung cp cp cu chm sc bnh nhn b
vt thng ngc h c th vt thng h. Nu vic bng
vt thng v p lc trc tip c yu cu cm mu,
cn phi ch m bo vt bng mu-bo ho khng v
tnh b bt li.
L do: Vic s dng bng hoc thit b bt khng ng cch
cho cc vt thng ngc h c th dn n s gia tng kh
trn mng phi m khng c bit trc v e da tnh
mng. Cha c nghin cu trn ngi no so snh vic
ng dng vt bng hoc thit b bt vi vt bng hoc thit
b khng bt, v ch c mt nghin cu trn ng vt duy
nht cho thy li ch ca vic s dng thit b khng bt.
Do thiu bng chng v vic s dng mt thit b bt, v
xem xt ri ro trn kh mng phi m khng bit trc, nn
khng khuyn co nh cung cp cp cu p dng bng vt
thng hoc thit b bt cho ngi b vt thng ngc h.
Chn ng
2015 (Mi): Nhn vin y t nn nh gi bt k ngi no
ang b chn thng u dn n thay i mc thc,
tng du hiu hoc triu chng ca chn ng, hoc cc
nguyn nhn khc m ngi cp cu cn quan tm. Vic
nh gi nn c tin hnh cng sm cng tt.
L do: Nh cung cp cp cu thng xuyn gp phi cc c
nhn b chn thng u nh v c th b chn ng (chn
thng s no nh). V s cc du hiu v triu chng ca
chn ng c th khin cho vic nhn din chn thng
ny tr nn kh khn. Ngoi ra, nhng hu qu lu di ca
chn ng khng bit trc c th rt ng k. Mc d
mt h thng ghi li chn ng mt giai on n gin c
th gip ngi cp cu nhn din c chn ng, nhng
khng c h thng nh gi no nh vy c xc nh.
Cng c nh gi chn ng th thao c cc chuyn gia
y t s dng i hi mt nh gi 2 giai on (trc khi thi
u v sau khi chn ng) khng thch hp nh l mt cng
c nh gi n l cho nh cung cp cp cu.
Chn thng Rng

2015 ( cp nht): Nh cung cp cp cu c l khng th cy
mt chic rng chn thng do khng c gng tay y t bo
v, thiu o to v k nng, hoc s gy au. Khi khng
th cy li rng ngay lp tc, vic bo qun tm thi chic
rng chn thng trong dung dch c th ko di kh nng
sng ca t bo rng (so vi nc bt) s rt c li. Dung
dch vi hiu qu thy c ko di kh nng sng
ca t bo rng t 30-120 pht bao gm Dung dch mui
cn bng Hank (c cha canxi, kali clorua v phosphate, ma
gi chloride v sulfat, natri clorua, natri bicarbonate, sodium
phosphate dibasic, v glucose), sp ong, lng trng trng,
nc da, Ricetral, hoc sa nguyn cht.
2010 (C): t chic rng vo sa-hoc nc sch nu
khng c sa.
L do: Chn thng rng c th lm mt rng vnh vin.
Cng ng nha khoa ng rng cy li rng ngay lp tc
i vi rng b chn thng l c hi ln nht ca s sng
ca rng , nhng n c th khng l mt la chn. Trong
trng hp cy li mt chic rng b tr hon th vic bo
qun tm thi chic rng chn thng trong mt dung
dch ph hp s tng c hi sng ca rng.
Gio dc Cp cu
2015 (Mi): Gio dc v o to v cp cu c th hu ch
ci thin bnh tt v t vong do chn thng v bnh, v
chng ti khuyn co nn ph cp vic ny.
L do: Bng chng cho thy rng gio dc v cp cu c th
lm tng t l sng, nng cao nhn thc bnh cp tnh, v
h tr phn tch cc triu chng.
Xc nh ngi b thng hoc b bnh

2015 ( cp nht): Cc t th hi phc khuyn co thay i
t nm nga sang nm nghing mt bn i vi bnh nhn
khng b nghi ng chn thng ct sng, xng hng,
hoc xng chu. C rt t bng chng cho thy bt k v tr
phc hi thay th no c li hn cho ngi khng cn phn
ng v th bnh thng.
2010 (C): Nu nn nhn nm p mt v khng phn ng,
hy quay nn nhn nm nga mt ln. Nu nn nhn kh
th v qu nhiu dch tit hoc i ma, hoc nu bn ang
c mt mnh v phi ri khi nn nhn khng phn ng
gi gip , hy t nn nhn t th HAINES (High Arm in
Endangered Spine, Tay cao trong trng hp ct sng gp
nguy him).
L do: Cc nghin cu cho thy mt s ci tin ch s h hp
khi nn nhn ang t th nm nghing bn so vi t th
nm nga dn n thay i v khuyn co cho bnh nhn
khng b nghi ng chn thng ct sng, xng hng,
hoc xng chu. T th HAINES khng cn c khuyn
co, do bng chng v v tr ny rt t v cht lng rt thp.
S dng Oxy trong Cp cu

2015 ( cp nht): Khng c bng chng h tr nh cung cp
cp cu theo di thng xuyn lng oxy b sung. Oxy b
sung c th c li ch trong mt vi tnh hung c th nh
chn thng do gim p v khi nh cung cp cp cu
c o to v cch s dng n ang theo di.
2010 (C): Khng c bng chng b sung hay phn i vic

s dng oxy thng xuyn nh mt bin php cp cu cho
nn nhn ang b kh th hoc au ngc. Oxy c th c li
cho vic cp cu th ln b chn thng do gim p.
L do: Bng chng cho thy li ch t vic nh cung cp cp
cu tham gia kha hc oxy cp cu ln s dng oxy cho
bnh nhn b gim p. Bng chng hn ch cng cho thy
oxy b sung c hiu qu trong vic gim kh th bnh
nhn ung th phi nng km theo kh th v thiu oxy lin
quan nhng khng phi cho nhng bnh nhn tng t
khng b thiu oxy. Mc d khng c bng chng xc nh
h tr vic s dng oxy, khi bnh nhn tip xc vi carbon
monoxide ang th mt cch t nhin, n c th s hp l
cung cp oxy trong khi ch i chm sc y t cao cp.
au ngc
2015 ( cp nht): Trong khi ch i EMS (emergency medical
service, dch v cp cu y t) n, nh cung cp cp cu c
th khuyn khch bnh nhn au ngc nhai 1 vin aspirin
liu ngi ln hoc 2 vin aspirin liu thp nu du hiu v
triu chng cho thy bnh nhn ny ang b nhi mu c
tim, v bnh nhn khng b d ng hoc chng ch nh
khc vi aspirin. Nu mt bnh nhn b au ngc m khng
khuyn ngh mt ngun tim, hoc nu nh cung cp cp
cu khng chc chn v nguyn nhn gy au ngc hoc
khng thoi mi vi vic theo di aspirin, khi ngi cp
cu khng nn khuyn khch bnh nhn dng aspirin v
quyt nh theo di aspirin c th c hon li cho ngi
bn EMS (emergency medical service, dch v cp cu y t).
2010 (C): Trong khi ch i EMS (emergency medical
service, dch v cp cu y t) n, nh cung cp cp cu c
th khuyn khch nn nhn nhai 1 vin aspirin liu ngi ln
(loi bao khng tan trong rut) hoc 2 vin aspirin tr em
liu thp nu bnh nhn khng b d ng vi aspirin hoc
chng ch nh khc vi aspirin, v d nh bng chng ca
t qu hoc chy mu gn y.
L do: Theo di aspirin lm gim ng k t l t vong do
nhi mu c tim, nhng khng c bng chng h tr
vic s dng aspirin lm gim au ngc khng phn bit.
Gim t l t vong cng c tm thy khi theo di aspirin
sm (tc l, trong vi gi u tin sau khi khi pht triu
chng nhi mu c tim) so vi theo di aspirin sau (tc
l, sau khi n bnh vin) gim au ngc do nhi mu
c tim cp tnh. Tuy nhin, vic ny vn cha r rng, cho
d nh cung cp cp cu c th nhn ra du hiu v triu
chng ca nhi mu c tim, v vic s dng aspirin cho
nguyn nhn gy au ngc khng do tim c th gy hi.
Mc d liu lng v dng aspirin c s dng gim
au ngc khng c Nhm Cng tc Cp cu ILCOR xem
xt c th, tnh kh dng sinh hc ca aspirin bao tan trong
rut l tng t nh loi bao khng tan trong rut khi nhai
36
v nut. Do , s khng cn b hn ch s dng thuc
aspirin bao khng tan trong rut, min l aspirin c nhai
trc khi nut.
Sc phn v
2015 ( cp nht): Khi ngi b sc phn v khng phn ng
vi liu Epinephrine u tin, v i ng chm sc nng cao
n chm 5-10 pht, nn xem xt dng liu tip theo.
33
2010 (C): Trong trng hp bt thng, khi h tr y t

nng cao khng c sn, c th a mt liu epinephrine th
hai nu cc triu chng ca sc phn v vn tn ti.
L do: Hng dn 2010 khuyn co rng nh cung cp cp
cu h tr hoc ch nh epinephrine (ca ring nn nhn)
cho ngi c triu chng sc phn v. Bng chng cng
c s cn thit phi dng mt liu epinephrine th hai cho
sc phn v cp tnh nhng ngi khng c phn ng
vi liu u tin; bn sa i hng dn cung cp lun
chng lm r cng nh khung thi gian xem xt mt liu
epinephrine th hai.
Bng vt thng Cm mu
2015 ( cp nht): Nh cung cp cp cu c th xem xt s
dng bng cm mu khi cc bin php kim sot chy mu
tiu chun (vi p lc trc tip c hoc khng c gc hoc
bng vi qun o) khng hiu qu i vi chy mu nghim
trng hoc e da mng sng.
2010 (C): S dng thng xuyn (cc yu t cm mu)
trong cp cu khng c khuyn co thi im ny v s
thay i ng k trong hiu qu ca cc yu t khc nhau
v kh nng ca chng vi cc hiu ng bt li, bao gm
ph hy m vi hiu ng ca tnh trng tin tc mch v
chn thng nhit tim tng.
L do: Cc ng dng ca p lc mnh, trc tip n mt vt
thng vn c coi l phng tin ch yu kim sot
chy mu. Khi p lc trc tip khng kim sot c tnh
trng chy mu nghim trng hoc e da mng sng, nh
cung cp cp cu c o to c th trong cc ch nh
v hng dn s dng c th xem xt bng cm mu. Bng
thm cm mu th h mi c chng minh l gy ra
t bin chng v tc dng ph hn cc loi cm mu trc
y, v hiu qu cm mu ln n 90% ca cc i tng.
Hn ch Vn ng Ct sng
2015 ( cp nht): Ngy cng c nhiu bng chng cho thy
tc hi v khng c bng chng tt no cho thy li ch r
rng, khng khuyn co nh cung cp cp cu ng dng
lin tc bin php dng ai c. Nh cung cp cp cu
nghi ng chn thng ct sng nn ngi b thng
cng nm im cng tt trong khi ch i ngi ca EMS
(emergency medical service, dch v cp cu y t) n.
2010 (C): Nh cung cp cp cu khng nn s dng cc
thit b c nh v li ch ca chng vi cp cu cha c
chng minh v chng c th c hi. Duy tr hn ch vn
ng ct sng bng cch gi n nh u bng tay
chuyn ng ca u, c, ct sng c gim thiu.
L do: Theo bo co h thng ILCOR nm 2015 v vic s
dng ai gi c nh mt phn trong hn ch vn ng ct
sng cho chn thng cn, khng c bng no ch ra vic
gim chn thng thn kinh vi vic s dng ai gi c.
Trn thc t, cc nghin cu chng minh tc dng c hi
thc t hoc tim tng nh tng p lc ni s v can thip
ng th vi vic s dng ai gi c. K thut thch hp
ng dng ai gi c nhng ngi c nguy c cao i hi
phi c o to v thc hnh y thc hin mt
cch chnh xc. p dng ai gi c khng phi l mt k
nng cp cu. Cc sa i ca hng dn ny phn nh s
thay i trong lp hc khuyn co ti Cp III: Tc hi do kh
nng ca hiu ng bt li.
34
Ti liu tham kho

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6. Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile-phone dispatch
of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med.
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7. FDA approves new hand-held auto-injector to reverse opioid overdose
[news release]. Silver Spring, MD: US Food and Drug Administration;
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PressAnnouncements/ucm391465.htm. Accessed July 27, 2015.
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35
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2015 AHA Guidelines Highlights Vietnamese

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2015 AHA Guidelines Highlights Vietnamese

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NHNG IM NI BT

trong Hng dn cp nht ca American Heart Association

cho Hi sinh tim phi (CPR) v

2015 American Heart Association

phi (CPR) v Chm sc tim mch khn cp (ECC) nm 2015,

H thng phn loi mi ca AHA cho cc lp khuyn ngh v Mc chng c*

MC (CHT LNG) CHNG C

Cc cm t gi vit khuyn ngh:

LP IIa (TRUNG BNH)

Cc cm t gi vit khuyn ngh:

Cc cm t gi vit khuyn ngh:

LP III: Khng c li ch (TRUNG BNH) Li ch = Ri ro

Chng c cht lng cao t hn 1 th nghim i chng

Chng c cht lng trung bnh t 1 hoc nhiu th nghim

(Phi ngu nhin)

Chng c cht lng trung bnh t 1 hoc nhiu nghin cu

Cc nghin cu quan st hoc lu tr ngu nhin hoc phi

( kin chuyn gia)

S ng thun trong kin chuyn gia da trn tri nghim lm sng

Cc cm t gi vit khuyn ngh:

Mt khuyn ngh c LOE (Level of Evidence; Mc chng c) C khng m ch rng

Nhng im ni bt trong Hng dn cp nht nm 2015

u tin ny l nm 2015, chng ti hon thnh t nh gi

American Heart Association

Phn phi cc lp khuyn ngh v

Cc lp khuyn ngh 2015

Phn trm trong s 315 khuyn ngh.

Nhng Khuyn ngh mi v cp nht quan trng c

sau ngng tim b hn m. D liu mi nht v cng dng

Tch Dy chuyn x tr cp cu cho ngi ln theo AHA thnh 2 dy chuyn:

Nhng im ni bt trong Hng dn cp nht nm 2015

Cc hp phn ca mt H thng chm sc

OHCA (out-of-hospital cardiac arrests, ngng tim ngoi

S dng Phng tin truyn thng x hi triu tp

Dy chuyn x tr cp cu ca IHCA v OHCA

Gim st v phng trnh

Nhn bit v kch

Kh rung tim nhanh

Nhn bit v kch

American Heart Association

Kh rung tim nhanh

ny sn lng v c th tin hnh CPR (Cardiopulmonary

Hi sinh theo nhm: H thng du hiu cnh

Ci thin cht lng lin tc cho cc

hi sinh v kt qu. Ci thin cht lng lin tc bao gm

Phn vng chm sc

Duy tr s sng c bn ngi

Nhng im ni bt trong Hng dn cp nht nm 2015

T rnh t c khuyn ngh cho mt ngi cu h duy

khu vc v bo m ngi xung quanh bit v tr ca

Cch tip cn h thng chm sc cho OHCA (out-of-hospital

T c nhn ngc c khuyn ngh l 100 n

Chng trnh AED (automated external defibrillator;

American Heart Association

Cha c chng c khuyn ngh nn hay khng nn

Ngi iu phi nhn bit Th ngp

Ch trng vo Nhn ngc*

S ln nhn ngc cung cp

h hp nhn to th ngi nn h hp nhn to thm vi

th t l sng st cng cao v s ln nhn ngc t hn th t

Bin nhn ngc*

2015 (Mi): i vi bnh nhn bit hoc nghi ng nghin

Duy tr s sng c bn ngi ln v

Nhng vic nn lm v khng nn lm trong hi sinh tim phi c bn ca

Tch Dy chuyn x tr cp cu cho ngi ln theo AHA thnh 2 dy chuyn:

T rnh t c khuyn ngh cho mt ngi cu h duy

T c nhn ngc c khuyn ngh l 100 n

Nhng vic nn lm v khng nn lm trong hi sinh tim phi c bn ca

N gi cu h qua o to c khuyn khch thc hin ng thi mt s