American Heart Association

Guidelines for CPR 2015

Dr. Faisal Muchtar, Sp.An-KIC
Intensive Care Unit
dr. Wahidin Sudirohusodo General Hospital
 American Heart Association
Guidelines for CPR 2015
• BLS
• ACLS
– Pulseless Arrest
– Bradycardia
– Tachycardia
• Post cardiac arrest care
 Chains of Survival
2015 (New): Separate Chains of Survival have been
recommended that identify the different pathways of care
for patients who cardiac arrest in the HOSPITAL AND
OUT OF HOSPITAL settings
 “Chain of Survival”
in-hospital cardiac arrest (IHCA)

• Surveillance for cardiac arrest

• Activate code (multidisciplinary team)
• Initiate CPR by professional providers
• Early defibrillation
• Integrated post cardiac arrest care
 “Chain of Survival”
out-of-hospital cardiac arrest (OHCA)

• Immediate recognition of cardiac arrest and

activation of the emergency response system
• Early CPR that emphasizes chest compressions
• Rapid defibrillation if indicated
• Effective advanced life support
• Integrated post cardiac arrest care
Adult Basic Life Support
(BLS)
 Basic Life Support

– Used for patients with life-threatening illness or

injury before the patient can be given full medical
care.
– Generally used in the pre-hospital setting, and can
be provided without medical equipment.
– Generally does not include the use of drugs or
invasive skills.
30:2 x 5 cycle unresponsesive

CallPulse :breathing
for help and AED
Breathing 5-6 sec
and pulse

No pulse : CPR
The BLS Survey includes four steps:
The BLS survey is the starting point for all
ACLS management
• Check for a response
• Call for help and to bring an AED
• Check circulation
• Check rhythm
 The Primary Assessment
The Primary Assessment uses the ABCDE model
• Airway – Use the least advanced airway possible to maintain
the airway and oxygenation
• Breathing – Monitor tube placement and oxygenation using
waveform capnography
• Circulation – Medications, CPR, fluids and defibrillation
• Differential Diagnosis –treat reversible causes
• Disability - neurological assessment “AVPU”(Alert, Voice,
Painful, Unresponsive)
• Exposure - looking for signs of trauma, bleeding,
burns, or medical alert bracelets
 The Secondary Assessment
• The secondary assessment includes a search for
underlying causes for the emergency and if possible
a focused medical history “SAMPLE’
• (S) Signs and symptoms
• (A) Allergies
• (M) Medications
• (P) Past Illnesses
• (L) Last Oral Intake
• (E) Events Leading Up To Present Illness
 Check pulse :carotid artery

 Start Chest compression if no definite pulse within

10 seconds
Chest compression

Push hard, Put fast

Chest compression
Chest compression
Chest compression

Depth 5 cm Full chest recoil

(2 inches)
 Minimal interruption

• Minimize the frequency and duration of

interruptions in compressions
• CPR without an advanced airway, goal
of a chest compression fraction as high
as possible, with a target of at least
60%.
Chest compression

Rate 100-120 times

Airway

Head tilt
Chin lift
Jaw thrust in C-spine injury
Breathing
 BLS Dos and Don’ts of Adult High-Quality CPR

Rescuers Should Rescuers Should Not

perform chest compressions at a Compress at a rate slower than 100/min or

rate of 100-120/min faster than 120/min
Compress to a depth of at least 2 inches Compress to a depth of less than 2 inches (5
(5 cm) cm) or greater than 2.4 inches (6 cm)

Allow full recoil after each compression Lean on the chest between compressions

Minimize pauses in compressions Interrupt compressions for greater than 10

seconds
Ventilate adequately (2 breaths after 30 Provide excessive ventilation
compressions, each breath (ie, too many breaths or breaths with
delivered over 1 second, each causing chest excessive force)
rise)
AED (Automated External Defibrillator)

1. Turn on AED
2. Stick to the paddle as
shown
3. Machine will analyze
to shock or not
4. If the device can
shock, press the
shock button on the
device
AED (Automated External Defibrillator)

AED ON
AED (Automated External Defibrillator)
Place the pad at
sternum /apex
AED (Automated External Defibrillator)
Connect the electrode pad to
the electrode cable of the
machine
AED (Automated External Defibrillator)

• ECG analyzer will detect the rhytm whether to

defibrillation if the ECG is VT or VF type
• Do not touch the patient because the
machine will read the wrong EKG
• If the EKG is VF type or VT, the machine
will charge power
• If the EKG is asystole type, the machine will
give CPR for 2 minutes and then analyze
the new EKG
AED (Automated External Defibrillator)

Press
shock
Advanced Cardiovascular
Life Support: ACLS
Advanced Cardiovascular Life
Support: ACLS
• Pulseless Arrest
• Bradycardia with Pulse
• Tachycardia with Pulse
Pulseless Arrest
 shock

 Hypovolemia  Toxins
 Hypoxia  Tamponade
  Tension PTX
Hydrogen ions (acidosis)
 Hyper/hypokalemia Thrombosis (coronary)
 Hypothermia  Thrombosis (pulmonary)

Amiodarone 5 Hs, 5Ts

300 mg----150 mg
Pulse/BP
EtCO2>40 mmHg
A-line wave form
Bradycardia with Pulse
 Unstable
bradycardia
Tachycardia with Pulse
 Narrow regular
50-100 j

Narrow irregular
120-200 j
(mono 200j)
Unstable
Tachycardia
Wide regular
100 j

Wide irregular
DF
Quantitative Waveform Capnography
• Confirmation and monitoring ETT placement
• Evaluating the effectiveness of chest
compressions
ETCO2 value is at least 10-20 mmHg.
• Identification of ROSC
• Failure to achieve an ETCO2of greater than 10
mm Hg by waveform capnography after 20
minutes of CPR decide to end resuscitative
efforts but should not be used in isolation
Capnography Recommendation
 CPR Quality
• Quantitative waveform capnography
–If Petco2<10 mm Hg, attempt to
improve CPR quality
• Intra-arterial pressure
–If relaxation phase (diastolic) pressure
<20 mm Hg, attempt to improve CPR
quality
Defibrillator
Defibrillator
SBP >90 mmHg
MAP>65 mmHg

BT 32C-36C
at least 24 hr
Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity(PEA)

NO PULSE
Supraventricular tachycardia
New and Updated Recommendations
CPR Guideline 2015
• Separate Chain of Survival

• Chest compressions at a rate of 100 to 120/min:

extremely rapid compression rates with inadequate compression depth

• Chest compressions at a depth of at least 2 inches or

5 cm for an average adult, while avoiding excessive
chest compression depths (greater than 2.4 inches [6
cm])
New and Updated Recommendations
CPR Guideline 2015
• Delivery 1 breath every 6 seconds (10 /min) while
continuous chest compression with advance airway
• Vasopressin was removed from the ACLS Cardiac
Arrest Algorithm
• Nonshockable rhythm ,administer epinephrine as
soon as feasible (IV/IO/ET)
• Targeted temperature management 32C to 36C in 24
hr
• The routine prehospital cooling of patients with rapid infusion
of cold IV fluids after ROSC is not recommended
Thank you