Les actualités en matière

ACR

Mr Amine REZQUELLAH
IAR, Infirmier Chef B.O.C AL FARABI,
OUJDA
The American Heart Association has
released Heart and Stroke Statistics - 2022 Update.
According to the report, cardiac arrest
remains a public health crisis.In one
year alone, 436,000 Americans die
from a cardiac arrest.There are more
than 356,000 out-of-hospital cardiac
arrests (OHCA) annually in the U.S.,
nearly 90% of them fatal. The
incidence of EMS-assessed non-
traumatic OHCA in people of any age
is estimated to be 356,461, or nearly
1,000 people each day.

AHA journal, 26 Jan 2022 https://doi.org/10.1161/CIR.0000000000001052Circulation.

2022;145:e153–e639
Bystander CPR improves survival
The location of Out of Hospital Cardiac Arrests (OHCA) most often
occurs in homes/residences (73.4%), followed by public settings
(16.3%), and nursing homes (10.3%).

If performed immediately, CPR can double or triple the chance of

survival from an out of hospital cardiac arrest.

https://cpr.heart.org/en/resources/cpr-facts-and-stats
Recognition of cardiac arrest and activation of the emergency response system
Early cardiopulmonary resuscitation (CPR) with an emphasis on chest
compressions
Rapid defibrillation
Advanced resuscitation by Emergency Medical Services and other healthcare
providers
Post-cardiac arrest care
Recovery (including additional treatment, observation, rehabilitation, and
psychological support)
Recognition of cardiac
arrest and Activation of the
emergency response system

Allo SAMU : 141 

Ambulance / Pompiers :
150 , 15

DEA
C-A-B- D
1. Push Hard, Push Fast, « 30cmp/2brth, Adult, 2 or 1resc , Child inft 2 resc 15/2 »
2. « Give O2 if available »
3. Adequate chest compression depth (adults: 2-2.4 inches; children: 2; infants: 1.5)
4. Optimal chest compression rate (100-120 per minute)
5. Minimizing interruptions in CPR (switch after 2min with a fresh rescuer) 
6. Allowing full chest recoil between compressions
7. Avoiding excessive ventilation
C-A-B
RAPID
DEFIBRILLATION
D
 ADVANCED RESUSCITATION BY
EMERGENCY MEDICAL SERVICES
AND OTHER HEALTHCARE
PROVIDERS
ADULT CARDIAC ARREST
Extracorporeal membrane oxygenation
ECMO
 Pediatric Cardiac Arrest Algorithm

1
CPR Quality
Start CPR
• Begin bag-mask ventilation and give oxygen • Push hard (≥⅓ of anteroposterior
• Attach monitor/defibrillator diameter of chest) and fast
(100-120/min) and allow complete
chest recoil
• Minimize interruptions in
Yes No compressions
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued
• If no advanced airway, 15:2
2 9 compression-ventilation ratio
VF/pVT Asystole/PEA • If advanced airway, provide
continuous compressions and
give a breath every 2-3 seconds
Shock Energy for Defibrillation
3
Shock Epinephrine • First shock 2 J/kg
ASAP • Second shock 4 J/kg
4 10 • Subsequent shocks ≥4 J/kg,
maximum 10 J/kg or adult dose
CPR 2 min CPR 2 min
IV/IO access • IV/IO access Drug Therapy
• Epinephrine every 3-5 min
• Consider advanced • Epinephrine IV/IO dose:
0.01 mg/kg (0.1 mL/kg of the
airway and capnography

PEDIATRIC CARDIAC ARREST

0.1 mg/mL concentration).
No Max dose 1 mg.
Rhythm Repeat every 3-5 minutes.
shockable? If no IV/IO access, may give
Yes endotracheal dose: 0.1 mg/kg
Yes Rhythm (0.1 mL/kg of the 1 mg/mL
shockable? concentration).
5 Shock • Amiodarone IV/IO dose:
5 mg/kg bolus during cardiac
arrest. May repeat up to
No
6 3 total doses for refractory
CPR 2 min VF/pulseless VT
 or
• Epinephrine every 3-5 min
11  Lidocaine IV/IO dose:
• Consider advanced airway Initial: 1 mg/kg loading dose
CPR 2 min
Treat reversible causes Advanced Airway

No • Endotracheal intubation or
Rhythm
supraglottic advanced airway
shockable? • Waveform capnography or
No Yes capnometry to confirm and
Rhythm
Yes monitor ET tube placement
shockable?
Shock Reversible Causes
7
• Hypovolemia
8 • Hypoxia
• Hydrogen ion (acidosis)
CPR 2 min • Hypoglycemia
• Amiodarone or lidocaine
• Hypo-/hyperkalemia
• Treat reversible causes • Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
12 • Thrombosis, pulmonary
• If no signs of return of spontaneous Go to 7. • Thrombosis, coronary
circulation (ROSC), go to 10
• If ROSC, go to Post–Cardiac Arrest
Care checklist
© 2020 American Heart Association
POST-CARDIAC ARREST
CARE
 RECOVER
Y

According to the AHA, “Accurate neurological prognostication in brain-

injured cardiac arrest survivors is critically important
Additional treatment, observation, rehabilitation, and psychological
support
THANK
YOU