Noile ghiduri de Resuscitare

Cardio Respiratorie (RCR)

D. Săndesc

Spitalul Judetean Timisoara

06.07.2006
 RCR - Surse bibliografice principale

1. European Resuscitation Council Guidelines for

Resuscitation 20051
2. International Liaison Committee on Resuscitation
(ILCOR): 2005 International Consensus Conference
on Cardiopulmonary Resuscitation2

1. Resuscitation 2005; 67S1: S1-S189

2. Resuscitation 2005; 67: 1-341
Epidemiologie

 Stop cardiac: 60% din decesele pacientilor cu

cardiopatie ischemica
Etiologie SCR %
Cardiopatie 82,4
Boli respiratorii 4,3
Trauma 3,1
Boli cerebrovasculare 2,2
Asfixie 2,2
Intoxicatii medicamentoase 1,9
Alte tentative suicid 0,9

Saravanan P et al. A survey of resuscitation training needs of senior

anesthetists. Resuscitation 2005; 64: 93-6
 Epidemiologie

 Stopul cardio-respirator (SCR)

 ~ 460.000/an SUA1
 ~ 700.000/an Europa2
 2/3: tentativa de RCR
 Supravietuirea dupa RCR
 5-10% (15% dupa Fibrilatie Ventriculara – FV)
 RCR cu Defibrilare in primele 3-5 minute: supravietuire
pina la 49-75% !
 Fiecare minut:  7-10% supravietuirea !
1. American Heart Association, Heart Disease and Stroke Statistics – 2005 Uptodate
2. Saus S et al. Task Force of the European Society of Cardiology on Cardiovascular Mortality
and Morbidity Statistics in Europe. Eur Heart J 1997; 18: 1231-48
RCR – Formula lui Safar

A. - Airway
B. - Breathing
C. - Circulate: masaj cardiac (15:2; 5:1)
D. - Drugs
E. - EKG
F. - Fibrilation
G. - Gauging (Evaluare)
H. - Human Mentation
I. - Intensive Care
Time is … life !!!
Resuscitarea: Lantul Supravietuirii
(Chain of Survival)

1. Recunoasterea imediata a urgentei si apel pentru

ajutor calificat (112)
2. Start RCR
3. Defibrilare rapida in SCR – FV; fiecare minut
intarziere:  10-15% sansa de supravietuire
4. Terapia intensiva post-resuscitare
RCR extraspital (personal
nemedical) – inregistrare telefonica

“Why is it that every time I press on his chest he

opens his eyes, and every time I stop to breathe for
him he goes to sleep?” *

* Berg RA et al. Cardiopulmonary resuscitation: Bystander cardiopulmonary

resuscitation- Is ventilation necessary? Circulation 1993; 88: 1907-1915
Noile ghiduri de RCR – principalele
modificari

1. Diagnosticul de Stop CR: pacient ce nu raspunde

la stimuli si nu respira normal , NU prin cautare
puls !
2. Masajul cardiac
a. Inceput imediat si mentinut continuu
b. Mainile resuscitatorului: in mijlocul pieptului
c. Frecventa 100 / min
d. Raport compresii toracice / respiratie: 30/2
Noile ghiduri de RCR – principalele
modificari

3. Defibrilarea:
 In FV cat mai precoce
 360 J din start la defibrilatoarele unipolare
 1 singur soc
4. Droguri:
 Renuntare la Adrenalina doze mari
 Amiodarona …
5. Hipotermia moderata postresuscitare
RCR bazala la adult
(Adult basic life support)
RCR – Bazal

1. Verifica siguranta
mediului/locului
2. Verifica daca victima
raspunde:
 zgaltaire umeri
 “sunteti bine /
totul e in regula?”
RCR – Bazal

3. a. Pacientul raspunde
 urmarire

3. b. Pacientul nu raspunde
 Striga dupa ajutor
 Pozitionare - decubit dorsal
 Eliberare cai aeriene
RCR – Bazal

4. Verifica daca pacientul

respira:
 priveste
 asculta
 simte
RCR – Bazal

5a. Pacientul respira normal

 pozitia de siguranta
 apel ambulanta
 supraveghere
RCR – Bazal
RCR – Bazal

5. b. Pacientul nu respira normal

 trimite sau cheama ambulanta
 Masaj cardiac
 in centrul toracelui
 100 / min (1/1)
 4-5 cm
RCR – Bazal

6. a. Combina masajul cardiac

cu respiratia artificiala

30 : 2
 RCR – bazal: aspecte particulare

 RCR fara respiratie gura la gura

 acceptabila
 comparabila cu RCR standard1
 Respiratie artificiala initiala
 Ventilatia
 evitarea hiperventilatiei
 500-600 ml (6-7 ml/kg) volum curent2

1. Kern KB et al. Circulation 2002; 105:645-9

2. Baskett P et al. Resuscitation 1996; 31: 231-4
RCR – Defibrilarea electrica
automata(AED) e
 RCR – Defibrilarea

FV – faze:
1. Electrica (~ 4 minute)
2. Circulatorie (min. 4-10)
a) epuizare energetica miocardica
b) defibrilarea directa neeficienta
c) masaj cardiac:  sansele defibrilarii1
3. Metabolica – supravietuirea improbabila2

RCR inainte de defibrilare (daca socul se administreaza la > 5 minute

dupa SCR)3

1. Ewy GA et al. In: 2006 Yearbook of Intensive Care and Emergency Medicine, J.L. Vincent (subred),
Springer, Brussels; 316-327
2. Kim F et al. Circulation 2005; 112: 715-719
3. Langhelle A, Nolan JP. Resuscitation 2005; 66: 271-83
RCR avansata
 RCR avansata – Droguri

1. Adrenalina (f 1mg/ml)
 1 mg la 3-5 min i.v. (2-3 mg traheal in 10ml)
2. Amiodarona(f 150 mg)
 Indicatii
 FV refractara la 3 socuri
 Doza: 300 mg i.v. (diluat in glucoza 5% pana la 20 ml) 
 repetare 150 mg  perfuzie 900 mg/24h
 Reactii adverse: bradicardie, hipotensiune
3. Atropina(f 1mg/ml)
 Indicatii: - asistolie, DEM cu AV < 60/min
 Doza: 3 mg i.v.
RCR avansata – Droguri

4. Lidocaina (f 2%-20 mg/ml ,4%-40 mg/ml )

 Indicatii: FV si TV refractare (linia a 2-a dupa
Amiodarona)
 Doza: 1-1,5 mg/kg 50 mg (maxim 3 mg/kg prima ora)
5. Magneziu sulfat (f 50% , 20%)
 Indicatii:
 FV refractara cu hipoMg
 Tahiaritmii ventriculare + hipoMg
 Torsades des pointes
 Toxicitate digitalica
 Doza: 2 g i.v. (4ml sol 50%) in 1-2 min  repetare la 10-15
min
RCR avansata – Droguri

6. Bicarbonat de Na(sol 8,4%-1mEq/ml)

 Indicatii:
 SCR cu hiperpotasemie
 Intoxicatie cu antidepresive triciclice
  pH  7,1
 Doza: 50 ml sol. 8,4% p.e.v.
7.
Calciu (sol 10%)
Indicatii : DEM cu – hiperpotasemie
- hipocalcemie
- supradozare blocanti de Ca
Doza : 10 ml i.v. +/-repetat
RCR la copii

 Frica de RCR la copii – nejustificata !

 Protocolul RCR adult – aplicabil la copil
Particularitati
 Start cu 5 respiratii
 RCR 1 minut inainte de a cauta ajutor
 Compresiuni toracice: 15/2 ,1/3 din diametru
 cu 2 degete: copii < 1 an
 1/2 maini: > 1 an
RCR la copii
RCR la copii
RCR la copii
RCR la copii

 Defibrilarea:4 J/Kg
 > 8 ani – similar cu adultii
 1-8 ani
 padele pediatrice (daca sunt disponibile)
 padele tip adult
 < 1 an – contraindicat
RCR la copii
Podus Dilutia Doza i.v./p.e.v
Adrenalina 1mg/10ml 10µg/kg
(f 1mg/ml) (100µg/ml) (1ml/10kg)
Atropina 1mg/10ml 20-40µg/kg
(f 1mg/ml) (100µg/ml) 2-4ml/10kg
Bicarbonat de 1mEg/kg
Na 8,4%
(1mEg/ml)
Xilina (f 1%, 2%) 10 mg/ml 1mg/kg
RCR - Concluzii
1. Elemetul esential- MCE
-Precoce
-100/min
-Neintrerupt
-Raport compresii /respiratii: 30/2

2. Defibrilarea (socul electric)-

esential in FV si TV fara puls
-soc unic, repetat la nevoie dupa minimum 2
minute de resuscitare
-360 J
RCR - Concluzii
3. Adrenalina 1 mg la 3 min

4. Tratamentul de prima linie al

aritmiilor ventriculare –amiodarona

5. RCR la copii – dupa schema de la

adult cu mici modificari