Cardiopulmonary Resuscitation

Department of Anesthesiology & Reanimation

Faculty of Medicine, Padjadjaran University/
Hasan Sadikin General Hospital
Bandung
Objective:

• Identification phases of resuscitation

• Algorythm of CPR initiation
• Airway management
• Breathing support
• Circulation Support
• Drug s and fluids
Introduction
1961 : Safar devided CPR into 3 phases
• Phase I :
Basic Life Support, goals of this phase action ( ABC)
Emergency Oxygenation
• Phase II :
Advanced Life Support, goals of this phase action (DEF)
Restoration of spontaneous circulation and stabilization of the
cardiopulmonary system
• Phase III :
Prolonged Life Support, goals ( GHI) Post resuscitative brain
oriented and intensive care
 Awake? / No
Breath ? / No

Airway management
Breath ?/No

Breathing Support 2x
Carotid Pulse / No

Circulation support
Airway management:
The most common site of airway obstruction in comatouse
patients :
• relaxed tongue , when patients head is in flexed or mid
position
•Foreign matter : vomitus, blood
•stimulation in stuporous or lightly comatose patients
Laryngospasm is usually caused by upper airway
• could be complete or partial obstruction, in complete
obstrc (if not corrected) leads to apnea and cardiac arrest
within 5 – 10 minute , in partial obstrc must be corrected
promptly can result in brain damage or even cardiac arrest
Recognition of Airway obtruction ;
•Can not hear and feel of air flow at the mouth
and nose for complete airway obstruction
• When patients still breathing inspiratory
retraction of intercostal and supraclavicular
• Partial airway obstruction : snoring, crowing,
gurgling, wheezing
• Hypercarbia : somnolence
• Hypoxemia : sympathetic stimulation
Manual clearing of the airway:
•The crossed finger maneuver
•Finger behind teeth manuever
•Tongue jaw lift manuever

Clearing the airway by suction

 Technique for foreign body clearing

If the victim is conscious ,

• encourage to expel by coughing and spitting it out
•Apply abdominal thrust s or back blows

If the victim is unconscious

• Apply back blows or abdominal thrust in horizontal
position
Positioning to open the airway
• Head tilt
• Neck lift
• Chin lift
• Jaw thrust

Open the airway using equipment

• Oropharyngeal airway
• Nasopharyngeal airway
• Endotracheal intubation
• Cricothyroidotomy and Tracheostomy
 H

Chin Lift Neck Lift

 Breathing support
Without equipment
Mouth to mouth and Mouth to nose
Mouth to adjunct ventilation
Bag Valve Mask with oxygen

Giving positive pressure during inspiration and

spontaneous expiration
Mouth to mouth or mouth to nose
ventilation

Exhalation consist of 16 - 18 % of
oxygen
 Recognition of cardiac arrest

unconsciousness, apnea or gasping,

death like appearance(cyanosis, or
pallor), absence of pulse in large arteries
( carotid or femoral )
 Circulation Support

Cardiac arrest :
• Primary : Ventricular fibrillation, asystole
caused by myocardial infarction
• Secondary : exsanguination, asphyxia

The most common caused of cardiac arrest :

Ventricular fibrillation
 Closed chest cardiac compressions

The aims of cardiac compression : Initiate

artificial circulation

External cardiac compression (C) in

combination with airway control ( A ) ,
breathing support (B) Made it possible to
promptly initiate attempts at reversal of
clinical death
1 operator
2 operators
Monitoring the effectiveness of CPR

•Cheking whether the spontaneously

pulse has returned at first after 1 minute
CPR, and every 2 – 5 minute there after
• intermittently palpating the carotid
pulse
 Emergency management of
hemorrhage
• Control of external hemorrhage without
surgical measures, by elevation and
compression
•Positioning of conscious patients in horizontal
with leg elevated
•ABC resuscitation initiation in unconscious
patients
 Drugs and Fluids

•Routes for drugs and fluid :

• Peripheral intravenous route for the
administration of drugs and fluids should be
establish as quicly as possible after the initiation
of CPR without interrupting CPR
 Drugs

Epinephrine ( Adrenaline ) may help restore

spontaneous circulation in cardiac arrest of 1
– 2 minute duration
Alpha and beta receptor activity
Alpha receptor activity is the most important in
cardiac arrest
Vasoconstriction, diastolic pressure raises, improve
myocardial and cerebral blood flow