Perdatin Jaya: Update on Critical Care 2014

Summary of
CPR 2010
VERA IRAWANY

Perdatin Jaya: Update on Critical Care 2014

THE IMPORTANCE OF THE

FIRST RING CHAIN OF
SURVIVAL
2

PREVENTABLE OF INHOSPITAL CARDIAC

ARREST

Perdatin Jaya: Update on Critical Care 2014

PENTINGNYA MATA
RANTAI PERTAMA DARI
RANTAI KESELAMATAN
2

PENCEGAHAN HENTI
JANTUNG YANG TERJADI
DI DALAM RUMAH SAKIT

Perdatin Jaya: Update on Critical Care 2014

Reference:

Perdatin Jaya: Update on Critical Care 2014

Chain of survival
(Rantai keselamatan)
1
2
3
4
5

Immediate recognition of CA and activation of emergency response

system
(Kenali segera adanya henti jantung dan aktifkan sistem kegawatdaruratan)
Early CPR with an emphasis on chest compressions
(Mulai bantuan RJP sedini mungkin penekanan pada kompresi dada)
Rapid defibrillation
(Defibrilasi sesegera mungkin)
Effective advance life support
(Bantuan hidup lanjut yang efektif)
Integrated post cardiac arrest care

The old Jaya:

(2005) algorithm
Perdatin
Update on Critical Remove
Care 2014
open

Remove open
airway and
rescue breath
time
consuming

AED
AUTOMATED EXTERNAL DEFIBRILATOR

Minimize
interruption

Perdatin Jaya: Update on Critical Care 2014

New Development in
Resuscitation since 2005

Ratio compression: ventilation = 30: 2

Defibrillator sequence from 3 stacked
shocks to 1 shock followed by immediate
CPR
Minimize interruptions in chest compression
EMS system and healthcare provider should
identify and strengthen weak links in the
chain of survival

Perdatin Jaya: Update on Critical Care 2014

New Development in
Resuscitation since 2005

Importance of post cardiac arrest care

organized with emphasis on multidiciplinary
program focus on optimizing
hemodynamic, neurologic and metabolic
functions also hypothermia therapy
Education and implementation:
1. The quality of rescuer education and
frequency of retraining critical factor in
improving the effectiveness of
resuscitation ( < 2 years)
2. Community and hospital based
resuscitation programs should

Perdatin Jaya: Update on Critical Care 2014

CPR...2010.....

Perdatin Jaya: Update on Critical Care 2014

Universal Algorithm CPR 2010

Perdatin Jaya: Update on Critical Care 2014

New Sequence for 2010

Chest compressions, Airway,
Breathing (CAB) is the new order of
operations from American Heart
Association.
This applies for adults, pediatrics and
infants, excluding newborns.
Newborn arrest are most likely
respiratory and should use the ABC
sequence.
Adult Chain of Survival.

Perdatin Jaya: Update on Critical Care 2014

Highlight of 2010 Guideline

Critical elements of CPR:
Chest compression
Early defibrillator
The C-A-B sequence:
Compression initiated sooner, airway
assessment delayed CPR focus on good
quality of CPR
More victims received CPR, rescuer unable or
unwilling perform ventilation (Hands-Only CPR)
Healthcare provider could tailored the sequences
of rescue actions in an integrated team of highly
trained rescuers to most likely cause of CA

Perdatin Jaya: Update on Critical Care 2014

Rescuer Proficiency

Perdatin Jaya: Update on Critical Care 2014

GOOD
QUALITY of
CPR

Summary of Key BLS Components for Adults, Children and

Infants

Perdatin Jaya: Update on Critical Care 2014

Highlight of 2010 Guideline

Key Points of Continued Emphasis for 2010 AHA Guidelines for CPR
and ECC
Early recognition of CA in adult
Minimize interruptions in effective chest compression until ROSC
Minimize the importance of pulse checks by healthcare providers (<
10 second)

Post-cardiac arrest care

Optimizing cardiopulmonary function and vital organ perfusion after
ROSC
Transportation to appropriate critical-care unit with a comprehensive
post-cardiac arrest treatment system of care
Identification and intervention for acute coronary syndrome (ACS)
Temperature control to optimiz neurologic recovery
Anticipation, treatment, and prevention of multiple organ dysfunction
Several recommendation for special population (Adult with ACS,
stroke and pediatric population), First Aid etc

Perdatin Jaya: Update on Critical Care 2014

HOW..?????

PREVENTABLE OF INHOSPITAL CARDIAC ARREST

Perdatin Jaya: Update on Critical Care 2014

Chain of Survival

Prevention cardiac arrest

is the first link - Chain of
Survival

Perdatin Jaya: Update on Critical Care 2014

Background: Prevention of inHospital Arrest

- Rates of survival and complete recovery are
poor in all ages group < 20% adult with
in-hospital CA will survive and discharged
(Keberhasilan dan perbaikan fisiologi yang sempurna pasca
henti jantung di RS, buruk pada semua kelompok umur
pasien)

- CA is rare in pregnant women and children

but outcomes after in-hospital cardiac arrest
are poor
(Henti jantung sangat jarang terjadi pada populasi wanita
hamil dan anak-anak, akan tetapi bila terjadi maka hasilnya
buruk)

Perdatin Jaya: Update on Critical Care 2014

Prevention of in-Hospital Arrest

The Facts:
Defisiencies in acute care
many significant
antecedents (related to
abnormalities of airway,
breathing, circulation)
Failure to use a systemic
approach to the
assessment of critically ill
patients
Poor communication
The Needs:
Lack of teamwork
Staff education
Insufficient use of
treatment limitation plans Monitoring of patients

Recognition of
deterioration
A system to call for help
and effective response

Perdatin Jaya: Update on Critical Care 2014

Recommended Strategies for

Prevention Avoidable in-Hospital CA

Perdatin Jaya: Update on Critical Care 2014

Recommended Strategies for

Prevention Avoidable in-Hospital CA
(2)

Perdatin Jaya: Update on Critical Care 2014

Kesimpulan
Basic Life Support:
1. Immediate recognition
(to prevent CA) and
activation emergency
response system
2. Early performance of
high quality CPR
3. Rapid defibrillator
when appropriate

Perdatin Jaya: Update on Critical Care 2014

Guidelines,
research

Decreased
in-hospital
CA
incidence

Kesimpulan
Education & training

Hospital Process:
EWS?MET/RRT