This is a 2.5 hour update/preview of the 2010 ECC guidelines for CPR and ACLS. It does not include "special situations" and does not include the PALS/NRP stuff (both of these presentations are coming later). It is in its final draft but has been ran through a paramedic refresher course with good reception. DISCLAIMER: It does not contstitute a formal ACLS refresher course, nor is it intended too. Also it incudes much content from my importance of CPR lecture, also on here.

1. New Changes to Old Friends An overview of the 2010 ECC recommendations for ADULT CPR and Emergency Cardiovascular Care (ECC)

7. Levels of Evidence

19. CPR: W.I.N. (What's Important Now)

22. 3 Phase Model

23. Understanding Coronary Perfusion Pressure Note this is Aortic Pressure. CPP is “roughly” half Aortic Pressure.

24. ROSC Associated with CPP

25. Overview of ECC 2010 Changes

33. New CPR Guidelines

34. Traditional Healthcare Version

35. 2005 to 2010 changes HCP only, Checking for “DEFNITE pulse”. HCP Only PULSE CHECK Component of CPR 2005 ECC recommendations 2010 ECC Recommendations DEPTH OF COMPRESSION 1 ½ - 2 inches Greater than 2 inches RATE 100 /MINUTE At least 100 /MIN VENTILATION 8-10 /MINUTE 8-10 /MINUTE CHEST RECOIL 100% 100% INTURUPTIONS Minimized Less than 10 seconds goal

38. Compression Rate… Percent segments within 10 cpm of AHA Guidelines 31 % 36.9% Abella, et al 2005 Circulation 76 % 75 % 58 % 42%

43. Intra-thoracic Pressure and CPR?

44. Importance of complete recoil

45. Get EVERY Compression Right Critical pressure for ROSC (Paradis et al. JAMA 1990;263:3257-8) Abella, et al 2005 Circulation

46. Cerebral Perfusion Pressures and Recoil Abella, et al 2005 Circulation

49. KEY POINT: “… High-quality CPR is important not only at the onset but throughout the course of resuscitation. Defibrillation and advanced care should be interfaced in a way that minimizes any interruption in CPR.” AHA 2010 Guidelines

55. Effect of Vent. Rate on CPP 12 RR /minute CPP 23.4 ± 1.0mmHg MIP 7.1 ± 0.7 mmHg/min 20 RR /minute CPP 19.5 ± 1.8 mmHg MIP 11.6 ± 0.7 mmHg/min 30 RR /minute CPP 16.9 ± 1.8 mmHg MIP 17.5 ± 1.0 mmHg/min

56. CPR Prompts

57. CPR Feedback? CPR FEEDBACK?

59. CPR Marathon? Howard Snitzer, 59, survived 96 minutes of CPR with no neuro Deficits. http://abcnews.go.com/Health/96-minute-cpr-marathon-saves-minnesota-mans-life/story?id=13048099

60. CPR Gadgets, Gizmo’s and Ideas

67. ELECTRICAL THERAPIES

72. CPR IMPROVING DEFIB?

73. Effects of “Progress”…. 1978 1975 1980s and 1990’s King County/Seattle Medic One EMS System Data, Cobb, 1999

75. CPR FIRST? % ROSC

92. AIRWAY

104. ACLS

123. POST ARREST CARE

126. Therapeutic Hypothermia?

127. Questions?

128. “ It is up to us to save the world.” - Peter Safar