This document discusses cardiopulmonary resuscitation (CPR) and basic life support (BLS) for cardiac arrest. It outlines the key steps of BLS which are the ABCs - airway, breathing, and circulation. Chest compressions and rescue breathing are used to provide blood flow and oxygen to the heart and brain. For cardiac arrest due to shockable rhythms like ventricular fibrillation, defibrillation is needed along with CPR. Advanced cardiac life support (ACLS) protocols are described for shockable and non-shockable rhythms. The document emphasizes that early CPR and defibrillation are critical to survival from cardiac arrest.

1. Cardiopulmonary Resuscitation
(Basic and Advanced Cardiac Life
Support)
David Maldonado MD
Mayo Clinic
Rochester, MN, USA

2. Agenda
• Cardiac Arrest
• Basic Life Support
• Advanced Cardiac Life Support for
Pulseless Arrest
• Ventricular Fibrillation (VF)
• Pulseless Ventricular Tachycardia (VT)
• Asystole
• Pulseless Electrical Activity (PEA)
• Algorithms

3. Cardiac Arrest
• Sudden loss of heart function
• With or without prior history of heart
disease
• May lead to death within minutes
• In U.S. up to 750,000 cardiac arrests with
attempted resuscitation every year
• 225,000 deaths

4. Causes of Cardiac Arrest
• Most commonly coronary artery disease
• Electrical impulses become too rapid
(ventricular tachycardia) or chaotic
(ventricular fibrillation)
• Also from profound bradycardia,
respiratory arrest/choking/drowning,
electrocution, trauma and other causes
• May also occur without any known cause
Americanheart.org

5. • Brain death begins within 4-6 minutes
• Cardiac arrest can be reversed within
minutes
• Chances of survival decrease 7-10% every
minute without CPR or defibrillation (not
including cold-water drowning)
• Early & effective CPR and early &
appropriate defibrillation are keys to
management
Americanheart.org

6. Cardiopulmonary Resuscitation (CPR)
Basic Life Support (BLS)
• Chest Compressions and Rescue
Breathing for person felt to be in cardiac
arrest
• To provide blood flow to brain and heart
• Maintain end-organ perfusion during arrest
• May still likely require defibrillation or
definitive treatment of ACLS
(anti-arrhythmic medications, fluid
resuscitation, electrolyte restoration, etc.)

7. BLS Healthcare Provider Algorithm
No movement or response
Open AIRWAY, check BREATHING
If not breathing, give 2 BREATHS that make chest rise
• Give 1 breath every 5 to 6
seconds
• Recheck pulse every 2
minutes
If no response, check pulse:
Definite pulse
Give cycles of 30 COMPRESSIONS and 2 BREATHS
Push hard and fast (100/min) and release completely
Minimize interruptions in compression
No pulse
AED/defibrillator ARRIVES
Check rhythm
Shockable rhythm?
Give 1 shock
Resume CPR immediately
for 5 cycles
Resume CPR immediately
For 5 cycles
Check rhythm every
5 cycles; continue until ALS
Providers take over or
victim starts to move
Shockable
(VF/VT)
Non Shockable
Adapted from Circulation;112 (24 Supplement): IV-19.
(2005)

8. ABCD’s of BLS
Step 1: Airway
• Head-tilt, Chin-lift maneuver
• Open airway

9. Step 2: Breathing
Look, listen, and feel
• Look for chest rise
• Listen for normal breath sounds
• Feel air flow with cheek or hand
• If not detected within 10 seconds, give 2
rescue breaths, then proceed to next step
• Each breath for 1 second
• Visible chest rise
• Bag-mask, mouth-to-mask, mouth-to-
mouth

10. Smurd.com

11. Step 3: Circulation
Check Pulse
• Pulse present: give 1 breath every 5-6
seconds
• Pulse absent: deliver effective chest
compressions
• “Push hard and fast”
• 100 compressions/minute
• 4-5 cm depth
• Complete chest recoil
• 30 compressions : 2 breaths = 1 cycle

12. Chest Compression Technique
Smurd.com

13. 100 compressions/minute
Abella et al. Circulation. 2005;111:428-434.

14. Compression Depth
4-5 cm
Edelson et al. Resuscitation. 2006; 71:136-145.

15. Step 4: Defibrillation
Advanced Cardiac Life Support (ACLS)
• Oxygen, monitor/defibrillator, IV
• Assess rhythm
• Shockable rhythm
• Ventricular fibrillation
• Pulseless Ventricular Tachycardia
• Non-shockable rhythm
• Asystole
• Pulseless Electrical Activity

16. Shockable Rhythms
VF and pulseless VT

17. • Deliver single shock (360 J Monophasic or
200 J Biphasic)
• Immediate 5 cycles of CPR
• Assess rhythm – Still shockable rhythm?
• Repeat defibrillation, 5 cycles of CPR, and
either epinephrine 1mg every 3-5 minutes
or Vasopression 40 Units IV x 1
• Assess rhythm – Still shockable rhythm?
• Repeat defibrillation, 5 cycles of CPR, and
consider antiarrhythmics
• Amiodarone 300mg IV push or
• Lidocaine 1-1.5mg/kg

18. Non-Shockable Rhythms
Asystole and PEA

19. • Immediate 5 cycles of CPR
• Epinephrine 1mg IV every 3-5 minutes or
Vasopressin 40 Units IV x 1
• Atropine 1mg IV for asystole or slow PEA
• Reassess rhythm – Still non-shockable?
• Repeat pattern and consider differential

20. Differential/Management
6 H’s and 5 T’s
• Hypovolemia Fluid resuscitation
• Hypoxia Supplemental O2
• Hydrogen (Acidosis) Treat cause, ?bicarbonate
• Hypo-/Hyperkalemia Correct imbalance
• Hypoglycemia Check/replace glucose
• Hypothermia Rewarming
• Toxins Toxin-specific Rx
• Tamponade Pericardiocentesis
• Tension Pneumothorax Needle decompress
• Thrombosis (MI or PE) MI/PE Rx
• Trauma Surgical evaluation

21. Post-resuscitative Care
• Supportive, multi-organ care
• ?Hypothermia, ?Glucose control
• Predictors of poor outcome at 24 hrs
• Absent corneal reflex
• Absent pupillary response
• Absent withdrawl response to pain