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CARDIOPULMONARY
RESUSCITATION
(BLS, ACLS)
Dr. Saeid Safari
MD, Specialist Anaesthetist,
Assistant Professor of Shahid Beheshti University of Medical Sciences,
• Learning Objectives
• Cardiac Arrest Recognition
• Activating the Emergency Response
System
• Chest Compressions
• Airway Management
• Automated External Defibrillators
(AED)
• Adult BLS Algorithm
• Pediatric BLS Algorithm
• Team Dynamics and High-Quality CPR
• Minimizing Interruptions
• Special Considerations
• Self-Care and Mental Health Support
• Practice and Skills Demonstration
• Common Challenges and
Troubleshooting
• Conclusion
Outline
Advanced Cardiac Life Support (ACLS) for
Healthcare Providers
• BLS skills
• Basic ECG rhythm interpretation
• Airway management
• Vascular access
• Pharmacology of the drugs commonly used in adult resuscitation
Learn CPR. Save a Life.
Learn to "Be the Beat" and perform
Hands-Only CPR if they see a teen or
adult suddenly collapse. If you are called
on to perform CPR in an emergency, you
will most likely be trying to save the life
of someone you love: a child, a spouse, a
parent, or a friend.
Don’t Drop the Beat
The American Heart Association has
teamed up with the Elevance Health
Foundation to teach Americans how to
perform Hands-Only CPR. All songs in
our 'Don't Drop the Beat'
playlist and Elevance Health Foundation
Station are between 100 - 120 beats per
minute, the same rate at which you
should perform compressions when
administering CPR.
Heroes Saving Hearts with CPR
• You can turn your hands into wings of life.
MEN ARE MORE LIKELY THAN WOMEN TO RECEIVE
CPR IN PUBLIC
• The team evaluated 19,331 cardiac events using data from the
Resuscitation Outcomes Consortium, which studies out-of-hospital
treatments of cardiac arrest and trauma in the United States and Canada.
• They found that 45 percent of men received bystander CPR in public,
compared to 39 percent of women, and that men’s odds of survival were
23 percent higher than those of women
These Highlights summarize the key
issues and changes in the 2020 American
Heart Association (AHA) Guidelines for
Cardiopulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC).
“Guidelines Highlights”
Figure 1. Applying Class of Recommendation and Level of Evidence to Clinical
Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated
May 2019)*
Adult Basic and Advanced Life Support
2020- AHA Chains of Survival for adult IHCA
and OHCA.
Adult Cardiac
Arrest Algorithm
CPR Steps: Definitions
Progressive Vital Organ Detoriation
P reCP R
Cardiac Arrest
CPR
Return Of Spontaneous Circulation (ROSC)
Po st CPR
Vital Organ Function Stability
Pre CPR
PreCPR: Rationale
• Preventing cardiac arrest, most effective compared to CPR or
PostCPR, in pts’ survival and post discharge condition.
• Preventing cardiac arrest, least costly compared to CPR or
PostCPR , in pts’ survival and post discharge condition.
• Cardiopulmonary arrest is frequently preceded by PreCPR
mismanagement, therefore is preventable.
Pre-CPR Goal:
To Prevent Cardiac Arrest!
Adult BLS Algorithm
for Healthcare
Providers.
AED indicates automated external
defibrillator; ALS, advanced life
support; BLS, basic life support;
and CPR, cardiopulmonary
resuscitation.
Chain of Survival
Simplified BLS
Algorithm
Assessment & ERS Activation
1. Establish Unresponsiveness
Sudden Loss of Consciousness + Abn. Respiration
vs
Tap, Shake, Shout
2. Call for Help
2010 Step by step activation of ERS consequentially
2015 Simultaneous assessment of responsiveness, pulse, & breathing
before & while activating ERS
5 – 6 cm
Chest Compression Depth
2020
Push Hard !
Class I, LOE C-LD
100 – 120
Chest Compression Rate
2020
Push Fast !
Fully Recoil !
do not leaning on chest
Respiratory Rate (No advanced airway)
Avoid Hyperventilation !
30 : 2
CPR (BLS)
Essential Actions:
• Chest Wall Compression
LUCAS - Chest Compression System
LUCAS - Chest Compression System
10
Respiratory Rate
(Advanced Airway)
2020
Avoid Hyperventilation !
Head-tilt/Chin-lift Maneuver
Head-tilt/Chin-lift Maneuver
Team-Based Resuscitation
BLS Dos and Don’ts of
Adult High-Quality CPR
High-Quality CPR Saves Lives
• Minimize Interruptions: Chest compression fraction (CCF) >80%
• Chest Compression rate of 100-120/min
• Compression depth of at least 50 mm (2 inches) in adults and at least
1/3 the AP dimension of the chest in infants and children
• Avoid Excessive Ventilation:
• Rate <12 Breaths per Minute,
• Minimal Chest Rise
• Full Chest Recoil: No Residual Leaning
High Quality CPR Components for BLS
High Quality CPR Components for BLS
CPR (BLS): CPR & AED
Essential Actions:
• Chest Wall Compression
• Early Defibrillation
Advanced Cardiovascular Life Support (ACLS)
Causes and Mechanisms
• There are many different types of arrhythmias, but the ones most
frequently recorded in sudden cardiac arrest are ventricular
tachycardia and ventricular fibrillation.
• Less common causes of dysrhythmias in cardiac arrest include
pulseless electrical activity (PEA), bradyarrhythmias, or asystole
• Tablets or toxins,
• Tamponade
• Tension pneumothorax
• Thrombosis – A heart attack
• Thromboembolism
• Traumatic cardiac arrest
• Hypovolemia
• Hypoxia
• Hydrogen ions (acidosis)
• Hyperkalemia or hypokalemia
• Hypothermia
• Hypoglycemia or hyperglycemia
Reversible causes
H T
Adult Cardiac Arrest
Algorithm.
CPR indicates cardiopulmonary
resuscitation; ET, endotracheal; IO,
intraosseous; IV, intravenous; PEA,
pulseless electrical activity; pVT,
pulseless ventricular tachycardia;
and VF, ventricular fibrillation.
Adult Cardiac Arrest Circular Algorithm.
Termination of Resuscitation Rule
Adult basic life support termination of
resuscitation rule.
Adult advanced life support
termination of resuscitation rule.
Schematic representation of ALS
recommendations for use of
advanced airways during CPR.
Adult Bradycardia Algorithm
Adult Tachycardia With a Pulse Algorithm
Adult
Post–Cardiac
Arrest Care
Algorithm.
Opioid-Associated Emergency for Lay
Responders Algorithm.
Opioid-Associated Emergency for
Healthcare Providers Algorithm.
Cardiac Arrest in Pregnancy In-Hospital
ACLS Algorithm.
Adult Cardio Pulmonary Resuscitation (CPR)  2020 (BLS-ACLS-Post CPR)

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Adult Cardio Pulmonary Resuscitation (CPR) 2020 (BLS-ACLS-Post CPR)

  • 1. CARDIOPULMONARY RESUSCITATION (BLS, ACLS) Dr. Saeid Safari MD, Specialist Anaesthetist, Assistant Professor of Shahid Beheshti University of Medical Sciences,
  • 2. • Learning Objectives • Cardiac Arrest Recognition • Activating the Emergency Response System • Chest Compressions • Airway Management • Automated External Defibrillators (AED) • Adult BLS Algorithm • Pediatric BLS Algorithm • Team Dynamics and High-Quality CPR • Minimizing Interruptions • Special Considerations • Self-Care and Mental Health Support • Practice and Skills Demonstration • Common Challenges and Troubleshooting • Conclusion Outline
  • 3. Advanced Cardiac Life Support (ACLS) for Healthcare Providers • BLS skills • Basic ECG rhythm interpretation • Airway management • Vascular access • Pharmacology of the drugs commonly used in adult resuscitation
  • 4.
  • 5. Learn CPR. Save a Life. Learn to "Be the Beat" and perform Hands-Only CPR if they see a teen or adult suddenly collapse. If you are called on to perform CPR in an emergency, you will most likely be trying to save the life of someone you love: a child, a spouse, a parent, or a friend. Don’t Drop the Beat The American Heart Association has teamed up with the Elevance Health Foundation to teach Americans how to perform Hands-Only CPR. All songs in our 'Don't Drop the Beat' playlist and Elevance Health Foundation Station are between 100 - 120 beats per minute, the same rate at which you should perform compressions when administering CPR.
  • 6.
  • 7. Heroes Saving Hearts with CPR • You can turn your hands into wings of life.
  • 8. MEN ARE MORE LIKELY THAN WOMEN TO RECEIVE CPR IN PUBLIC • The team evaluated 19,331 cardiac events using data from the Resuscitation Outcomes Consortium, which studies out-of-hospital treatments of cardiac arrest and trauma in the United States and Canada. • They found that 45 percent of men received bystander CPR in public, compared to 39 percent of women, and that men’s odds of survival were 23 percent higher than those of women
  • 9.
  • 10. These Highlights summarize the key issues and changes in the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). “Guidelines Highlights”
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Figure 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated May 2019)*
  • 18. Adult Basic and Advanced Life Support
  • 19. 2020- AHA Chains of Survival for adult IHCA and OHCA.
  • 21. CPR Steps: Definitions Progressive Vital Organ Detoriation P reCP R Cardiac Arrest CPR Return Of Spontaneous Circulation (ROSC) Po st CPR Vital Organ Function Stability
  • 23. PreCPR: Rationale • Preventing cardiac arrest, most effective compared to CPR or PostCPR, in pts’ survival and post discharge condition. • Preventing cardiac arrest, least costly compared to CPR or PostCPR , in pts’ survival and post discharge condition. • Cardiopulmonary arrest is frequently preceded by PreCPR mismanagement, therefore is preventable.
  • 24. Pre-CPR Goal: To Prevent Cardiac Arrest!
  • 25.
  • 26. Adult BLS Algorithm for Healthcare Providers. AED indicates automated external defibrillator; ALS, advanced life support; BLS, basic life support; and CPR, cardiopulmonary resuscitation.
  • 29. Assessment & ERS Activation 1. Establish Unresponsiveness Sudden Loss of Consciousness + Abn. Respiration vs Tap, Shake, Shout 2. Call for Help 2010 Step by step activation of ERS consequentially 2015 Simultaneous assessment of responsiveness, pulse, & breathing before & while activating ERS
  • 30.
  • 31.
  • 32. 5 – 6 cm Chest Compression Depth 2020 Push Hard ! Class I, LOE C-LD
  • 33. 100 – 120 Chest Compression Rate 2020 Push Fast !
  • 34. Fully Recoil ! do not leaning on chest
  • 35. Respiratory Rate (No advanced airway) Avoid Hyperventilation ! 30 : 2
  • 36. CPR (BLS) Essential Actions: • Chest Wall Compression
  • 37.
  • 38. LUCAS - Chest Compression System
  • 39. LUCAS - Chest Compression System
  • 43.
  • 44.
  • 46. BLS Dos and Don’ts of Adult High-Quality CPR
  • 47. High-Quality CPR Saves Lives • Minimize Interruptions: Chest compression fraction (CCF) >80% • Chest Compression rate of 100-120/min • Compression depth of at least 50 mm (2 inches) in adults and at least 1/3 the AP dimension of the chest in infants and children • Avoid Excessive Ventilation: • Rate <12 Breaths per Minute, • Minimal Chest Rise • Full Chest Recoil: No Residual Leaning
  • 48. High Quality CPR Components for BLS
  • 49. High Quality CPR Components for BLS
  • 50.
  • 51.
  • 52.
  • 53.
  • 54. CPR (BLS): CPR & AED Essential Actions: • Chest Wall Compression • Early Defibrillation
  • 56. Causes and Mechanisms • There are many different types of arrhythmias, but the ones most frequently recorded in sudden cardiac arrest are ventricular tachycardia and ventricular fibrillation. • Less common causes of dysrhythmias in cardiac arrest include pulseless electrical activity (PEA), bradyarrhythmias, or asystole
  • 57. • Tablets or toxins, • Tamponade • Tension pneumothorax • Thrombosis – A heart attack • Thromboembolism • Traumatic cardiac arrest • Hypovolemia • Hypoxia • Hydrogen ions (acidosis) • Hyperkalemia or hypokalemia • Hypothermia • Hypoglycemia or hyperglycemia Reversible causes H T
  • 58.
  • 59. Adult Cardiac Arrest Algorithm. CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycardia; and VF, ventricular fibrillation.
  • 60. Adult Cardiac Arrest Circular Algorithm.
  • 61. Termination of Resuscitation Rule Adult basic life support termination of resuscitation rule. Adult advanced life support termination of resuscitation rule.
  • 62. Schematic representation of ALS recommendations for use of advanced airways during CPR.
  • 64. Adult Tachycardia With a Pulse Algorithm
  • 66. Opioid-Associated Emergency for Lay Responders Algorithm.
  • 68. Cardiac Arrest in Pregnancy In-Hospital ACLS Algorithm.