bcls and ccls

1. Basic and Advanced
Cardiovascular Life Support
By: Dr. Ram Gopal Maurya
MBBS,MD,PDCC
Dept. of Anaesthesiology
HIMS, Ataria, Sitapur

2.  It is sudden cessation of mechanical activity of heart
with some or no electrical activity leading to cessation
of blood circulation.
 Cardiac arrest may be
out-of-hospital cardiac arrest
or
in-hospital cardiac arrest
What is cardiac arrest?

3.  Management of out-of-hospital cardiac arrest.
Basic cardiopulmonary life support
(BCLS)

4. Core links in adult BCLS

6.  Safe place for resuscitation
 Victim’s response check
 Call for help, inform emergency medical system and
get emergency equipment
 Check pulse and breath simultaneously
 Early high-quality cardiopulmonary resuscitation
Steps in adult BCLS

7.  Early defibrillation
 Recovery position
 Transfer

8.  1st step
 For safety of rescuer
Scene safety

9.  By tapping on the shoulder
from front and ask loudly hello,
are you alright? in local
language.
 Do not shake or tap on the face
as it may cause movement at
neck level and could harm a
victim with cervical injury
Check response

10.  If victim is responsive; place the
victim in recovery position and
constantly monitor until victim
is shifted nearest medical
facility

12.  Check for carotid
pulse simultaneously
scan the chest and
abdomen for signs
of breathing.

14.  Respiratory arrest condition
 Provide normal tidal volume breath for every 5
seconds (12 breath per minute) using mouth to mouth
breath.
 Each breath over 1 second
 End point is visible chest rise
 Reassess for pulse every 2 minutes
Abnormal or no breathing with
definite carotid pulse

15.  Early high-quality cardiopulmonary resuscitation
 Once the cardiac arrest is recognized, start providing
chest compression immediately. Cycles of CPR (cycles
of 30 chest compressions: 2 breaths) should be
initiated.
Early chest compression

16.  High-quality chest compressions
• Ensure a chest compression speed of 120
compressions/minute to a depth of 5–6 cm.
• Allow complete chest recoil between compression
without lifting hand from the chest (do not lean on
the victim’s chest)
• Avoid unnecessary interruption of chest
compressions.
High-quality cardiopulmonary
resuscitation

17.  Optimal ventilation and airway management
• Do not interrupt chest compression to secure the
airway, apply ECG electrodes or defibrillator
pads/paddles
• Do not hyperventilate
• End point for ventilation is visible chest rise; deliver
normal tidal volume breaths.
Cont…

18.  Site of chest
compression:
Lower half of
sternum or two
finger breadth
above the
xiphisternum
How to do chest compression

19.  Hand position:
Place the heel of
second hand on
top of first hand
and interlock the
fingers

20.  Body position and
movement:
• The elbows and
wrists should be
aligned in one
straight line,
shoulder should be
positioned vertically
on top of the chest.
• Waist area s/b above
the level of pt. chest.

21.  2 rescue breath is given after 30 chest compression.
 Deliver each breath over 1 sec and pause for 1 sec after
first breath to allow exhalation.
 End point is visible chest rise.
How to give rescue breath

22. What will you do after 5 cycle of CPR?
 5 cycle of 30 chest compression and 2 breaths s/b
completed in 2 min.

23.  should be done at the
earliest possible.
 It can be done with AED (
automated external
defibrillator) or manual
defibrillator.
 The first shock must be
administered at the
earliest, irrespective of the
stage of the CPR cycle.
Early defibrillation

25.  Switch ON the AED
 Follow the voice prompts
• Attach AED pads without interrupting the chest
compressions
• Analyze the rhythm by AED for need of electric shock.
Do not touch the victim during rhythm analysis
• Administer electric shock if prompted by AED
• Resume CPR, starting with chest compression
steps of using automated external
defibrillator

26.  In case of return of spontaneous circulation and normal
breathing, the victim should be positioned in recovery
position till the medical help arrives and the victim is to be
shifted to medical facility.
 The recovery position can be either left or right lateral.
 The recovery position allows maintenance of the airway
and drainage of any oral secretions.
 Victim should be reassessed every 2 min or earlier if
required.
Recovery position

27.  should be shifted to the nearest suitable healthcare
facility for definite management of underling
etiology.
Transfer

28.  For management of in-hospital cardiac arrest by
trained medics and paramedics.
 CCLS incorporation of airway management, drugs,
and identification of the cause of arrest and its
correction, while chest compression and ventilation
are ongoing.
Comprehensive cardiopulmonary life support
(CCLS) or Advanced Cardiovascular Life
Support

29. Core links in adult CCLS

31.  Safe place for resuscitation
 Patient’s response check
 Activate Code blue team or local team
 Check pulse and breath simultaneously
 Early high-quality cardiopulmonary resuscitation
 Early defibrillation
 Post-resuscitation care
Steps in adult CCLS

32.  simultaneously
• Venous access
• Airway management
• Drugs including antiarrhythmics
• Assess and manage the reversible causes
Cont...

33.  Non invasive BP
 ECG
 Pulse oxymeter
 Capnography (EtCO2 )
Attach monitors

34.  Peripheral venous access most prefered
 The second choice remains intraosseous (IO)
cannulation. All drugs and fluids may be administered
through the IO route similar to intravenous access.
 Endotracheal route can also be used. Naloxone,
adrenaline, atropine and lidocaine can be given. The
intratracheal dose should be 2–2½ times that of
intravenous dose and diluted to 10 mL.
Venous access

35.  The definitive airway may be secured with an
endotracheal tube or supraglottic devices.
 However, if the BMV is optimal, then securing
definitive airway can be deferred to prevent
unnecessary interruption of chest compression.
 “After definite airway continue high
quality cpr with chest compression at
120/min and 1 breath at every 6 sec.”
Airway management

36.  Adrenaline: 1 mg diluted in 10 mL should be
administered as bolus, repeated every 3–5
min.
 Antiarrhythmics: Amiodarone 300 mg slow
over few min. If arrhythmias persist even after
initial 2–3 cycles of CPR. A second intravenous
dose of amiodarone 150 mg may be
administered if arrhythmias persist.
 Lignocaine may be considered as an alternate
drug in patients with persistent arrhythmia.
Drugs including antiarrhythmics

37. Team formation

38.  ‘HIT THE TARGET’
• H – Hypoxia,
• I – Increased H Ions [Acidosis],
• T – Tension Pneumothorax,
• T – Toxins/Poisons
• H – Hypovolaemia,
• E – Electrolyte Imbalance [Hypo-/Hyperkalaemia],
• T – Tamponade Cardiac,
• A – Acute Coronary Syndrome,
• R – Raised Intracranial Pressure [Subarachnoid Haemorrhage],
• G – Glucose [Hypo-/hyperglycaemia],
• E – Embolism (Pulmonary Thrombosis),
• T – Temperature [Hypothermia]).
Assess and manage the reversible
causes

39. Hypovolumia Toxin
Hypoxia Tension pneumothorax
Hydrogen ion ( acidosis) Tamponade cardic
Hypo/hyperkalaemia Thrombosis coronary
hypothermia Thrombosis pulmonary
5 H – 5 T

42. CCLS for suspected or confirmed
coronavirus disease (COVID-19) patient

46. Thank you
 Ref:
• Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor MV, et al. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained
paramedics and medics outside the hospital. Indian J Anaesth 2017;61:874-82.
• Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor MV, et al. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation
by trained paramedics and medics inside the hospital. Indian J Anaesth 2017;61:883-94
• Singh B, Garg R, Chakra Rao SS, Ahmed SM, Divatia JV, Ramakrishnan TV, et al. Indian Resuscitation Council (IRC) suggested guidelines for Comprehensive
Cardiopulmonary Life Support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient. Indian J Anaesth 2020;64:S91-6.
• www.cprindia.in