This document provides information on cardiopulmonary resuscitation (CPR) and protocols for basic life support (BLS) and advanced cardiac life support (ACLS). It outlines the steps for BLS, including chest compressions, airway management, rescue breathing, and use of an automated external defibrillator. It then describes ACLS, which aims to diagnose the cause of cardiac arrest and provide cause-specific treatment while continuing BLS efforts. Key drugs and procedures covered in ACLS are also summarized, such as defibrillation, intubation, vasopressors like epinephrine, and antiarrhythmics like amiodarone and lidocaine. The document emphasizes the importance of high-quality C

1. Dr Aggy S. Valentine MD, DA
Senior Consultant in Anaesthesia
Kerala State Health Services

2. CARDIO PULMONARY RESUSCITATION
 Symptomatic therapy aimed at sustaining vital organ
function until natural cardiac function is restored
 Basic Life Support (BLS)
 Advanced Cardiac Life Support (ACLS)
 Post Resuscitation Support

3.  BLS is to maintain cardiac output and vital organ
perfusion.
 ACLS is to diagnose cause of arrest and proceed
to the cause specific treatment while
continuining BLS.

4.  Basic Life Support is the
foundation for saving lives
following cardiac arrest.

5. TIME IS CRITICAL
 4 – 6 min, Irreversible neurological deficit.
 RESUSCITATE HEART , RESTORE
BRAIN
 Move quickly, calmly, do a systematic and
effective resuscitation

6. BLS includes
Recognition of signs of sudden cardiac
arrest.
Cardio pulmonary resuscitation
Defibrillation

7. Adult Chain of Survival

8. Code Blue
To provide immediate life
saving measures in case of life
threatening emergencies.

9. Scope of Code Blue
 It is an event of utmost emergency, a
mode of alerting all medical, nursing,
paramedical and allied health-care
services and other personnel (house-
keeping, bio-medical, transport,
maintenance, security, etc)

10.  Victims of cardiac arrest need immediate CPR.
 Start CPR within 10 seconds of finding a patient
in cardiac arrest.
 Inform and then start CPR
 Trolley should reach within 2 minutes.

11. Adult BLS Sequence
 Before approaching the victim, the rescuer must
ensure that the scene is safe.
 Immediate recognition and activation of the
emergency response system.
 Tap the victim on the shoulder and ask “Are you
alright?”
 If victim responds but is injured, leave victim to
phone for help.

12.  Then come back as soon as possible to check on
the patient.
 If a lone rescuer finds an unresponsive patient ( no
movement in response to stimulation, gasping, no
breathing ) alert emergency services.
 Return to patient, provide CPR, defibrillation if
needed.
 If two or more rescuers present, one begins CPR
while the other phones for help.

13. Pulse Check
 Should take not more than 10 seconds.
 If no pulse felt
within that
period, start
chest
compression.

14. “A-B-C” to “C-A-B”
 This development came in the 2010 CPCR
guidelines
 Adults and Pediatric patients

16. Chest Compressions
 Consists of forceful, rhythmic application of pressure
over lower half of sternum.
 All patients in cardiac arrest should receive
chest compressions

17. How does chest compression
work?
 Chest compressions increase intrathoracic pressure
and directly compresses the heart. This generates
blood flow and oxygen delivery to the heart and
brain.

22. Effective Chest Compressions
 Push hard and push fast.
 100-120 compressions per minute.
 Compression depth – 5cms.
 Allow complete recoil of chest after each
compression to allow heart to fill completely.
 Avoid interruptions in compression.
 Rotate compressor every two minutes.

23.  Compression/Ventilation ratio – 30:2
 Two breaths should take no less than
10 seconds.
 One breath should take just over 1
second.

24. Airway
 To open the airway,
Head tilt
Chin lift.

25. Head tilt, chin lift.

26. Rescue Breaths
 Mouth to mouth or Bag mask.
 Deliver each rescue breath over 1 second.
 Give a sufficient tidal volume to produce
visible chest rise.
 Use a compression/ventilation ratio of 30
chest compressions to 2 ventilations

27. Pocket Mask

28. Ambu bag

30. Early Defibrillation
 Early Defibrillation with AED
Follow AED prompts.
 Interval from collapse to defibrillation is one of the
most important determinants of survival from cardiac
arrest.
 Resume chest compressions immediately after the
shock.

31. Defibrillation
 Defibrillation stuns the heart, briefly stopping cardiac
electrical activity.
 If the heart if still viable, its normal pace maker may
resume firing and produce an effective rhythm.

33. Steps for using AED
• Switch power On.
• Attach paddles.
• Analyze rhythm ( done by AED ).
• Deliver shock ( if advised by AED ).
• Biphasic: 120 – 200J
Monophasic: 300J
• Resume CPR immediately after shock.

35. Conventional Defibrillation
 Power on.
 Attach paddles.
 Analyze rhythm.
 Select joules.
 Charge.
 All clear.
 Deliver shock.

36. To Summarize BLS
 Person collapses
 Confirm Unresponsiveness : Shake &Shout
Scan for breathing
If normal breathing absent
 Activate EMS / Call for help
 Check pulse
 Position the patient & yourself

37. To Summarize BLS
 Start Chest Compression
 After 30 chest compression Open Airway by
Triple maneuver
 Two rescue breaths
 Continue Chest Compression & Ventilation
(30:2) till AED / Manual Defibrillation

38. To Summarize BLS
 Defibrillation ( 360J monophasic or 120-200J
biphasic)
 5 cycles of Compression & Ventilation
 Analyze rhythm
 ACLS

39. ACLS-2015
 Advanced cardiac life support or advanced
cardiovascular life support (ACLS) refers to a set of
clinical interventions for the urgent treatment of
cardiac arrest, stroke and other life-threatening
medical emergencies, as well as the knowledge and
skills to deploy those interventions.

40. IMPORTANCE OF BLS IN ACLS
 ACLS is built heavily upon the foundation of BLS

42. Shockable Rhythms
 Ventricular Tachycardia (VT)
 Ventricular Fibrillation(VF)

43. Unshockable Rhythms
 Asystole
 Pulseless electrical activity

44. Ventricular Tachycardia

45. Ventricular Fibrillation

46. Ventricular Fibrillation
 Rate: Rapid- no effective cardiac rhythm
 Rhythm: Irregular
 P, QRS, T- waves: Absent
 No blood pressure

47. Asystole

48. Asystole
 P, QRS, T- waves: Complete absent of
cardiac electrical activity
 Complete absent of effective cardiac
pumping function

49. Pulseless Electrical Activity (PEA)
 PEA rhythm occurs when any organized heart
rhythm that is observed on the electrocardiogram
(ECG) does not produce a pulse.
 Performing a pulse check after a rhythm/monitor
check will ensure that you identify PEA in every
situation

50. Causes of Cardiac Arrest

52.  Failure of a single adequate shock to restore a pulse
should be followed by continued CPR and second
shock delivered after five cycles of CPR
 If cardiac arrest still persist- patient is intubated and
IV/IO access achieved

53. Intubation

54. LMA

55. i-gel

56. i-gel

57. Routes of administration
Peripheral IV – easiest to insert during CPR, must
followed by 20 ml NS push
Central IV – fast onset of action, but do not wait or
waste time for CV line
Intraosseous – alternative IV route in peds, also in
adult
Intratracheally (down an ET tube)- not recommended
now a days

59. Epinephrine (Adrenaline)
• It increases heart rate, stroke volume and blood
pressure
• May help in asystole, PEA and symptomatic
bradycardia
• IV Dose: 1 mg every 3-5 minutes

60. Amiodarone
• Indications: Vtach, Vfib
• IV Dose:
300 mg in 20-30 ml of N/S or D5W
Supplemental dose of 150 mg in 20-30 ml of N/S
Followed with continuous infusion of 1 mg/min
for 6 hours then 0.5mg/min to a maximum daily
dose of 2 grams
• Contraindications:
Cardiogenic shock, profound Sinus Bradycardia,
2nd and 3rd degree blocks that do not have a
pacemake

61. Lidocaine
• Indications:
PVCs, Vtach, Vfib
Can be toxic so no longer given
prophylactically
• IV dose :
1-1.5 mg/kg bolus then continuous infusion
of 2-4mg/min
Can be given down ET tube
• Signs of toxicity:
slurred speech, seizures, altered
consciousness

62.  Oxygen
• FIO2 100%
• Assist Ventilation
• O2 Toxicity should not be a concern during ACLS
IV Fluids
Volume Expanders
• crystalloids , e.g. Ringer’s lactate, N/S

63.  Vasopressin (ADH)- is out according to 2015
guidelines for ACLS
 Sodium Bicarbonate
• Used for METABOLIC acidosis / hyperkalemia
• IV Dose: 1 mEq/kg
• Side effects:
Metabolic alkalosis
Increased CO2 production

64. Monitoring during CPR
Physiologic parameters
 Monitoring of PETCO2 (35 to 40 mmHg)
 Abrupt and sustained increase is a sensitive
indicator of ROSC that can be monitored without
interrupting chest compressions

65. ROSC
 Abrupt and sustained increase in ETCO2 (typically
greater than 40mm Hg)
 Palpable pulse.
 Assess BP. Maintain BP with fluids and vasopressor
 Obtain 12- lead ECG.
 Maintain SpO2 greater than 94%

67.  Does the patient follow commands ?
No – Consider induced hypothermia
Yes – STEMI or high suspicion of AMI
Advanced critical care
Coronary reperfusion

70. HAVE A HEART... SAVE A LIFE !!

72. THANK YOU