The document discusses various devices that can be used to support circulation during CPR, including mechanical chest compression devices, impedance threshold devices, and devices that provide simultaneous chest and abdominal compression. It also reviews guidelines from 2008 that recommend broader CPR training for bystanders, emphasize hands-only CPR for witnessed adult cardiac arrests, and discuss post-cardiac arrest syndrome. The document appears to be reviewing updates and recommendations regarding CPR techniques and devices.

1. Adjuncts and Update in CPR Nalinas Khunkhlai, MD Department of Emergency Medicine and Narenthorn EMS center, Rajavithi hospital

2. Objective

3. CPR Devices Devices to Support Circulation Active Compression-Decompression CPR (ACD-CPR) Impedance Threshold Device (ITD) Mechanical Piston Device Load-Distributing Band CPR (LDB-CPR) or Vest CPR Phased Thoracic-Abdominal Compression-Decompression CPR (PTACD-CPR) Ref : Circulation Dec 2005 ; Guideline ACLS ECC

4. Lund University Cardiopulmonary Assist System (LUCAS) 1. Automatic mechanical compression and active decompression resuscitation Suction cup to actively lift the anterior chest during decompression.. To enhance venous return to the heart.

5. 1. Automatic mechanical compression and active decompression resuscitation Lund University Cardiopulmonary Assist System (LUCAS)

6. Active Compression - Decompression

8. 2. Impedance Threshold Device A valve to limit air entry into the lungs during chest recoil. To reduce intrathoracic pressure And enhance venous return to the heart ResQpod

9. 2. Impedance Threshold Device ResQpod

10. 3.Mechanical Piston Device Simultaneous Sterno-Thoracic Cardiopulmonary Resuscitation (SST-CPR) Device depresses the sternum via compressed gas-powered plunger mounted on a backboard.

12. Simultaneous Sterno-Thoracic Cardiopulmonary Resuscitation (SST-CPR)

13. 4.Load-Distributing Band CPR or Vest CPR Autopulse

14. 5. Phase chest and abdominal compression-decompression Combines the concepts of ACD-CPR device and Interposed Abdominal Compression-CPR technique

15. IAC-CPR : Interposed abdominal compression

16. Other Gadget for non-chest compression part : King LT

17. Other Gadget for non-chest compression : EtCO2 15-38 mmHg PCO 2

18. Other Gadget for non-chest compression part

19. Dent ER

20. Ohhhhh…..

23. Jan 2008 : Problem : Bystander CPR rates previously are too low Recommendation : Broaden CPR training ( Friend and Family CPR) Reassurance (HIV not transmitted through performance of CPR.) Improve EMS and CPR Quality

24. Mar 2008 : Hands-Only CPR Recommendation : When adult sudden collapse, trained or untrained bystanders should – at a minimum – activate their community EMS and provide at least hand-only CPR (Class IIa) CC-only : continue until the AED arrives or EMS . Bystander who’s not confident , provide CC-only.

25. Apr 2008 : Essential feature of designating OHCA

26. Oct 2008 : Hands-Only CPR

28. Post-Cardiac Arrest Syndrome : Pathophysiology, Clinical manifestation

29. Post-Cardiac Arrest Syndrome : Pathophysiology, Clinical manifestation

31. โอ้วว พอที .... Thank you For your attention.